Application of peripheral electrical stimulation for treatment of erectile dysfunction: a systematic review and meta-analysis.

Introduction: Erectile dysfunction (ED) is a common and debilitating condition that can have significant impacts on quality of life. Peripheral electrical stimulation (PES) has emerged as a potential alternative therapy for ED, as it aims to improve penile hemodynamics and neuromuscular function. However, the clinical evidence on the effectiveness of PES for managing ED remains unclear.

Objective: To conduct a comprehensive systematic review evaluating the effectiveness of PES for the management of ED in adult male patients.

Methods: PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to April 2024 using relevant keywords. Studies evaluating the use of any form of PES for the management of ED in adult male patients were included. Two independent reviewers screened titles and abstracts, retrieved full-text articles, and extracted data using a standardized form. Methodological quality was assessed using the appropriate Joanna Briggs Institute (JBI) checklists. A meta-analysis was conducted using RevMan 5.4.1 software.

Results: A total of 13 studies [6 randomized controlled trials (RCTs) and 7 quasi-experimental studies], published from 1998 to 2024, satisfied the inclusion criteria. Studies reported on using different PES techniques, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), functional electrical stimulation (FES), and transanal pelvic plexus stimulation (TPPS). Six studies were eligible for the meta-analysis. The first analysis, evaluating the before-and-after results of PES on ED, showed a mean difference in International Index of Erectile Function (IIEF) scores of 3.09 (95% CI: -2.19 to 8.38; I2 = 99%), indicating a non-significant improvement in erectile function following PES. The second analysis, comparing the intervention group with a control group, showed a significantly higher mean difference of 6.27 (95% CI: 4.30 to 8.27; I2 = 79%), suggesting a positive effect of PES on erectile function compared to the control group, though moderate heterogeneity was observed. All the studies were of low to moderate quality, and the certainty of the evidence was weak.

Conclusion: Limited and low-quality research suggested the potential benefits of PES for treating ED. However, the current evidence is weak and cannot support routine administration. More high-quality research is needed to establish PES optimization.