Erectile dysfunction (ED) is commonly encountered in the field of andrology, and is defined as an inability to maintain an erection for sexual intercourse. This pathological condition often bothers males over 40 years old. 
Adopting this new treatment strategy, many began exploring the use of low intensity shock wave lithotripsy (LI-SWT) to achieve the goal of improving erectile function.
AIM OF OUR STUDY To assess the efficacy and safety of low intensity extracorporeal shock wave therapy (LI-ESWT) on patients with erectile dysfunction

A prospective single-center study. The study included 21 patients between January 2015 and October 2017. All patient planned under first course of Low Intensity Shock Wave Lithotripsy (Li-SAWT) and if there is  response, they will undergo a second course..
Inclusion criteria will be male patients older than 18-year-old who in stable sexual relationship. Diagnosed with ED at least 6 months and still not satisfied with oral or inctracavornosal injection treatment for erectile dysfunction. Exclusion criteria are patients who had penile surgery, coagulopathy abnormalities, unstable or uncontrolled medical or psychiatric disorder, with neurological disorder, post radical pelvic surgery, on hormonal therapy or post pelvic radiation
Age, Comorbidities, received treatment for ED, past surgical history, sexual desire, orgasmic function, improvement after treatment and complications will be collected from the patients’ file. 
Treatment course is two phases using low-energy shock waves generator (ED1000, Medispec, Gaithersburg, MD, USA), each phase will be 3 weeks long with two sessions each week (total 6 sessions). Between the two phases a three weeks break time, the total duration of the treatment course is nine weeks.  LI-SWT was applied on ten penile sites – Five points dorsally (glans, bilateral distal and proximal penile shaft) and five points ventrally (middle penoscrotal area, bilateral proximal and distal penile shaft). One session treatment will deliver to the patient’s penis 3000 J, which is divided to 10 points (each is 300J). Energy per mm was from 0.7 up to 0.25 depending on the patient tolerability, the maximum he is comfortable with. Patient will be in supine position. No anesthesia given.
Outcome were assessed using International index of erectile function –erectile function (IIEF-EF) score before and after treatment.

21 patients were included in the study with mean age 43.9 years. Diabetes Mellitus was present in 14/21(66.6%),Hypertension	9/21,Coronary Artery Disease	3/21,Smoker	2/21, Obesity	11/21, Post Renal Transplant 2/21,Post pelvic Surgery 3/21.All patient has sexual desire 21/21, and 20/21 has orgasmic Function (95.25%). All patients completed 1st phase of treatment.

71.4% felt an improvement and completed the second phase. The base mean of IIEF-EF score for all patients was 10.14 and increased to 10.73 after first phase. 15/21 patients who completed full treatment course had IIEF-EF score raised to 12.8. 66.6% (14/21) of the patients would repeat the treatment and recommend it for a friend. Only one patient post treatment mild ecchymosis and pain which was treated conservatively.

Li-SWT is a safe modality for erectile dysfunction and could be an effective treatment with minimal changes which could be beneficial with other non-surgical managements like oral and intracavernosal injection treatments.