This 2021 multicenter, open-label prospective study evaluated the safety and efficacy of combining low-intensity extracorporeal shockwave therapy (Li-ESWT) with phosphodiesterase-5 inhibitors (PDE5i) in 109 men with vasculogenic erectile dysfunction (ED) unresponsive to PDE5i monotherapy. Li-ESWT was administered twice weekly for 3 weeks, delivering 3,000 shockwaves per session at 0.25 mJ/mm²