Optimizing the Use of Extracorporeal Shock Wave Therapy for CP/CPPS: A Modality-Based Systematic Review and...

Area of Science:

• Urology
• Pain Management
• Medical Devices

Background:

• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a challenging condition often resistant to conventional treatments.
• Low-intensity extracorporeal shock wave therapy (Li-ESWT) presents a mechanism-based therapeutic option.
• Previous reviews noted significant heterogeneity in Li-ESWT studies, possibly due to variations in wave-generator modalities.

Purpose of the Study:

• To synthesize randomized controlled trial (RCT) evidence on the efficacy of Li-ESWT for CP/CPPS.
• To investigate the influence of different wave-generator modalities (focused, radial, multifocal) as a prespecified effect modifier.
• To analyze treatment strategies, comparing monotherapy with add-on therapy to standard medical treatment (SMT).

Main Methods:

• Systematic search of major databases (PubMed, Embase, Web of Science, Cochrane Library) for RCTs published between January 2015 and October 2025.
• Inclusion of studies comparing Li-ESWT (focused, radial, or multifocal) against sham or SMT.
• Primary outcome assessment using the total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at approximately 12 weeks, with subgroup analyses by modality and strategy.

Main Results:

• Eight RCTs involving 455 participants were included.
• Li-ESWT demonstrated a significant improvement in total NIH-CPSI compared to control (WMD -8.46; 95% CI -12.12 to -4.79).
• Focused devices showed consistent positive effects (WMD -6.59; I² = 0.0%), while radial and multifocal devices yielded significant benefits but with substantial heterogeneity, warranting cautious interpretation.

Conclusions:

• Li-ESWT provides clinically meaningful symptom relief for CP/CPPS, mainly by alleviating pain.
• The effectiveness may vary by wave-generator modality, with focused devices showing the most consistent results.
• Further research, including head-to-head comparisons, is needed to clarify the optimal use of different Li-ESWT modalities in CP/CPPS management.