LiESWT
on Non‐Neurogenic
LUTS
: An Updated Systematic Review and Meta‐Analysis
Yu‐Ting Wang, Su‐Wei Hu, Chih‐Heng Chen, Chia‐Chang Wu, Yuan‐Hung Wang ABSTRACT
Objectives
To evaluate the efficacy of low‐intensity extracorporeal shockwave therapy (LiESWT) for non‐neurogenic lower urinary tract symptoms (LUTS).
Materials and Methods
A systematic review and meta‐analysis was conducted according to PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched through February 2026 for studies evaluating LiESWT for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), stress urinary incontinence (SUI), overactive bladder (OAB), and interstitial cystitis/bladder pain syndrome (IC/BPS). Randomized controlled trials (RCTs) and prospective non‐randomized studies were included. Random‐effects models were used, with treatment‐parameter subgroup analyses and RCT‐only sensitivity analyses where applicable.
Results
Thirty‐two studies involving 1631 patients were included. In CP/CPPS, LiESWT was associated with significant improvements in patient‐reported outcomes. RCT‐only sensitivity analyses generally supported these findings, although IPSS improvement was not significant at 24 weeks. Symptomatic improvements were also observed in SUI, OAB, and IC/BPS, although estimates were based on few studies and were considered exploratory. Significant patient‐reported improvements were observed at follow‐up points extending to 48 weeks in CP/CPPS, 4 weeks in SUI, 24 weeks in OAB, and 12 weeks in IC/BPS. Objective outcomes were less consistent and varied across disease entities. In CP/CPPS, treatment‐parameter subgroup analyses suggested that cumulative energy delivery may influence treatment response, with no clear incremental benefit at higher cumulative energy levels.
Conclusions
LiESWT may improve symptoms in patients with non‐neurogenic LUTS, with the strongest evidence for CP/CPPS. Evidence for SUI, OAB, and IC/BPS remains limited and exploratory, and long‐term efficacy across these conditions remains uncertain. Treatment‐parameter findings should be interpreted cautiously given the heterogeneity of treatment protocols and the exploratory nature of the subgroup analyses. Further adequately powered RCTs using standardized treatment protocols and longer follow‐up are needed to define optimal treatment parameters and establish the durability of benefit.