Systematic Review of TCM Combined with Extracorporeal Shock Wave for Chronic Prostatitis in Chinese Populations: Efficacy, Safety, and Gaps

Abstract

Chronic prostatitis (CP) affects 8% to 16% of adult males worldwide, with Type III (CP/chronic pelvic pain syndrome [CPPS]) accounting for over 90% of cases, leading to ongoing pelvic pain, urinary issues, and diminished quality of life. Single treatments such as antibiotics, α-blockers, or Extracorporeal Shock Wave Therapy (ESWT) alone often have limited effectiveness or only short-term benefits.

This systematic review assesses the effectiveness, safety, and research gaps of combining traditional Chinese medicine (TCM) with ESWT for treating CP.

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews, and its protocol has been prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). As it involves secondary analysis of previously published literature, formal ethical approval was not required. However, all included studies must comply with the Declaration of Helsinki (2013 revision) and Chinese clinical research ethical regulations, and explicitly report their ethical approval number and informed consent procedures. Studies lacking this information were excluded.

The interventions involved oral or retention enema TCM combined with ESWT, while control groups received monotherapies. The combined therapy demonstrated superior efficacy compared to monotherapies, with notable reductions in NIH Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analog Scale (VAS) score, and inflammatory markers (interleukin-1β [IL-1β] and tumor necrosis factor-α [TNF-α]), as well as enhanced urodynamics. Where extractable data were available, adverse events were mild, and no treatment-related serious adverse events were reported; however, the evidence was insufficient to estimate a pooled adverse-event incidence. Safety reporting was incomplete. Research gaps include small single-center samples, non-standardized TCM/ESWT protocols, and short follow-up periods.

Future research should focus on multicenter randomized controlled trials, standardized treatment regimens, and long-term studies to confirm the safety and effectiveness of this combination.