What question did this study set out to answer?

This research aims to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) modalities for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

February 8, 2026Open Access

Optimizing the Use of Extracorporeal Shock Wave Therapy for CP/CPPS: A Modality-Based Systematic Review and Meta-Analysis Comparing Focused and Radial Devices

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This research aims to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) modalities for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from major databases.
Compared Li-ESWT modalities (focused, radial, multifocal) against sham or standard medical therapy (SMT).
Measured outcomes primarily using the NIH-CPSI at approximately 12 weeks post-treatment.
Performed subgroup analyses based on wave-generator modality and monotherapy or add-on therapy.
Li-ESWT significantly reduced NIH-CPSI scores compared to control (weighted mean difference [WMD] −8.46; 95% CI −12.12 to −4.79).
Focused devices exhibited consistent effectiveness (WMD −6.59; no heterogeneity).
Radial devices displayed extreme heterogeneity with unclear effectiveness (WMD −10.38; 95% CI −21.33 to +0.57).
Multifocal devices showed significant improvement (WMD −10.84; I2 = 81.0%).
Improvements were primarily driven by reductions in pain-related symptoms.

Resumen

Background/Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a multifactorial condition often refractory to standard medical therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a mechanism-oriented option; however, prior reviews reported substantial heterogeneity, potentially due to pooling different wave-generator modalities despite their distinct physical properties. This study synthesized randomized evidence on Li-ESWT for CP/CPPS and explored a wave-generator modality as a prespecified effect modifier. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2015 to 31 October 2025 (date of last search) for randomized controlled trials (INPLASY: 2025120064). Eligible studies compared Li-ESWT (focused, radial, or multifocal) with sham or standard medical therapy (SMT). The primary outcome was total NIH-CPSI at the follow-up closest to 12 weeks. Pooled effects were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by wave-generator modality and therapy strategy (monotherapy vs add-on to SMT). Results: Eight RCTs (n = 455) were included. Li-ESWT significantly improved total NIH-CPSI versus the control (WMD −8.46; 95% CI −12.12 to −4.79; I2 = 94.8%). Benefits were observed in both monotherapy and the add-on to SMT trials. By modality, focused devices showed consistent effects (WMD −6.59; I2 = 0.0%), whereas radial devices showed an imprecise estimate with extreme heterogeneity (WMD −10.38; 95% CI −21.33 to +0.57; I2 = 98.2%). Multifocal devices showed a significant benefit (WMD −10.84; I2 = 81.0%). Improvements were mainly driven by pain-domain reduction. Conclusions: Li-ESWT provides clinically meaningful symptom relief in CP/CPPS, predominantly through pain reduction. Modality- and strategy-based subgroup findings are exploratory given substantial heterogeneity, limited trials, and no head-to-head comparisons; focused devices showed consistent effects, whereas estimates for radial and multifocal devices warrant cautious interpretation.

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