Low-intensity extracorporeal shockwave therapy as a preventive and restorative strategy in men's health: recent advances and future directions from an Asian perspective

PURPOSE OF REVIEW: Low-intensity extracorporeal shockwave therapy (Li-ESWT) has emerged as one of the most actively investigated regenerative therapies in contemporary men's health. This review evaluates key developments published between 2025 and 2026 regarding the role of Li-ESWT as a preventive and restorative strategy in urological disease, with particular emphasis on clinical evidence, translational innovation, and evolving practice patterns in Asia. RECENT FINDINGS: Current evidence supports the selective use of Li-ESWT in carefully chosen men with mild-to-moderate vasculogenic erectile dysfunction, with recent meta-analyses consistently demonstrating improvements in erectile function. Subgroup and meta-regression analyses have further helped define optimal treatment parameters. Emerging evidence suggests potential benefit in postprostatectomy penile rehabilitation, where Li-ESWT may promote preservation of tissue integrity and neurovascular recovery. In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), recent systematic reviews support improvements in pain and symptom scores, possibly through modulation of inflammatory and nociceptive pathways. Combination regenerative strategies involving platelet-rich plasma and Li-ESWT represent an evolving but still investigational area in erectile dysfunction and Peyronie's disease. Preliminary studies have also explored the application of Li-ESWT in interstitial cystitis/bladder pain syndrome and other nonprostatic lower urinary tract disorders. SUMMARY: Li-ESWT is undergoing a conceptual transition from symptomatic rescue therapy toward earlier biological intervention aimed at preserving endothelial, neural, and tissue integrity before irreversible dysfunction develops. Asian centres continue to play a pivotal role in elucidating mechanisms of action, driving clinical adoption, and advancing translational innovation in regenerative men's health. However, significant challenges remain, including protocol heterogeneity, device variability, limited long-term outcome data, and uncertainty regarding cost-effectiveness.