Low-Intensity Shockwave Therapy for the Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis.

To perform a systematic review and meta-analysis aiming to improve the level of evidence and determine the efficacy and safety of low-intensity shockwave therapy (LiST) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

We searched PubMed, Cochrane Library and Scopus databases from inception to November 2020 for randomized controlled trials (RCTs) exploring the role of LiST for the management of CP/CPPS. We performed a random effects meta-analysis of RCTs comparing LiST versus sham therapy on CP/CPPS symptoms at different timepoints after treatment. Weighted mean differences (WMD) with the corresponding confidence intervals (CIs) were estimated. Furthermore, we assessed the strength of evidence with the GRADE system (PROSPERO: CRD42020208813).

We included five sham RCTs and one non-sham RCT. In the meta-analysis of sham-RCTs, both the NIH-CPSI pain domain score and the numeric pain rating scale improved significantly after LiST compared to sham therapy at the assessment directly after treatment protocol completion (WMD: 3.2, 95% CI: 0.88 to 5.52, I2 =90% and WMD: 1.43, 95% CI: 0.85 to 2.01, I2 =32%, respectively), at one month (WMD: 4.4, 95% CI: 2.84 to 5.95, I2 =68% and WMD: 2.59, 95% CI: 1.92 to 3.27, I2 =83%, respectively) and at three months after last treatment session (WMD: 3.61, 95% CI: 1.49 to 5.74, I2 =90% and WMD: 2.64, 95% CI: 2.13 to 3.16, I2 =71%, respectively). Similarly, the NIH-CPSI total and quality of life domain scores improved significantly after LiST compared to sham therapy for the same timepoints. Conversely, the long-term efficacy of LiST, as well as the effect of LiST on lower urinary tract symptoms and erectile function were clinically insignificant.

LiST is an effective treatment modality for the improvement of pain and quality of life in patients with CP/CPPS. Therefore, it should be recommended as a part of individualized treatment strategies in such patients.

BJU international. 2021 Jan 12 [Epub ahead of print]

Ioannis Mykoniatis, Nikolaos Pyrgidis, Ioannis Sokolakis, Petros Sountoulides, Georgios Hatzichristodoulou, Apostolos Apostolidis, Dimitrios Hatzichristou

Department of Urology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Greece., Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany.