Low‐intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta‐analysis

Objectives 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). Methods We searched PubMed, Cochrane Library and Scopus databases from inception to November 2020 for randomised 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 vs sham therapy on CP/CPPS symptoms at different time‐points after treatment. Weighted mean differences (WMDs) with the corresponding confidence intervals (CIs) were estimated. Furthermore, we assessed the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020208813). Results We included five sham RCTs and one non‐sham RCT. In the meta‐analysis of sham RCTs, both the National Institute of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) pain domain score and the numeric pain rating scale improved significantly after LiST vs sham therapy at the assessment directly after treatment protocol completion (WMD 3.2, 95% CI 0.88–5.52, I2 = 90%; and WMD 1.43, 95% CI 0.85–2.01, I2 = 32%, respectively), at 1 month (WMD 4.4, 95% CI 2.84–5.95, I2 = 68%, and WMD 2.59, 95% CI 1.92–3.27, I2 = 83%, respectively), and at 3 months after last treatment session (WMD 3.61, 95% CI 1.49–5.74, I2 = 90%, and WMD 2.64, 95% CI 2.13–3.16, 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 time‐points. Conversely, the long‐term efficacy of LiST, as well as the effect of LiST on lower urinary tract symptoms and erectile function, was clinically insignificant. Conclusions 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 individualised treatment strategies in such patients.