Efficacy and safety of low-intensity shockwave therapy on lower urinary tract symptoms in non-prostatic condition: A systematic review and meta-analysis.

Objective: To evaluate the efficacy and safety of low-intensity shockwave therapy (LiSWT) for non-prostatic storage lower urinary tract symptoms (LUTS), including overactive bladder (OAB), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: A systematic search of MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov was conducted up to September 2024. Randomized controlled trials (RCTs), prospective studies, and single-arm studies evaluating LiSWT for non-prostatic LUTS in adults were included. Outcomes assessed included urinary frequency, urgency, nocturia, pain for IC/BPS, pad-test for SUI, uroflowmetry parameters, and questionnaire-based symptom scores. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and ROBINS-I. Random-effects meta-analysis was performed. Results: Twelve studies (six RCTs, six observational) involving 624 participants were included. LiSWT significantly reduced urinary frequency in OAB and IC/BPS patients, with SUI improvements emerging at 12 weeks. Compared to sham treatment, only the OAB group showed significant reductions at 4 weeks. Urgency symptoms improved in OAB and SUI, but differences from sham were not significant. Nocturia improved in OAB and IC/BPS but was not significantly different from sham. Overall pain reduction was significant for IC/BPS (MD -1.61 (95%CI -2.21 to -1.02)). In SUI, most participants had >50% improvement in pad-test weight, but the mean difference compared to sham was not significant. Significant improvements in uroflowmetry also observed in OAB and SUI groups, while IC/BPS showed non-significant changes. Compared to sham, LiSWT did not significantly improve uroflowmetry parameters at 4 weeks. OAB and IC/BPS questionnaire-symptom scores significantly improved, but quality-of-life data was limited. Limitations: Heterogeneity in treatment protocols, short follow-ups, and high risk of bias in some studies limited generalizability. Conclusions: LiSWT may present a novel non-invasive treatment modality for non-prostate LUTS etiology. While it demonstrates some subjective symptom improvements, its overall clinical utility remains uncertain due to methodological limitations, heterogeneity, and high bias risk in current studies. Larger, high-quality RCTs are urgently needed to establish standardized treatment protocols and long-term safety profiles.Registration: PROSPERO (CRD42024590708).