# Sinaga HSG. et al., 2026: . Efficacy and safety of low-intensity shockwave therapy on lower urinary tract symptoms in non-prostatic condition: A systematic review and meta-analysis. Jens Rassweiler Tuesday, 30 June 2026 70 Hits [ 0 Comments ](https://www.storzmedical.com/en/disciplines/literature-database-blog/database-cpps-ipp-ed/sinaga-hsg-et-al-2026/?layout=listings#comments) Sinaga HSG, Helda, Rahardjo HE, Sinaga GHP Arab J Urol. 2025 Jul 29;24(1):42-56. [doi: 10.1080/20905998.2025.2528171](https://pubmed.ncbi.nlm.nih.gov/41509092/) ## Abstract 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). ## Comment Jens Rassweiler **Objectives** This systematic review and meta-analysis investigates clinical trials or observational studies assessing low-intensity shockwave therapy (LI-SWT) for non-prostatic LUTS, such as symptoms related to overactive bladder, interstitial cystitis/bladder pain syndrome, neurogenic bladder, or pelvic pain-related urinary dysfunction.The study’s main aim is to determine whether Li-SWT improves urinary symptoms, quality of life, pain, bladder function, or symptom scores compared with baseline or control treatment. **Methods** The authors searched major medical databases up to September 2024 and included 12 studies with 624 participants, including both randomized trials and observational studies. **Results** They found that Li-SWT was associated with improvements in several symptoms, such as reduced urinary frequency in OAB and IC/BPS, improved urgency in OAB and SUI, reduced nocturia in OAB and IC/BPS, and reduced pain in IC/BPS. Some patients with SUI also showed meaningful improvement on pad tests, and uroflowmetry measures improved in OAB and SUI groups. However, when Li-SWT was compared with sham treatment, many benefits were not statistically significant, except for some short-term improvement in OAB urinary frequency. The evidence was limited by differences in treatment protocols, short follow-up periods, small study sizes, and risk of bias. **Discussion** *Clinical Significance of the Review* This topic is clinically relevant because many patients with LUTS do not have prostate-related disease, and current treatments may be limited by: - Incomplete symptom relief - Drug-related adverse effects - Need for long-term medication - Refractory symptoms despite standard therapy Low-intensity shockwave therapy is attractive because it is **non-invasive**, usually performed in outpatient settings, and has been explored for its possible effects on: - Tissue regeneration - Angiogenesis - Anti-inflammatory pathways - Neuromodulation - Pain reduction If effective, it could represent an additional therapeutic option for selected patients with non-prostatic LUTS. If the meta-analysis found symptom improvement with Li-SWT, the findings should be interpreted as promising but preliminary, especially if evidence comes mainly from small or uncontrolled studies. The key question is whether Li-SWT performs better than sham therapy or standard treatment, not just whether symptoms improve after treatment. For LUTS and pelvic pain syndromes, placebo effects can be strong, so randomized sham-controlled trials are especially important. *Strengths of the Study* Potential strengths include: \- **Focus on non-prostatic LUTS** Much of the shockwave literature focuses on erectile dysfunction or chronic prostatitis/prostate-related symptoms, so this review addresses a less-established area. \- **Safety evaluation** Safety is important because Li-SWT is increasingly used in urology despite varying levels of evidence. *Limitations* Important limitations include: \- **Heterogeneity of included conditions** “Non-prostatic LUTS” may include several different diseases with different mechanisms. Pooling them together can reduce interpretability. \- **Small sample sizes** Li-SWT studies in this area are often small and may be underpowered. Thus, a meta-analysis may not be able to compensate this issue. \- **Variation in treatment protocols** Shockwave dose, energy settings, number of sessions, treatment site, and device type may differ across studies. \- **Subjective outcome measures** LUTS are often assessed using symptom scores, which can be influenced by expectation and placebo response.. *Practical Implications* Li-SWT may be considered an emerging non-invasive therapy for selected non-prostatic LUTS, but it should probably not yet be viewed as a definitive standard treatment unless supported by high-quality randomized controlled trial data. Clinicians should consider: - Patient diagnosis - Severity and duration of symptoms - Prior treatment failure - Availability of validated treatment protocols - Cost and accessibility - Strength of evidence for the specific condition being treated **Conclusion** This systematic review and meta-analysis addresses an important and developing area in urology. Low-intensity shockwave therapy may have potential benefits for non-prostatic lower urinary tract symptoms and appears likely to be well tolerated. However, the strength of the conclusion depends heavily on the quality, size, and design of the included studies. More large, randomized, sham-controlled trials with standardized Li-SWT protocols and longer follow-up are needed before firm clinical recommendations can be made. Jens Rassweiler 0 #### Comments No comments made yet. Be the first to submit a comment Thursday, 30 July 2026 I have read and agreed to the [Privacy Policy](https://www.storzmedical.com/javascript:void(0);)