{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:13:31Z","timestamp":1784852011264,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic prostatitis\/chronic pelvic pain syndrome (CP\/CPPS) is a multifactorial condition often refractory to standard medical therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a mechanism-oriented option; however, prior reviews reported substantial heterogeneity, potentially due to pooling different wave-generator modalities despite their distinct physical properties. This study synthesized randomized evidence on Li-ESWT for CP\/CPPS and explored a wave-generator modality as a prespecified effect modifier. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2015 to 31 October 2025 (date of last search) for randomized controlled trials (INPLASY: 2025120064). Eligible studies compared Li-ESWT (focused, radial, or multifocal) with sham or standard medical therapy (SMT). The primary outcome was total NIH-CPSI at the follow-up closest to 12 weeks. Pooled effects were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by wave-generator modality and therapy strategy (monotherapy vs add-on to SMT). Results: Eight RCTs (n = 455) were included. Li-ESWT significantly improved total NIH-CPSI versus the control (WMD \u22128.46; 95% CI \u221212.12 to \u22124.79; I2 = 94.8%). Benefits were observed in both monotherapy and the add-on to SMT trials. By modality, focused devices showed consistent effects (WMD \u22126.59; I2 = 0.0%), whereas radial devices showed an imprecise estimate with extreme heterogeneity (WMD \u221210.38; 95% CI \u221221.33 to +0.57; I2 = 98.2%). Multifocal devices showed a significant benefit (WMD \u221210.84; I2 = 81.0%). Improvements were mainly driven by pain-domain reduction. Conclusions: Li-ESWT provides clinically meaningful symptom relief in CP\/CPPS, predominantly through pain reduction. Modality- and strategy-based subgroup findings are exploratory given substantial heterogeneity, limited trials, and no head-to-head comparisons; focused devices showed consistent effects, whereas estimates for radial and multifocal devices warrant cautious interpretation.<\/jats:p>","DOI":"10.3390\/jcm15031270","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T15:24:19Z","timestamp":1770305059000},"page":"1270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing the Use of Extracorporeal Shock Wave Therapy for CP\/CPPS: A Modality-Based Systematic Review and Meta-Analysis Comparing Focused and Radial Devices"],"prefix":"10.3390","volume":"15","author":[{"given":"Min-Jui","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0107-4450","authenticated-orcid":false,"given":"Chien-Chang","family":"Kao","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9093-1009","authenticated-orcid":false,"given":"Ming-Hsin","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7214-8766","authenticated-orcid":false,"given":"Chih-Wei","family":"Tsao","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S85","DOI":"10.1016\/j.ijantimicag.2007.08.028","article-title":"Epidemiology of Prostatitis","volume":"31","author":"Krieger","year":"2008","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s00345-013-1062-y","article-title":"Management of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome (Cp\/Cpps): The Studies, the Evidence, and the Impact","volume":"31","author":"Nickel","year":"2013","journal-title":"World J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1146\/annurev.med.57.011205.135654","article-title":"Prostatitis\/Chronic Pelvic Pain Syndrome","volume":"57","author":"Habermacher","year":"2006","journal-title":"Annu. Rev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/j.juro.2008.03.139","article-title":"Mechanisms in Prostatitis\/Chronic Pelvic Pain Syndrome","volume":"179","author":"Pontari","year":"2008","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.eururo.2015.08.061","article-title":"Contemporary Management of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome","volume":"69","author":"Magistro","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Barone, B., Mirto, B.F., Falcone, A., Del Giudice, F., Aveta, A., Napolitano, L., Del Biondo, D., Ferro, M., Busetto, G.M., and Manfredi, C. (2023). The Efficacy of Flogofilm\u00ae in the Treatment of Chronic Bacterial Prostatitis as an Adjuvant to Antibiotic Therapy: A Randomized Prospective Trial. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082784"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.eururo.2010.04.004","article-title":"Can Low-Intensity Extracorporeal Shockwave Therapy Improve Erectile Function? A 6-Month Follow-up Pilot Study in Patients with Organic Erectile Dysfunction","volume":"58","author":"Vardi","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.eururo.2009.03.043","article-title":"Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome in Males: A Randomised, Double-Blind, Placebo-Controlled Study","volume":"56","author":"Zimmermann","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_9","first-page":"972601","article-title":"Efficacy of Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome: A Randomized, Controlled Trial","volume":"2013","author":"Vahdatpour","year":"2013","journal-title":"ISRN Urol."},{"key":"ref_10","first-page":"293","article-title":"Long-Term Effect of Extracorporeal Shock Wave Therapy on the Treatment of Chronic Pelvic Pain Syndrome Due to Non Bacterial Prostatitis","volume":"19","author":"Moayednia","year":"2014","journal-title":"J. Res. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1002\/nau.24017","article-title":"Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy for the Treatment of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis","volume":"38","author":"Yuan","year":"2019","journal-title":"Neurourol. Urodyn."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/13685538.2016.1197899","article-title":"Comparison of the Efficiency of Combined Extracorporeal Shock-Wave Therapy and Triple Therapy Versus Triple Therapy Itself in Category Iii B Chronic Pelvic Pain Syndrome (Cpps)","volume":"19","author":"Pajovic","year":"2016","journal-title":"Aging Male"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1002\/nau.25524","article-title":"Extracorporeal Shockwave Therapy in Treatment of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: Systematic Review and Meta-Analyses","volume":"43","author":"Labetov","year":"2024","journal-title":"Neurourol. Urodyn."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.21037\/tau-20-1423","article-title":"Low-Intensity Extracorporeal Shock Wave Therapy for Male Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis","volume":"10","author":"Li","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1230","DOI":"10.1002\/cl2.1230","article-title":"Prisma2020: An R Package and Shiny App for Producing Prisma 2020-Compliant Flow Diagrams, with Interactivity for Optimised Digital Transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/s41391-020-00284-2","article-title":"Evaluation of a Low-Intensity Shockwave Therapy for Chronic Prostatitis Type Iiib\/Chronic Pelvic Pain Syndrome: A Double-Blind Randomized Sham-Controlled Clinical Trial","volume":"24","author":"Mykoniatis","year":"2021","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_18","first-page":"185","article-title":"Extracorporeal Shockwave Therapy Combined with Drug Therapy in Chronic Pelvic Pain Syndrome: A Randomized Clinical Trial","volume":"17","author":"Rayegani","year":"2020","journal-title":"Urol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.36740\/WLek202108110","article-title":"Evaluation of Efficacy of Extracorporeal Shock Wave Therapy in Complex Treatment of Patients with Chronic Non-Bacterial Prostatitis\/Chronic Pelvic Pain Syndrome","volume":"74","author":"Trishch","year":"2021","journal-title":"Wiadomo\u015bci Lek."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"678","DOI":"10.5534\/wjmh.210078","article-title":"Clinical Efficacy of Multi-Focal Low-Intensity Extracorporeal Shockwave Therapy in the Treatment of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: Prospective-Randomized, Double Blind, Placebo-Controlled Study","volume":"40","author":"Kim","year":"2022","journal-title":"World J. Mens. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/s41391-021-00464-8","article-title":"Outcomes and Clinical Predictors of Extracorporeal Shock Wave Therapy in the Treatment of Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: A Prospective Randomized Double-Blind Placebo-Controlled Clinical Trial","volume":"25","author":"Sakr","year":"2022","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.prnil.2024.06.003","article-title":"Safety and Efficacy of Extracorporeal Shockwave Therapy on Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study","volume":"12","author":"Hur","year":"2024","journal-title":"Prostate Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1589\/jpts.30.1145","article-title":"Effect of Radial Shock Wave on Chronic Pelvic Pain Syndrome\/Chronic Prostatitis","volume":"30","author":"Salama","year":"2018","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1038\/s41391-022-00571-0","article-title":"The Efficacy and Safety of Low-Intensity Extracorporeal Shock Wave Treatment Combined with or without Medications in Chronic Prostatitis\/Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis","volume":"26","author":"Kong","year":"2023","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"157","DOI":"10.5534\/wjmh.220241","article-title":"Extracorporeal Shockwave Therapy Alleviates Inflammatory Pain by down-Regulating Nlrp3 Inflammasome in Experimental Chronic Prostatitis and Chronic Pelvic Pain Syndrome","volume":"42","author":"Bae","year":"2024","journal-title":"World J. Mens. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ryskalin, L., Morucci, G., Natale, G., Soldani, P., and Gesi, M. (2022). Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life, 12.","DOI":"10.3390\/life12050743"},{"key":"ref_27","first-page":"115","article-title":"Efficacy and Safety of Extracorporeal Shock Wave Therapy for Orthopedic Conditions: A Systematic Review on Studies Listed in the Pedro Database","volume":"116","author":"Schmitz","year":"2015","journal-title":"Br. Med. Bull."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4103\/ua.ua_13_25","article-title":"Comparative Effectiveness Radial Shockwave Therapy Versus Focused Linear Shockwave Therapy as an Erectile Dysfunction Treatment Systematic Review and Meta-Analysis","volume":"17","author":"Ramadhani","year":"2025","journal-title":"Urol. Ann."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wang, H.-J., Tyagi, P., Chen, Y.-M., Chancellor, M.B., and Chuang, Y.-C. (2019). Low Energy Shock Wave Therapy Inhibits Inflammatory Molecules and Suppresses Prostatic Pain and Hypersensitivity in a Capsaicin Induced Prostatitis Model in Rats. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20194777"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/1557988317736585","article-title":"Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men with Chronic Pelvic Pain Syndrome Refractory to 3-as Therapy","volume":"12","author":"Guu","year":"2018","journal-title":"Am. J. Mens. Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wu, W.-L., Bamodu, O.A., Wang, Y.-H., Hu, S.-W., Tzou, K.-Y., Yeh, C.-T., and Wu, C.-C. (2021). Extracorporeal Shockwave Therapy (Eswt) Alleviates Pain, Enhances Erectile Function and Improves Quality of Life in Patients with Chronic Prostatitis\/Chronic Pelvic Pain Syndrome. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163602"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1270\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T15:44:12Z","timestamp":1770306252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031270"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031270","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]}}}