Safety and Efficacy of Extracorporeal Shock Wave Therapy for the Management of Chronic Pelvic Pain Syndrome: A Systematic Review

OBJECTIVE: To summarize findings of clinical trials from the past 10 years regarding the safety and efficacy of extracorporeal shock wave therapy (ESWT) for the management of chronic pelvic pain syndrome (CPPS) in male patients, and highlight any current knowledge gap. METHODS: We performed a systematic review (CRD420251164315) of MEDLINE and EMBASE, for clinical trials investigating ESWT in men with CPPS published between 2015 and October 2025. Main outcomes assessed were National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and domains. Additional measures include visual analog scale (VAS); International Prostate Symptom Score (IPSS); International Index of Erectile Function (IIEF); UPOINT phenotype system. RESULTS: Eleven studies were included. All demonstrated significant improvement in NIH-CPSI total and pain measures (NIH-CPSI pain domain and/or VAS) following ESWT, compared with baseline and/or control. Eight studies evaluated the NIH-CPSI quality-of-life domain, all reported significant improvement. Eleven studies evaluated urinary symptoms (NIH-CPSI urinary domain and/or IPSS), 9 reported significant improvement. No major adverse events occurred, minor events included 1 first-degree burn and 4 cases of transient hematuria and haematospermia. CONCLUSION: ESWT appears to be a safe and effective treatment for CPPS, improving pain and quality-of-life outcomes across trials. Larger randomized trials with longer follow-up are warranted to confirm findings and define optimal protocols.