SWL literature
SWL Literature

Sokolakis I. et al., 2021: The Effect of Low-intensity Shockwave Therapy on Non-neurogenic Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Preclinical and Clinical Studies

Sokolakis I, Pyrgidis N, Neisius A, Gierth M, Knoll T, Rassweiler J, Hatzichristodoulou G.
Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
Department of Urology, Barmherzige Brüder Hospital Trier, Trier, Germany.
Department of Urology, University Hospital Regensburg, Regensburg, Germany.
Department of Urology, Klinikverbund Südwest, Sindelfingen Hospital, Sindelfingen, Germany.
Department of Urology, SLK Hospital Heilbronn, Heilbronn, Germany.
Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.

Abstract

Context: Low-intensity shockwave therapy (LiST) has emerged as an effective treatment for pain in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and it has been postulated that LiST may also be effective in patients with lower urinary tract symptoms (LUTS).

Objective: To perform a systematic review and meta-analysis of experimental and clinical studies exploring the effect of LiST on LUTS in an attempt to provide clinical implications for future research.

Evidence acquisition: We systematically searched PubMed, Cochrane Library, and Scopus databases from inception to March 2021 for relevant studies. We provided a qualitative synthesis regarding the role of LiST in LUTS and performed a single-arm, random-effect meta-analysis to assess the absolute effect of LiST on LUTS only in patients with CP/CPPS (PROSPERO: CRD42021238281).

Evidence synthesis: We included 23 studies (11 experimental studies, seven nonrandomized controlled trials [non-RCTs], and five RCTs) in the systematic review and seven in the meta-analysis. All experimental studies were performed on rats with LUTS, and the clinical studies recruited a total of 539 participants. In patients with CP/CPPS, the absolute effect of LiST on maximum flow rate and postvoid residual was clinically insignificant. However, the available studies suggest that LiST is effective for the management of pain in patients with either CP/CPPS or interstitial cystitis/bladder pain syndrome. Additionally, LiST after intravesical instillation of botulinum neurotoxin type A may enhance its absorption and substitute botulinum neurotoxin type A injections in patients with overactive bladder. Furthermore, the available evidence is inconclusive about the role of LiST in patients with benign prostatic obstruction, stress urinary incontinence, or underactive bladder/detrusor hypoactivity.

Conclusions: LiST may be effective for some disorders causing LUTS. Still, further studies on the matter are necessary, since the available evidence is scarce.

Patient summary: Low-intensity shockwave therapy represents a safe, easily applied, indolent, and repeatable on an outpatient basis treatment modality that may improve lower urinary tract symptoms.

German Society for Shock Wave Lithotripsy.Eur Urol Focus. 2021 May 10:S2405-4569(21)00127-9. doi: 10.1016/j.euf.2021.04.021. Online ahead of print. PMID: 33985934. Review.

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Comments 1

Hans-Göran Tiselius on Thursday, August 26 2021 08:30

Patients with pain caused by clinical non-neurogenic LUTS constitute a group that is considered difficult to treat. The underlying pathology comprises several common urological conditions:
Benign prostatic obstruction (BPO)
Overactive bladder
Underactive bladder/detrusor
Urinary incontinence
Interstitial cystitis
Bladder pain syndrome
Chronic prostatitis
Chronic pelvic pain syndrome
Bladder tumour
Urethral strictures
Other less defined abnormalities or painful conditions.
The results reported in this article were obtained from a systematic review of data in the literature. All clinical and experimental results are summarized in the article. Some points are emphasized below.
For patients with BPO improvements were recorded following perineal ESWT as measured in terms of Qmax and PVR. Similar improvements were recorded for patients with chronic prostatitis and pelvic pain syndrome, but for the latter condition as well as for interstitial cystitis the authors concluded that additional studies are required. Although Li-ESWT might be a treatment alternative for stress incontinence the conclusion was that this approach is not yet possible to recommend as a treatment alternative.
For patients with OAB it was observed that combined instillation of botulinum neurotoxin type-A and Li-ESWT might be an effective treatment.
Interestingly rat studies on underactive bladder showed promising results and it is of note that RCTs are underway.
The summary of this extensive review was that: “Li-ESWT may serve as a promising addition to the urologist’s armamentarium for management of LUTS”. These are good news for a urological field in which there so far has been and is a shortage of therapeutic tools.

Hans-Göran Tiselius

Patients with pain caused by clinical non-neurogenic LUTS constitute a group that is considered difficult to treat. The underlying pathology comprises several common urological conditions: Benign prostatic obstruction (BPO) Overactive bladder Underactive bladder/detrusor Urinary incontinence Interstitial cystitis Bladder pain syndrome Chronic prostatitis Chronic pelvic pain syndrome Bladder tumour Urethral strictures Other less defined abnormalities or painful conditions. The results reported in this article were obtained from a systematic review of data in the literature. All clinical and experimental results are summarized in the article. Some points are emphasized below. For patients with BPO improvements were recorded following perineal ESWT as measured in terms of Qmax and PVR. Similar improvements were recorded for patients with chronic prostatitis and pelvic pain syndrome, but for the latter condition as well as for interstitial cystitis the authors concluded that additional studies are required. Although Li-ESWT might be a treatment alternative for stress incontinence the conclusion was that this approach is not yet possible to recommend as a treatment alternative. For patients with OAB it was observed that combined instillation of botulinum neurotoxin type-A and Li-ESWT might be an effective treatment. Interestingly rat studies on underactive bladder showed promising results and it is of note that RCTs are underway. The summary of this extensive review was that: “Li-ESWT may serve as a promising addition to the urologist’s armamentarium for management of LUTS”. These are good news for a urological field in which there so far has been and is a shortage of therapeutic tools. Hans-Göran Tiselius
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Sunday, November 28 2021

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