Low-energy extracorporeal shock wave therapy for interstitial cystitis/bladder pain syndrome: mechanisms, evidence, and translational perspectives-a narrative review.

Abstract

Background and objective: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic heterogeneous disorder characterized by persistent bladder-related pain, urinary symptoms, and substantial impairment in quality of life. Despite currently available multimodal treatment strategies, therapeutic outcomes vary among patients, highlighting the need to further investigate non-invasive approaches targeting inflammation, tissue repair, and sensory dysfunction. Low-energy extracorporeal shock wave therapy (ESWT) has been investigated as a non-invasive intervention with potential regenerative and neuromodulatory effects in IC/BPS. Its clinical relevance and translational applicability require further clinical validation. This narrative review summarizes the biological rationale, current clinical evidence, and translational considerations of low-energy ESWT in IC/BPS.

Methods: PubMed/MEDLINE and Web of Science Core Collection were searched for English-language studies published from January 1, 2010 to May 31, 2026. Relevant clinical, preclinical, and mechanistic studies were narratively synthesized.

Key content and findings: Among 53 relevant publications, 13 original studies formed the main evidence base. Preclinical studies suggest that low-energy ESWT may affect inflammation, oxidative stress, urothelial barrier function, angiogenesis, and neural sensitization. Clinical studies, including randomized controlled trials and prospective investigations, have reported improvements mainly in pain-related outcomes among selected patient populations, whereas effects on symptom scores, voiding outcomes, bladder capacity, and long-term outcomes remain uncertain. Heterogeneity in protocols, patient characteristics, and outcome measures limits interpretation.

Conclusions: Low-energy ESWT remains an investigational adjunctive treatment for IC/BPS, and current evidence is insufficient to support routine clinical use. Future studies should prioritize adequately powered, sham-controlled trials with standardized treatment protocols, prespecified phenotype stratification, harmonized outcome assessment, and longer follow-up to determine whether clinically meaningful and durable benefit exists and which patients, if any, are most likely to benefit.