Low-intensity extracorporeal shockwave therapy for chronic prostatitis/chronic pelvic pain syndrome: a retrospective single-center observational study in Japan.

Abstract

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogeneous condition that can remain symptomatic despite conventional therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has shown symptomatic benefits in previous clinical studies; however, real-world evidence from Japanese clinical practice remains limited. This study aimed to evaluate the effectiveness and safety of a standardized four-session Li-ESWT protocol in patients with treatment-refractory CP/CPPS at a Japanese outpatient urology clinic.

Methods: This retrospective, single-center observational study included 19 consecutive patients with CP/CPPS who underwent Li-ESWT between July 2023 and June 2025. Treatment was administered once weekly for four weeks using 3,000 pulses per session at an energy flux density of 0.25-0.35 mJ/mm² and a frequency of 8.0 Hz. The primary outcome was the change in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score from baseline to immediately after completion of treatment. Secondary outcomes included changes in pain, urinary, and quality-of-life (QoL) domain scores.

Results: All 19 patients completed treatment. The mean NIH-CPSI total score decreased from 25.9±5.4 at baseline to 21.6±7.5 after treatment (mean change, -4.32±4.27; P<0.001). Six patients (31.6%) achieved a clinically meaningful improvement of at least 6 points, while 16 (84.2%) showed some overall symptom improvement. Significant improvements were observed in the pain domain (11.5±3.2 to 9.2±3.5, P<0.01) and QoL domain (10.1±1.4 to 8.5±2.7, P<0.01), whereas the urinary domain did not significantly improve (4.3±3.2 to 3.9±3.6, P=0.31). No serious adverse events were observed.

Conclusions: In this small retrospective Japanese cohort with persistent symptoms despite conservative treatment, a standardized four-session Li-ESWT protocol was associated with improvement in overall NIH-CPSI scores, particularly in pain and QoL, and was well tolerated. Larger prospective controlled studies with longer follow-up are needed to confirm these findings.