Low-intensity shockwave therapy in men's health: Insights from a systematic review on erectile dysfunction and CP/CPPS in the Middle East.

Low-intensity shockwave therapy (LiSWT) has gained attention as a non-invasive treatment for various men's health conditions, including erectile dysfunction (ED), Peyronie's disease (PD), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, despite its increasing use, robust evidence supporting its effectiveness remains limited. This systematic review aims to evaluate the efficacy and safety of LiSWT in managing men's health conditions within the Middle East to provide region-tailored clinical recommendations. A systematic search was conducted using PubMed to identify studies that evaluated LiSWT in ED, PD, or CP/CPPS. Studies were included if they employed a prospective design and reported outcomes based on validated questionnaires. The quality of included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Fourteen studies met the inclusion criteria; 7 RCTs, 2 non-randomized comparative studies, and 5 observational studies. Ten studies focused on ED, while 4 evaluated CP/CPPS. No studies on PD were identified. For ED, LiSWT demonstrated significant improvements in IIEF-5 and EHS scores across most studies, with better outcomes observed in younger patients, those with milder ED, and shorter disease duration. However, some studies found no significant differences between LiSWT and PDE-5 inhibitors or sham treatments, with benefits often diminishing over time. For CP/CPPS, LiSWT showed significant reductions in NIH-CPSI and IPSS scores, with improvements sustained up to 12 months. Study quality ranged from moderate to high, though limitations such as high risk of bias in some RCTs and selection bias in observational studies were noted. While LiSWT represents a promising therapeutic option for ED and CP/CPPS, its application should be costumized to meet the specific needs of individual patients. Future research should focus on developing standardized protocols and conducting large-scale randomized controlled trials to establish its long-term efficacy and optimize clinical use in the Middle East.