الفهرس 
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Abstract
Background: Li-SWT is expected to improve OABS through enhancement of angiogenesis and re-innervation and suppression of inflammation and overactivity. Aim of the work: to evaluate the efficacy of Li-SWT on persistent storage symptoms after TUS for BPO in a RCT. Patients and Methods: Patients with persistent storage symptoms ≥ 3 months after TUS for BPO were eligible once they have urgency episodes/24 hrs ≥ 1 and daytime frequency ≥ 8. Patients were allocated to Li-SWT (group 1), sham (group 2) and solifenacin 10 mg/day (group 3) in 3:1:1 ratio. Li-SWT was applied to suprapubic, perineal or both regions using 8-weekly sessions. The primary end point was the percent change from baseline in the total score of OABSS at 3 months. Responders were defined as patients who achieved reduction in the total score of OABSS ≥ 3 at 3 months and those patients continued on the same treatment modality. Change from baseline in OABSS and 3-day voiding diary parameters were assessed every month till 6 months. Moreover, change from baseline in IPSS, QoL score at 2, 4 and 6 months, as well as Qmax and PVR at 3 and 6 months and UDS at 6 months were evaluated. Treatment-related adverse effects were evaluated. VAS (0-10) was used for pain evaluation during SW sessions. Results: Between July 2020 and January 2022, 132 patients were enrolled (79, 25 and 28 patients in group 1, 2 and 3 respectively). Baseline data were comparable between groups. The percent change from baseline in the total score of OABSS at 3 months was significantly better in group 1 compared to group 2 and it was not significantly different between group 1 and 3 (-55%, -11% and -60% in group 1, 2 and 3 respectively). The percent of responders at 3 months was 80.3%, 23.8% and 73.1% in group 1, 2 and 3 respectively. Also, group 1 achieved significant improvement compared to group 2 and similar improvement compared to group 3 in 3-day voiding diary parameters apart from nocturia at 3 months, as well as IPSS and QoL score at 2 months. This improvement remained comparable between responders in group 1 and 3 at 6 months. There was significant improvement in cystometric capacity at first sensation of bladder filling in group 1 and 3 and significant reduction in the percent of patients who had DO in group 1. No adverse effects related to Li-SWT were noted apart from tolerable local pain during the procedure (VAS= 4.22±1.02). Solifenacin 10 mg was associated with bothersome anti-cholinergic adverse effects in 73% of the patients with 11.5% discontinuation rate due to intolerable adverse effects. Conclusion: Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with efficacy similar to MRAs but without bothersome adverse effects. Recommendations: To confirm the efficacy of Li-SWT on post prostatectomy storage symptoms, further RCTs were needed with long-term follow up period.