Objective: assess the effectiveness of shock waves in bph management by patients who do not react to medical treatment Method and patients: This research is a prospective, non-randomized single-arm study at Benha University Hospital's Urology Department. This comprised (32) individuals with BPH, with or without at least 6 months of poor response to pharmacological treatment by one or more α-blockers, poor surgical candidates for co-morbidities or not interested in surgery. All patients underwent six LISWT sessions once a week, and all patients were assessed by changes in IPSS, QMAX, IIEF5, and PVRU at 3rd and 6th, and 3 months after treatment completion Results: substantial improvement was seen in the maximal flow rate from9±1.50ml/sec before to sessions beginning to 13.9±1.2ml/sec, and also in PVR from 79.34±56.87ml to 55.43±35.65ml during the sixth week of follow-up. The IPSS also improved substantially from 28±4.5 to 20.34±5 at the 6th week of follow-up. Conclusion:LISWT is safe to use for BPH treatment particularly in non-respondent medical therapy without severe side effects based on its antispasmodic characteristics.