Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy

Abstract

Managing patients with chronic pelvic pain syndrome (CPPS) refractory to the traditional 3-As therapy (antibiotics, alpha-blockers, and anti-inflammatories) is a challenging task. Low-intensity extracorporeal shock wave therapy (LI-ESWT) was recently reported to be able to improve pain, urinary symptoms, and even sexual function by inducing neovascularization and anti-inflammation, reducing muscle tone, and influencing nerve impulses. This study evaluates whether combined treatment with LI-ESWT can restore clinical ability and quality of life (QoL) in patients refractory to 3-As therapy. This was an open-label, single-arm prospective study. Patients with CPPS without more than a 6-point decrease in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score under the maximal dosage of 3-As therapy were enrolled. LI-ESWT treatment consisted of 3,000 shock waves administered once weekly for 4 weeks. The NIH-CPSI, visual analog scale (VAS) score, International Prostate Symptom Score (IPSS), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate efficacy at 1, 4, and 12 weeks after LI-ESWT. Thirty-three patients were enrolled in this study. After LI-ESWT treatment, 27 of the 33 patients (81.82%) had a successful response to LI-ESWT, with a decrease of 3.29 and 5.97 in the VAS score and total IPSS at the 3-month follow-up. Waist circumference was the only significant predictor of a successful response to LI-ESWT. LI-ESWT can serve as a salvage therapy for patients with CPPS refractory to traditional 3-As therapy. Further studies are needed to determine an adequate therapeutic protocol and important predictors in patients with different CPPS etiologies.

Therapeutic effects of Low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence

“…Clinical trials on the safety and efficacy profile of LiESWT in treating female SUI are still not completely clear. Clinically, LiESWT has emerged in recent years to treat (1) chronic pelvic pain syndrome (CPPS) (0.10-0.25 mJ/ mm 2 , 3000 pulses, once/week, 4 weeks) to improve pain, bladder voiding and QoL 17,[24][25][26][27] ; (2) erectile dysfunction (ED) (0.10-0.25 mJ/mm 2 , 3000-6000 pulses, once/week, 4-8 weeks) to increase penile hemodynamics and induce penile tissue regeneration 18,28,29 . In this study, the recruited subjects had normal BMI, blood pressure, renal function, liver function, blood sugar level, and lipid profiles, thus eliminating the potential confounding factors ( Table 1).…”

Low-Intensity Extracorporeal Shock Wave Therapy Ameliorates the Overactive Bladder: A Prospective Pilot Study

“…LiESWT has been used clinically for several years in urology, but the efficacy and safety profile of LiESWT in treating OAB are not completely clear. For the CPPS studies, the shock intensity ranging from 0.10 to 0.25 mJ/mm 2 , 3000 impulses, and once/week treatment continuing for 4 weeks were used to treat the disease [ 17 – 19 ]. The results showed that LiESWT improved the pain score, bladder urination, and QoL without side-effects.…”

“…Recently, our group showed that LiESWT can significantly improve the visual analog scale (VAS) pain score and total international prostate symptom scores (IPSS) for men with CPPS refractory to 3-As therapy (antibiotics, alpha-blockers, and anti-inflammatories). The response can last until the 3-month follow-up [ 19 ]. To date, the clinical efficacy of LiESWT on patients with OAB has not previously been investigated.…”

Efficacy of Radial Extracorporeal Shock Wave Therapy for Chronic Pelvic Pain Syndrome: A Nonrandomized Controlled Trial

“…Two latest studies reviewed literature from 2008 to 2018 (Franco et al, 2018; Guu et al, 2018) on the positive results of fESWT in the improvement of CPPS. Four studies with 237 participants reported that fESWT reduced prostatitis symptoms compared to the sham control or no intervention control, measured by NIH-CPSI score at 12 weeks’ follow-up (Pajovic et al, 2016; Vahdatpour et al, 2013; Zeng et al, 2012; Zimmermann et al, 2009).…”