Extracorporeal shock wave therapy in association with bromelain and escin for the management of patients affected by chronic prostatitis/chronic pelvic pain syndrome

Abstract

Extracorporeal shock wave therapy (ESWT) has been purposed for the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with encouraging results. Phytotherapeutic compounds have been used in everyday clinical practice for patients with CP/CPSS due to their anti-inflammatory properties. The present study aimed to investigate the effects of ESWT in association with the use of bromelain and escin extracts in patients with CP/CPSS. For this purpose, 95 patients with a clinical diagnosis of CP/CPSS were enrolled in the study. The patients were randomly allocated to either the ESWT plus bromelain and escin group (group A; n=48) or the ESWT only group (group B; n=47). A total of five weekly ESWT treatment sessions were administered alone or in combination with bromelain and escin. Each session consisted of 3,000 focused shock waves. Doses of 160 and 500 mg/day bromelain and escin were administered respectively for 5 weeks. The changes in urinary symptoms, pain and quality of life were considered the main outcome measures and were assessed at baseline, and at 4, 12 and 24 weeks of follow-up. Urinary symptoms, pain and quality of life were evaluated using the international prostatic symptoms score (IPSS), visual analog scale (VAS) and the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). After 4 weeks, the mean VAS score, mean IPSS and mean satisfaction rate score had significantly improved in patients receiving ESWT plus bromelain and escin. After 12 weeks, the mean IPSS and mean satisfaction rate score were stable in the ESWT plus bromelain and escin group, while the mean VAS score was significantly lower when compared with the baseline values in both groups. On the whole, the present study demonstrates that in patients affected by CP/CPPS, treatment with ESWT plus bromelain and escin leads to pain resolution, and both treatments improve the IPSS, VAS and NIH-CPSI results.

Effectiveness of Silymarin, Sulforaphane, Lycopene, Green Tea, Tryptophan, Glutathione, and Escin on Human Health: A Narrative Review

“…A total of 100 CP/CPPS patients were randomized into two groups, one group treated with ESWT alone and another group treated with ESWT plus bromelain and escin. Pain intensity, urinary and prostatitis symptoms, and quality of life were assessed after 4, 12, and 24 weeks, showing a significant reduction and even disappearance of pain in a significantly higher percentage of patients in the treated group with combined therapy compared to the group treated with ESWT alone, as well as slight improvements that were also found with regard to prostatic and urinary symptoms [115]. This can be explained by going back to the anti-inflammatory activity of both escin and bromelain (inhibition of mediators such as NF-kB, IL-1β, IL-6, TNF-α, and PGE2), which inhibit different inflammatory pathways by cooperating with the ESWT in addressing the complex pathogenesis of CP/CPPS.…”

Chronic Prostatitis/Chronic Pain Pelvic Syndrome and Male Infertility

“…Moreover, recently, it was shown how low-intensity extracorporeal shockwave therapy (ESWT) is a safe, noninvasive and effective option for patients with CP/CPPS [ 34 ]. A recent clinical study investigating the combined role of ESWT, bromelain and escin in 95 patients with CP/CPPS reported an improvement in IPSS and NIH-CPSI results after 12 weeks of this combination therapy [ 35 ], despite having certain limitations, such as the lack of a placebo.…”