Extracorporeal Shockwave Therapy Combined with Drug Therapy in Chronic Pelvic Pain Syndrome : A Randomized Clinical Trial
Vol. 17 No. 2 (2020),
16 March 2020
AbstractPurpose: Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least three of the last 6 months. Evidence for treatment approach is limited. So the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS.
Materials and Methods: In this randomized clinical trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alpha-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2 and 3 Hz of frequency). The control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups.
Results: The patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline (P < .001). In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved (P < .001). There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group (P < .01). Qmax, PVR and IIEF score were not statistically different in the two groups.
Conclusion: ESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.
McNaughton-Collins M, Stafford RS, O’Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159 :1224–8.
Nickel JC. Clinical evaluation of the man with chronic prostatitis/chronic pelvic pain syndrome. Urology. 2002; 60 (6 Suppl): s20-s23.
Krieger JN, Nyberg L, Nickel JC () .NIH consensus definition and classification of prostatitis. JAMA 1999; 282: 236–237.
Engeler D, Baranowski A, Elneil S, Hughes J, Messelink E, et al. Guidelines on chronic pelvic pain. European Association of Urology 2014.
Bartoletti R, Cai T, Mondaini N, et al. Italian Prostatitis Study Group. Prevalence, incidence estimation, risk factors and characterization of chronic prostatitis/chronic pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study. J Urol 2007; 178: 2411–5.
Marszalek M1, Wehrberger C, Hochreiter W, Temml C, Madersbacher S. Symptoms suggestive of chronic pelvic pain syndrome in an urban population: prevalence and associations with lower urinary tract symptoms and erectile function. J Urol. 2007 May;177(5):1815-9.
Wenninger K, Heiman JR, Rothman I, et al. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 1996;155:965–7.
Pontari MA. Chronic prostatitis/chronic pelvic pain syndrome. Urol Clin North Am 2008;35:81–9.
Delavierre D, Rigaud J, Sibert L, Labat JJ. Symptomatic approach to chronic prostatitis /chronic pelvic pain syndrome. Prog Urol. 2010; 20:940-53.
Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol 1999 Aug;162(2):369-75.
Lenk S. Diagnosis of chronic prostatitis. Urologe A 2001;40:9-11.
Weidner W, Wagenlehner FM, Marconi M, Pilatz A, Pantke KH, Diemer T. Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: Andrological implications. Andrologia. 2008; 40(2): 105-12.
Porpert KJ, Alexander RB, Nickel CJ, Kusek JW, Litwin MS, et al. The chronic prostatitis collaborative research network. Design of a multicenter randomized clinical trial for chronic prostatitis/ chronic pelvic pain syndrome. Urology. 2002; 59:870-6.
Nickel JC, Downey J, Ardern D, Clarke J, Nickel K. Failure of monotherapy strategy for difficult chronic prostatitis/ chronic pelvic pain syndrome. J Urol. 2004; 172:551-4.
Chuang YC, Chancellor MB. The application of botulinum toxin in the prostate. J Urol 2006;176(6 Pt 1):2375-82.
Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol 2005;174:155–60.
Tiselius HG. Urology(shock wave therapy in practice). Germany; march 2013.
Christoph Schmitz, Nikolaus B. M. Császár,et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British Medical Bulletin, 2015, 116:115–138.
Wess OJ. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment. Urol Res. 2008; 36:327–34.
Marszalek M, Berger I, Madersbacher S. Low-energy extracorporeal shock wave therapy for chronic pelvic pain syndrome: finally, the magic bullet? Eur Urol 2009;56(3):425-6.
Wang J, Zhou C, Liu L, Pan X, Guo T. Clinical effect of cardiac shock wave therapy on patients with ischaemic heart disease: a systematic review and meta-analysis. Eur J Clin Invest. 2015 Dec;45(12):1270-85.
X.Yan, G. Yang, L. Cheng et al., Effect of extracorporeal shock wave therapy on diabetic chronic wound healing and its histological features. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012:26(8):961-7.
Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, doubleblind, placebo-controlled study. Eur Urology. 2009;56(3):418-424.
Zeng XY, Liang C, Ye ZQ. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study. Chin Med J. 2012; 125(1):114-118.
Pajovic B, Radojevic N, Dimitrovski A, Vukovic M. Compsrison of the efficacy of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). The Aging Male. 2016;19(3):202-207.
Zimmermann R, Cumpanas A, Hoeltl L, Janetschek G, Stenzl A, et al. Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int.2008;102(8): 976-980.
Vahdatpour B, Alizadeh F, Moayednia A, et al. Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial. ISRN Urol 2013;2013:972601.
Nikolaevich KM. Radial Shock Wave Therapy in Chronic Pelvic Pain Syndrome (CPPS). Urology. 2013; 6.
Guu SJ, Geng JH, Chao IT, et al. Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy. Am J Mens Health. 2017; [Epub ahead of print], doi: 10.1177/1557988317736585.
Al Edwan GM, Muheilan MM, M.Atta ON. Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis. Annals of medicine and surgery. 2017;14:12-17.
Moayednia A, Haghdani S, Khosrawi S, et al. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci. 2014; 19:293–6.
- Abstract Viewed: 920 times
- pdf/4673 Downloaded: 340 times