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Guu SJ et al, 2017: Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy.

Guu SJ, Geng JH, Chao IT, Lin HT, Lee YC, Juan YS, Liu CC, Wang CJ, Tsai CC.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
Teaching and Research Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

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.

Am J Mens Health. 2017 Oct 1:1557988317736585. doi: 10.1177/1557988317736585. [Epub ahead of print]

 

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Comments 1

Peter Alken on Tuesday, 10 April 2018 10:37

An “open-label, single-arm prospective study” with extremely good results on patients who failed everything else!? The materials and methods section leaves some lack of conceptual clarity:
“All patients had received at least a 6-week trial of 3-As therapy, including fluoroquinolone (500 mg once daily), alpha-blocker (recommend dose once daily), and acetaminophen/ nonsteroidal anti-inflammatory drug (NSAID; recommend dose twice or three times daily). These patients
did not have more than a 6-point decrease in the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) total score after taking the full course and maximal dosage of the 3-As therapy for at least 3 of the preceding 6 months.”
But then the text goes on: “ If unrecognized hypogonadism with serum total testosterone levels surprisingly very good. The tricky questions remains if a positive response requires that classical therapy initially failed. Why would LI-ESWT not help from the very start?

An “open-label, single-arm prospective study” with extremely good results on patients who failed everything else!? The materials and methods section leaves some lack of conceptual clarity: “All patients had received at least a 6-week trial of 3-As therapy, including fluoroquinolone (500 mg once daily), alpha-blocker (recommend dose once daily), and acetaminophen/ nonsteroidal anti-inflammatory drug (NSAID; recommend dose twice or three times daily). These patients did not have more than a 6-point decrease in the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) total score after taking the full course and maximal dosage of the 3-As therapy for at least 3 of the preceding 6 months.” But then the text goes on: “ If unrecognized hypogonadism with serum total testosterone levels surprisingly very good. The tricky questions remains if a positive response requires that classical therapy initially failed. Why would LI-ESWT not help from the very start?
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