Bian Z. et al., 2022: Dietary habits and lifestyle related to the effectiveness of low-intensity extracorporeal shock wave therapy for chronic prostatitis/chronic pelvic pain syndrome-like symptoms: Initial results
Bian Z, Jin C, Zhang L, Chen Fan Mo F, Zhang S, Meng J, Zhang M, Hao Z, Song Z, Lian C.
Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
To identify factors that could influence the treatment outcomes of low-intensity extracorporeal shock wave therapy (Li-ESWT) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)-like symptoms and establish a predictive model based on these factors to precisely screen individuals who might be more suitable for Li-ESWT. This study enrolled 84 patients with CP/CPPS-like symptoms who received Li-ESWT. Patients were divided into an effective group and an ineffective group based on the reduction of their National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). A nomogram was established based on logistic regression analyses. Then, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were used to evaluate the nomogram. Univariate and multivariate logistic regression analysis showed that a higher NIH-CPSI score, a habit of holding urine, alcohol consumption, and urination soon after intercourse were independent predictors of Li-ESWT efficacy (p < 0.05). The nomogram constructed based on these four indicators and the added age effectively predicted the probability of Li-ESWT effectiveness for CP/CPPS-like symptoms (0.809 [95% CI: 0.717-0.901]; Hosmer-Lemeshow: p = 0.936). This study established a predictive model for the efficacy of Li-ESWT in treating CP/CPPS-like symptoms patients and help improve the management of CP/CPPS-like symptoms.
Andrologia. 2022 Oct;54(9):e14490. doi: 10.1111/and.14490. Epub 2022 Jun 7. PMID: 35671994
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that has an important impact on men's health. Precise definitions of disease, risk factors, and pathophysiology have not been fully elucidated. Lower urinary tract symptoms and pelvic pain are the main complaints of patients seeking clinical intervention. There is evidence that low- intensity extracorporeal shock wave therapy (Li-ESWT) can play an important role in addressing CP/CPPS.
A previous study of the group verified that Li-ESWT was effective in treating drug refractory prostatitis-like symptoms (PLS). However, the results among patients who received Li-ESWT treatment were heterogeneous. Previous studies have identified several potential risk factors for CP/CPPS, including age, night work, body mass index (BMI), anxiety, smoking, low water intake, alcohol consumption, unbalanced diet, frequent sexual activity, delayed ejaculation, and spicy food. Aim of this study was to establish and validate a signature based on clinical indicators, dietary habits, lifestyle, and past medical history for CP/CPPS-like symptoms patients who received Li-ESWT treatment. 84 patients with CP/CPPS-like symptoms who received Li-ESWT were enrolled and divided into an effective group and an ineffective group based on the reduction of their National Institutes of Health Chronic Prostatitis. The NIH-CPSI (0–43 points) was used to assess changes in the patient's condition.
After adjustment via regression analysis, we found that the NIH-CPSI score, a habit of holding urine, alcohol consumption, and urination soon after intercourse were independent predictors of Li-ESWT effectiveness (p less than 0.05). Based on this study, the authors were able to create a normogram: Combining the scores of these five indica- tors, the probability of whether a subject will benefit from Li-ESWT could be better predicted (Figure 1).
The study shows, that efficacy of Li-ESWT for CP/CPPS strictly depends on factors that can be influenced by the patient. The treatment cannot provide cure in any case. This is an important factor of selecting the patients adequately and of teaching them accordingly. Of course, the model needs to be validated in a new large sample cohort. The main problem of Li-ESWT for CP/CPPS is the range of underlying symptoms and diseases. The proper diagnosis should be made prior to the treatment and of course motivation and compliance of the patient is needed.
Moreover, the future will show, whether other non-invasive treatment modalities, like magnetotherapy will play an important role in the future. The main problem beside proper diagnosis is also to determine the area to be treated. This could be much easier accomplished when using magnetic fields.