Daneshwar D. et al., 2023: Treatment of prostatitis with low‐intensity extracorporeal shockwave therapy (LI‐ESWT)

Tuesday, 29 August 2023

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Daneshwar D, Nordin A.
Urology Clinic, Prince Court Medical Centre, 39, Jalan Kia Peng, 50450, Kuala Lumpur, Malaysia.
MedCentral Consulting, International Youth Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.

Abstract

Background: Prostatitis is known as the inflammation of the prostate. The treatments of prostatitis are either pharmacological or non-pharmacological treatment. However, some of the treatments are not effective and very invasive which can lead to side effects. Thus, low-intensity extracorporeal shockwave therapy (LI-ESWT) is used as an alternative treatment for prostatitis due to its convenient and non-invasive procedure. However, a definite protocol for this treatment is not available due to the variability of the treatment protocols and the lack of research comparing the efficacy of these protocols.

Objective: To review and compare the efficacy of different LI-ESWT protocols in treating prostatitis.

Methods: The study was performed by comparing the intensity, duration, frequency and combination with different types of pharmacotherapy drugs of the different LI-ESWT protocols from various studies. The finding from various studies which consist of disease improvement and quality of life (QoL) were also presented in this review.

Result: From the findings, the protocol can be categorized into three different intensities which are at 3000 pulses, < 3000 pulses and > 3000 pulses. Most studies reported that each protocol is very effective and safe to use and can improve CP symptoms, urinary symptoms, erectile function and QoL. It is also found that no complications or adverse effects occur to the patient.

Conclusion: Most of the LI-ESWT protocols described are safe and effective in treating CP through the absence of treatment-related adverse effects and maintenance of clinical effects.
Int Urol Nephrol. 2023 May 5. doi: 10.1007/s11255-023-03616-y. Online ahead of print. PMID: 37145375

Comments 1

Jens Rassweiler on Tuesday, 29 August 2023 10:30

This review article discusses the treatment of prostatitis using low-intensity extracorporeal shockwave therapy (LI-ESWT). Prostatitis is a common urogenital disease in males, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most prevalent type. CP is characterized by pelvic discomfort and tenderness without clear infection or pathology. Various treatment options, including medications and surgical procedures, are available, but they are not always effective and can have side effects.

LI-ESWT has emerged as a non-invasive and convenient treatment option for CP. It involves the application of low-intensity shockwaves to the perineum, which can reduce pain and improve tissue healing. Several studies have reported positive outcomes with LI-ESWT, including improvements in pain scores, quality of life, and urinary symptoms in CP patients.
Based on this, the study was performed by comparing the intensity, duration, frequency and combination with different types of pharmacotherapy drugs of the different LI-ESWT protocols from various studies. The finding from various studies which consist of disease improvement and quality of life (QoL) were also presented in this review.

Different protocols have been used in LI-ESWT treatment, varying in the number of shockwaves, energy flux density, and frequency. From the findings, such protocols can be categorized into three different intensities which are at 3000 pulses, 3000 pulses.
The most common protocol involves 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz, delivered in four sessions over four weeks. This protocol has shown significant improvements in pain and quality of life for CP patients. Other protocols with variations in parameters have also demonstrated positive results, including increased frequency and number of pulses.

Even though radial LI-ESWT has also been proven to be effective in improving the symptoms of CP, the difference in its treatment effect from that of focused LI-ESWT remains unclear. Hence, this knowledge gap should be filled by comparing the efficacy between these two types of shockwave therapy.

Overall, focused LI-ESWT appears to be a safe and effective treatment option for CP. However, there is no standardized treatment protocol, and more research is needed to determine the optimal parameters for LI-ESWT. The article recommends the protocol involving 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz as an standard treatment option for CP when comparing it to other settings.

Jens Rassweiler

LI-ESWT has emerged as a non-invasive and convenient treatment option for CP. It involves the application of low-intensity shockwaves to the perineum, which can reduce pain and improve tissue healing. Several studies have reported positive outcomes with LI-ESWT, including improvements in pain scores, quality of life, and urinary symptoms in CP patients. 
Based on this, the study was performed by comparing the intensity, duration, frequency and combination with different types of pharmacotherapy drugs of the different LI-ESWT protocols from various studies. The finding from various studies which consist of disease improvement and quality of life (QoL) were also presented in this review.

Different protocols have been used in LI-ESWT treatment, varying in the number of shockwaves, energy flux density, and frequency. From the findings, such protocols can be categorized into three different intensities which are at 3000 pulses,  3000 pulses.
The most common protocol involves 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz, delivered in four sessions over four weeks. This protocol has shown significant improvements in pain and quality of life for CP patients. Other protocols with variations in parameters have also demonstrated positive results, including increased frequency and number of pulses.

Even though radial LI-ESWT has also been proven to be effective in improving the symptoms of CP, the difference in its treatment effect from that of focused LI-ESWT remains unclear. Hence, this knowledge gap should be filled by comparing the efficacy between these two types of shockwave therapy.

Overall, focused LI-ESWT appears to be a safe and effective treatment option for CP. However, there is no standardized treatment protocol, and more research is needed to determine the optimal parameters for LI-ESWT. The article recommends the protocol involving 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz as an standard treatment option for CP when comparing it to other settings.

Jens Rassweiler

This review article discusses the treatment of prostatitis using low-intensity extracorporeal shockwave therapy (LI-ESWT). Prostatitis is a common urogenital disease in males, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most prevalent type. CP is characterized by pelvic discomfort and tenderness without clear infection or pathology. Various treatment options, including medications and surgical procedures, are available, but they are not always effective and can have side effects. LI-ESWT has emerged as a non-invasive and convenient treatment option for CP. It involves the application of low-intensity shockwaves to the perineum, which can reduce pain and improve tissue healing. Several studies have reported positive outcomes with LI-ESWT, including improvements in pain scores, quality of life, and urinary symptoms in CP patients. Based on this, the study was performed by comparing the intensity, duration, frequency and combination with different types of pharmacotherapy drugs of the different LI-ESWT protocols from various studies. The finding from various studies which consist of disease improvement and quality of life (QoL) were also presented in this review. Different protocols have been used in LI-ESWT treatment, varying in the number of shockwaves, energy flux density, and frequency. From the findings, such protocols can be categorized into three different intensities which are at 3000 pulses, 3000 pulses. The most common protocol involves 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz, delivered in four sessions over four weeks. This protocol has shown significant improvements in pain and quality of life for CP patients. Other protocols with variations in parameters have also demonstrated positive results, including increased frequency and number of pulses. Even though radial LI-ESWT has also been proven to be effective in improving the symptoms of CP, the difference in its treatment effect from that of focused LI-ESWT remains unclear. Hence, this knowledge gap should be filled by comparing the efficacy between these two types of shockwave therapy. Overall, focused LI-ESWT appears to be a safe and effective treatment option for CP. However, there is no standardized treatment protocol, and more research is needed to determine the optimal parameters for LI-ESWT. The article recommends the protocol involving 3000 pulses at an energy flux density of 0.25 mJ/mm2 and a frequency of 3 Hz as an standard treatment option for CP when comparing it to other settings. Jens Rassweiler

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