Ivan Labetov et al., 2024: Extracorporeal shockwave therapy in treatment of chronic prostatitis/chronic pelvic pain syndrome: Systematic review and meta-analyses

Friday, 30 August 2024

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Ivan Labetov 1 , Anastasia Vaganova 1 2 , Gleb Kovalev 1 , Dmitry Shkarupa 1
1Neurourology department, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia.
2Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.

Abstract

Aims: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health-related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well-being were analyzed in the present study.

Methods: We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self-reported scores, including the NIH-CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow-up.

Results: The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH-CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long-lasting and was confirmed in the 6-month follow-up (p < 0.01).

Conclusions: Based on the meta-analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis.

Neurourol Urodyn. 2024 Jun 7. doi: 10.1002/nau.25524. Online ahead of print. PMID: 38847290
DOI: 10.1002/nau.25524

Comments 1

Jens Rassweiler on Friday, 30 August 2024 11:00

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent male health issue affecting up to 50% of the male population during their lifetime. Despite advances in medicine, CP/CPPS remains challenging to treat, with existing therapies often proving ineffective. Extracorporeal shockwave therapy (ESWT) has emerged as a potential treatment option, previously used in other urological conditions like Peyronie’s disease and erectile dysfunction.
This study systematically reviews and meta-analyzes the effectiveness and safety of eEWT in treating CP/CPPS, focusing on pain outcomes and overall well-being. The systematic review followed PRISMA 2022 guidelines and was registered with PROSPERO. The researchers searched databases like PubMed, Scopus, and Google Scholar, including only randomized prospective studies. The primary outcomes measured were pain and well-being scores using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and Visual Analogue Scale (VAS). Data analysis involved random-effects models, and risk of bias was assessed using the Cochrane risk-of-bias tool.
From 519 initially identified articles, 8 studies met the inclusion criteria, encompassing different ESWT protocols (Energy mostly 0.25 mJ/mm2; 3 Hz, 3000 SW) and follow-up durations. ESWT was well-tolerated with no reported side effects in most studies.
Interestingly, the authors focused on different follow-up periods following ESWT.
• 1-3 Month Follow-Up: Eleven studies reported no significant impact on pain scores initially, but after excluding outliers, ESWT showed a significant effect on both pain and overall well-being.
• 6-12 Month Follow-Up: Four studies indicated a significant positive effect of ESWT on both pain and well-being scores. A 12-month follow-up study also showed sustained pain relief.
Conclusion: ESWT appears to be an effective treatment for CP/CPPS, particularly in reducing pain and improving well-being. The therapy’s effects are sustained for up to six months and are effective as both a standalone treatment and in combination with conventional therapies. However, the certainty of the evidence is limited by the high risk of bias in many studies, small sample sizes, and significant heterogeneity across trials. Further high-quality, large-scale studies are needed to confirm these findings.
Implications: ESWT offers a promising alternative for managing CP/CPPS, potentially addressing a significant gap in current treatment options. However, clinicians should consider the limitations of existing evidence when recommending this therapy

Jens Rassweiler

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent male health issue affecting up to 50% of the male population during their lifetime. Despite advances in medicine, CP/CPPS remains challenging to treat, with existing therapies often proving ineffective. Extracorporeal shockwave therapy (ESWT) has emerged as a potential treatment option, previously used in other urological conditions like Peyronie’s disease and erectile dysfunction.
This study systematically reviews and meta-analyzes the effectiveness and safety of eEWT in treating CP/CPPS, focusing on pain outcomes and overall well-being. The systematic review followed PRISMA 2022 guidelines and was registered with PROSPERO. The researchers searched databases like PubMed, Scopus, and Google Scholar, including only randomized prospective studies. The primary outcomes measured were pain and well-being scores using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and Visual Analogue Scale (VAS). Data analysis involved random-effects models, and risk of bias was assessed using the Cochrane risk-of-bias tool.
From 519 initially identified articles, 8 studies met the inclusion criteria, encompassing different ESWT protocols (Energy mostly 0.25 mJ/mm2; 3 Hz, 3000 SW) and follow-up durations. ESWT was well-tolerated with no reported side effects in most studies.
Interestingly, the authors focused on different follow-up periods following ESWT.
•	1-3 Month Follow-Up: Eleven studies reported no significant impact on pain scores initially, but after excluding outliers, ESWT showed a significant effect on both pain and overall well-being.
•	6-12 Month Follow-Up: Four studies indicated a significant positive effect of ESWT on both pain and well-being scores. A 12-month follow-up study also showed sustained pain relief.
Conclusion: ESWT appears to be an effective treatment for CP/CPPS, particularly in reducing pain and improving well-being. The therapy’s effects are sustained for up to six months and are effective as both a standalone treatment and in combination with conventional therapies. However, the certainty of the evidence is limited by the high risk of bias in many studies, small sample sizes, and significant heterogeneity across trials. Further high-quality, large-scale studies are needed to confirm these findings.
Implications: ESWT offers a promising alternative for managing CP/CPPS, potentially addressing a significant gap in current treatment options. However, clinicians should consider the limitations of existing evidence when recommending this therapy

Jens Rassweiler

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent male health issue affecting up to 50% of the male population during their lifetime. Despite advances in medicine, CP/CPPS remains challenging to treat, with existing therapies often proving ineffective. Extracorporeal shockwave therapy (ESWT) has emerged as a potential treatment option, previously used in other urological conditions like Peyronie’s disease and erectile dysfunction. This study systematically reviews and meta-analyzes the effectiveness and safety of eEWT in treating CP/CPPS, focusing on pain outcomes and overall well-being. The systematic review followed PRISMA 2022 guidelines and was registered with PROSPERO. The researchers searched databases like PubMed, Scopus, and Google Scholar, including only randomized prospective studies. The primary outcomes measured were pain and well-being scores using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and Visual Analogue Scale (VAS). Data analysis involved random-effects models, and risk of bias was assessed using the Cochrane risk-of-bias tool. From 519 initially identified articles, 8 studies met the inclusion criteria, encompassing different ESWT protocols (Energy mostly 0.25 mJ/mm2; 3 Hz, 3000 SW) and follow-up durations. ESWT was well-tolerated with no reported side effects in most studies. Interestingly, the authors focused on different follow-up periods following ESWT. • 1-3 Month Follow-Up: Eleven studies reported no significant impact on pain scores initially, but after excluding outliers, ESWT showed a significant effect on both pain and overall well-being. • 6-12 Month Follow-Up: Four studies indicated a significant positive effect of ESWT on both pain and well-being scores. A 12-month follow-up study also showed sustained pain relief. Conclusion: ESWT appears to be an effective treatment for CP/CPPS, particularly in reducing pain and improving well-being. The therapy’s effects are sustained for up to six months and are effective as both a standalone treatment and in combination with conventional therapies. However, the certainty of the evidence is limited by the high risk of bias in many studies, small sample sizes, and significant heterogeneity across trials. Further high-quality, large-scale studies are needed to confirm these findings. Implications: ESWT offers a promising alternative for managing CP/CPPS, potentially addressing a significant gap in current treatment options. However, clinicians should consider the limitations of existing evidence when recommending this therapy Jens Rassweiler

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