Joe K. C. Lee et al., 2024: Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study

Friday, 14 June 2024

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Joe K C Lee, Terence Y X Law, Liang Shen, Gregory X W Pek , Qi Y Lim, Yi Q Tan, Jun Y Chia, Man K Li
Department of Urology, National University Hospital, Singapore, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Li Man Kay Urology Associates Mount Elizabeth Novena Hospital, Singapore, Singapore.

Abstract

Background: Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS.

Methods: Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King's Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks.

Results: Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King's Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period.

Conclusions: ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.

PMID: 38523905
PMCID: PMC10960085
DOI: 10.1016/j.prnil.2023.11.001 FREE PMC TEXT

Comments 1

Jens Rassweiler on Friday, 14 June 2024 11:00

The article discusses a pilot study on the effectiveness of Extracorporeal Shockwave Therapy (ESWT) for male patients suffering from Chronic Pelvic Pain Syndrome (CPPS). CPPS is characterized by long-term pelvic pain without identifiable causes like infection. Traditional treatments often provide limited relief. The study explores ESWT as a potential solution, based on its success in treating other conditions like erectile dysfunction.
The study included 14 male patients with CPPS who had not responded well to conventional treatments. They received ESWT (6000 impulses) on the perineum, aiming to alleviate pelvic pain using the Dornier Aries device at a maximum energy level of 5-7 (0.06-0.10 mJ/mm2). The treatment involved delivering shockwaves to specific points in the pelvic floor associated with pain (i.e. trigger points; Fig. 1). Patients underwent four sessions of ESWT over four weeks, with additional sessions offered if needed.

Results showed promising improvements in pain levels, erectile function, and urinary symptoms post-treatment. Notably, patients experienced a significant reduction in pain intensity, as well as improvements in erectile function and urinary symptoms. The study suggests that ESWT could be a safe and effective option for managing CPPS in men, potentially addressing associated symptoms like erectile dysfunction and lower urinary tract symptoms. The study has demonstrated that there was no significant difference between patients who needed 4 sessions versus those who needed 8 sessions of ESWT except for the weak-stream domain in IPSS. The results suggest that for some patients, 4 sessions may be enough for pain score to show improvement, but for some patients, it may take a longer treatment to get the same results.
While the study's findings are encouraging, it acknowledges limitations such as a small sample size and the absence of a control group, which could affect the reliability of results. Nonetheless, the study indicates that ESWT holds promise as a treatment for CPPS and warrants further investigation. Herein, the concept of applying ESWT on certain trigger points at the perineum delivering 6000 impulses per session is important.

Jens Rassweiler

[img]https://www.storzmedical.com/images/blog/Lee.PNG[/img]
 
Results showed promising improvements in pain levels, erectile function, and urinary symptoms post-treatment. Notably, patients experienced a significant reduction in pain intensity, as well as improvements in erectile function and urinary symptoms. The study suggests that ESWT could be a safe and effective option for managing CPPS in men, potentially addressing associated symptoms like erectile dysfunction and lower urinary tract symptoms. The study has demonstrated that there was no significant difference between patients who needed 4 sessions versus those who needed 8 sessions of ESWT except for the weak-stream domain in IPSS. The results suggest that for some patients, 4 sessions may be enough for pain score to show improvement, but for some patients, it may take a longer treatment to get the same results. 
While the study's findings are encouraging, it acknowledges limitations such as a small sample size and the absence of a control group, which could affect the reliability of results. Nonetheless, the study indicates that ESWT holds promise as a treatment for CPPS and warrants further investigation. Herein, the concept of applying ESWT on certain trigger points at the perineum delivering 6000 impulses per session is important.

Jens Rassweiler

The article discusses a pilot study on the effectiveness of Extracorporeal Shockwave Therapy (ESWT) for male patients suffering from Chronic Pelvic Pain Syndrome (CPPS). CPPS is characterized by long-term pelvic pain without identifiable causes like infection. Traditional treatments often provide limited relief. The study explores ESWT as a potential solution, based on its success in treating other conditions like erectile dysfunction. The study included 14 male patients with CPPS who had not responded well to conventional treatments. They received ESWT (6000 impulses) on the perineum, aiming to alleviate pelvic pain using the Dornier Aries device at a maximum energy level of 5-7 (0.06-0.10 mJ/mm2). The treatment involved delivering shockwaves to specific points in the pelvic floor associated with pain (i.e. trigger points; Fig. 1). Patients underwent four sessions of ESWT over four weeks, with additional sessions offered if needed. [img]https://www.storzmedical.com/images/blog/Lee.PNG[/img] Results showed promising improvements in pain levels, erectile function, and urinary symptoms post-treatment. Notably, patients experienced a significant reduction in pain intensity, as well as improvements in erectile function and urinary symptoms. The study suggests that ESWT could be a safe and effective option for managing CPPS in men, potentially addressing associated symptoms like erectile dysfunction and lower urinary tract symptoms. The study has demonstrated that there was no significant difference between patients who needed 4 sessions versus those who needed 8 sessions of ESWT except for the weak-stream domain in IPSS. The results suggest that for some patients, 4 sessions may be enough for pain score to show improvement, but for some patients, it may take a longer treatment to get the same results. While the study's findings are encouraging, it acknowledges limitations such as a small sample size and the absence of a control group, which could affect the reliability of results. Nonetheless, the study indicates that ESWT holds promise as a treatment for CPPS and warrants further investigation. Herein, the concept of applying ESWT on certain trigger points at the perineum delivering 6000 impulses per session is important. Jens Rassweiler

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