Guu SJ. et al., 2019: The 12-month follow-up of the low-intensity extracorporeal shockwave therapy in the treatment of patients with chronic pelvic pain syndrome refractory to 3-As medications
Guu SJ, Liu CC, Juan YS, Li CC, Tsai CC.
Department of Urology , Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung , Taiwan. Department of Urology , Pingtung Hospital, Ministry of Health and Welfare , Pingtung , 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.
PURPOSE: Applying low-intensity extracorporeal shockwave therapy (LI-ESWT) has been reported to improve symptoms of refractory chronic pelvic pain syndrome (CPPS) in short-term follow-up. This study aims to demonstrate the effect of LI-ESWT on refractory CPPS over the span of a 12-month follow-up. MATERIALS AND METHODS: This was an open-label, single-arm prospective study. LI-ESWT consisted of 3000 shock waves once weekly for 4 weeks (Duolith SD1 T-Top) were applied. Clinical symptoms were re-assessed at 1, 3, 6, and 12 months using NIH-CPSI score, visual analog scale, 5-item version of the International Index of Erectile Function and International Prostate Symptom Score. RESULTS: Thirty-one of the 43 patients enrolled had a successful response at the 1-month follow up after the treatment. Twenty-six of the 31 patients who responded successfully to LI-ESWT at the 1-month follow-up, maintained their response at the 6- and 12-month follow-up. The existence of psychosocial disorder at the baseline characteristics analysis was the only potential factor that may hinder the effectiveness of LI-ESWT. CONCLUSIONS: LI-ESWT has shown to be a safe and effective therapy for CPPS patients at the long-term follow-up. History of psychological disorders might be a significant predictor of a successful response.
Aging Male. 2019 Apr 4:1-8. doi: 10.1080/13685538.2019.1597341. [Epub ahead of print]
During my whole urological career, patients with chronic pelvic pain syndrome (CPPS) have remained a therapeutic challenge. What the authors refer to as 3 As (antibiotics, anti-inflammatory agents; NSAID´s and alpha receptor antagonists) have shown highly variable effects. In view of this not entirely positive experience it is interesting that that ESWT offers a new therapeutic way.
With 3000 shockwaves administered with a frequency of 4Hz at six different anatomical points, significant improvements were recorded in NIH-CPSI, IPSS, EHS and VAS scores up to one year after the treatment!
Reflection: It would indeed be interesting to use the UPOINT classification system for CPPS with the aim of evaluating the effect of different treatment methods and then particularly the role of ESWT. Moreover, it seems essential to define the optimal variables of ESWT in terms of number of shockwaves, energy level and frequency.