Kim KS et al., 2021: Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome IIIb: A Prospective-Randomized, Double-Blind, Placebo-Controlled Study.
Kim KS, Choi YS, Bae WJ, Cho HJ, Ha US, Hong SH, Lee JY, Ahn ST, Moon DG, Kim SW.
Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Department of Urology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Korea.
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Korea.
Abstract
Purpose: There is no definite treatment method for chronic pelvic pain syndrome (CPPS). The purpose of this study was to compare and assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) versus placebo treatment in CPPS IIIb patients.
Materials and methods: Thirty participants with CPPS IIIb were included and randomized in this prospective, double-blind, placebo-controlled study. Li-ESWT was performed at the perineum without anesthesia once per week for 8 weeks. CPPS-related symptoms were evaluated using the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI). Pain and erectile function were appraised using the Visual Analogue Scale (VAS) and International Index of Erectile Function-Erectile Function (IIEF-EF), respectively. The Global Efficacy Assessment Question (GEAQ) was also assessed. The parameters were evaluated immediately after the last Li-ESWT treatment and 4 weeks after Li-EWST treatment.
Results: Fifteen subjects each in the Li-ESWT and placebo groups completed this study. Amelioration of NIH-CPSI total, pain, and quality of life score in the Li-ESWT group was found compared to the placebo group (p=0.002, 0.02, 0.001, respectively). Improvement of the VAS score was observed in the Li-ESWT group (p=0.002). The differences in the GEAQ "Yes" responses were also significant in the Li-ESWT group. No patients experienced side effects related to ESWT during therapeutic period or follow-up duration.
Conclusions: Results indicated that Li-ESWT improved the NIH-CPSI score, pain, and the quality of life in CPPS IIIb patients. Li-ESWT could be an effective alternative treatment modality for CPPS IIIb.
World J Mens Health. 2021 Jul 14. doi: 10.5534/wjmh.210010. Online ahead of print. PMID: 34448374
Comments 1
It is well recognized to everyone involved in the care of patients with chronic pelvic pain (CPPS) that the treatment options are few and usually associated with little or no clinical effect. The use of Li-ESWT has come to rescue and when applied in different studies the results are indeed promising [1-3].
The article referred to in this comment has its focus on the effect of Li-ESWT in Korean patients.
Treatment strategy:
500 sw were directed to 6 different spots in perineum. A total number of sw=3000 with energy flow density 0.25 mJ/mm2 were administered with a frequency of 3 Hz. Altogether eight treatment sessions were carried out. There was one treatment scheduled once a week. The results showed a statistically significant reduction in most NUH-scores in the Li-ESWT treated patients compared with the scores recorded in placebo-treated patients.
Although the exact mechanism by which Li-ESWT works is unknown, the method is indeed promising and perfectly well suited for office urology. This method provides an alternative to several other inferior medical and physical treatments. Li-ESWT is easy to perform and easy to repeat. When I was clinically active a method like this had been highly desirable
References
1. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol 2009;56:418-24.
2. Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci 2014;19:293-6.
3. Pajovic B, Radojevic N, Dimitrovski A, Vukovic M. Comparison of the efficiency of combined extracorporeal shockwave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). Aging Male 2016;19:202-7
Hans-Göran Tiselius