Rayegani SM. et al., 2019: Extracorporeal Shockwave Therapy Combined with Drug Therapy in Chronic Pelvic Pain Syndrome - A Randomized Clinical Trial
Rayegani SM, Razzaghi MR, Raeissadat SA, Allameh F, Eliaspour D, Abedi AR, Javadi A, Rahavian AH.
Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Center of Excellence in Training Laser Application in Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Urology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
PURPOSE: Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least 3 of the last 6 months. The evidence for treatment is limited so the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS. MATERIALS AND METHODS: In this randomized clinical trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alfa-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2 and 3 Hz of frequency); the control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups. RESULTS: The patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline. (P < .001) In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved. (P < .001) There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group. (P < .01) Qmax, PVR and IIEF score were not statistically different in the two groups. CONCLUSION: ESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.
Urol J. 2019 Apr 20. doi: 10.22037/uj.v0i0.4673. [Epub ahead of print]
Comments 1
The body of literature on CP/CPPS is ever increasing but the efficacy of the diagnostic and therapeutic armamentarium is not. In this respect a publication title of the EAU guidelines group on pelvic pain (https://uroweb.org/guideline/chronic-pelvic-pain/) is no surprise: “The 2013 EAU guidelines on chronic pelvic pain : is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development” (1)
Prospective randomized studies like the present one are needed. See also (2).
Sometimes it helps to get a different view on an unsolved problem. The interested reader may find it in this free PCM article on brain behavior of CP/CPPS patients (3).
1 Engeler DS et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development.
Eur Urol. 2013 Sep;64(3):431-9. doi: 10.1016/j.eururo.2013.04.035.
2: Yuan P, et al. Efficacy of low-intensity extracorporeal shock wave therapy for the treatment of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis. Neurourol Urodyn. 2019 Apr 29. doi: 10.1002/nau.24017).
3 Lin Y et al. Alterations in regional homogeneity of resting-state cerebral activity in patients with chronic prostatitis/chronic pelvic pain syndrome. PLoS One. 2017 Sep 19;12(9):e0184896. doi: 10.1371/journal.pone.0184896.