Efficiency Assessment of Shock Wave Therapy in Patients with Pelvic Pain Employing Harmonic Analysis of Penile Bioimpedance

Abstract

In searching for novel objective methods to diagnosticate pelvic pain and assess efficiency of analgesic therapy, 37 male patients were examined prior to and after the course of extracorporeal shock wave therapy (5-10 sessions) with the waves directed to projections of prostate and/or crura and shaft of the penis. The repetition rate of mechanical pulses was 3-5 Hz. The range of energy pulse density was 0.09-0.45 mJ/mm(2). The overall number of pulses in a session was 1500-3000 in any treated zone with total energy smaller than 60 J. The applicator was relocated every other series of 300-500 pulses. Effect of the shock wave therapy was assessed according to subjective symptomatic scales: International Prostate Symptom Score, International Index of Erectile Function, Quality of Life, and nociceptive Visual Analog Scale. The objective assessment of shock wave therapy was performed with harmonic analysis of penile bioimpedance variability, which quantitatively evaluated the low-frequency rhythmic and asynchronous activities at rest as well as the total pulsatile activity of the penis. The magnitude of spectrum components of bioimpedance variations was assessed with a novel parameter, the effective impedance. The spectral parameters were measured in 16 patients prior to and after the treatment course. The corresponding control values were measured in the group of healthy patients. Prior to the shock wave therapy course, all spectrum parameters of penile bioimpedance significantly differed from the control (p<0.05). After this course, low-frequency rhythmic and the total pulsatile activity decreased to normal, while asynchronous activity remained significantly different from the normal. The novel objective physiological criteria of pelvic pain diagnostics and efficiency of its treatment reflecting the regional features of circulation and neural activity corresponded to the clinical symptom scaling prior to and after the shock wave course, and on the whole, these criteria corroborated improvement of the patient state after this therapy.