Abstract
Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), affecting over 90% of patients with symptomatic prostatitis, remains a therapeutic challenge and adversely affects patients’ quality of life (QoL). This study probed for likely beneficial effects of ESWT, evaluating its extent and durability. Patients and methods: Standardized indices, namely the pain, urinary, and QoL domains and total score of NIH-CPSI, IIEF-5, EHS, IPSS, and AUA QoL_US were employed in this study of patients with CP/CPPS who had been refractory to other prior treatments (n = 215; age range: 32–82 years; median age: 57.5 ± 12.4 years; modal age: 41 years). Results: For CP symptoms, the mean pre-ESWT NIH-CPSI total score of 27.1 ± 6.8 decreased by 31.3–53.6% over 12 months after ESWT. The mean pre-ESWT NIH-CPSI pain (12.5 ± 3.3), urinary (4.98 ± 2.7), and QoL (9.62 ± 2.1) domain scores improved by 2.3-fold, 2.2-fold, and 2.0-fold, respectively, by month 12 post-ESWT. Compared with the baseline IPSS of 13.9 ± 8.41, we recorded 27.1–50.9% amelioration of urinary symptoms during the 12 months post-ESWT. For erectile function, compared to pre-ESWT values, the IIEF-5 also improved by ~1.3-fold by month 12 after ESWT. This was corroborated by EHS of 3.11 ± 0.99, 3.37 ± 0.65, 3.42 ± 0.58, 3.75 ± 0.45, and 3.32 ± 0.85 at baseline, 1, 2, 6, and 12 months post-ESWT. Compared to the mean pre-ESWT QoL score (4.29 ± 1.54), the mean QoL values were 3.26 ± 1.93, 3.45 ± 2.34, 3.25 ± 1.69, and 2.6 ± 1.56 for months 1, 2, 6, and 12 after ESWT, respectively. Conclusions: This study shows ESWT, an outpatient and easy-to-perform, minimally invasive procedure, effectively alleviates pain, improves erectile function, and ameliorates quality of life in patients with refractory CP/CPPS.
Highlights
Prostatitis affects an estimated 8.2% of the global population and remains a major health issue [1]
The National Institutes of Health (NIH) clinical syndromes-based classification system divides prostatitis into four categories: namely, category I, which includes acute systemic infection and replaces the so-called ‘acute bacterial prostatitis’; category II, which replaces the erstwhile ’chronic bacterial prostatitis’, and comprises recurrent urinary tract infection (UTI) in men with prostatic bacterial presence between infections; category III for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), evidenced by chronic pelvic pain with no known alternative attributable pathology; and category IV for asymptomatic prostatitis based on biopsy- or semen analysis-confirmed inflammation [3,4,5]
The present study evaluated the effect of extracorporeal shockwave therapy (ESWT) on pain, erectile function, and quality of life (QoL) in patients with CP/CPPS (n = 215) using standardized evaluation indices, namely the pain domain, urinary domain, QoL domain, and total score of NIH-CPSI, Index of Erectile Function (IIEF)-5, EHS, IPSS, and AUA QoL_US
Summary
Prostatitis affects an estimated 8.2% of the global population and remains a major health issue [1]. Discomfort in the pelvis for at least 3 of the last 6 months, often accompanied by lower abdominal pain; painful ejaculation; genital pain; lower urinary tract symptoms (LUTS). Such as hesitancy, straining, feeling of incomplete bladder emptying, poor or intermittent stream, dribbling, prolonged micturition, urgency, frequency, or nocturia; psycho-social impairments; and erectile/sexual dysfunction [3,4,5,6]. Trichomonas Vaginalis infection has been suggested as a probable pathoetiologic factor in CP/CPPS because of its complicity in chronic persistent prostatic infection and prostate epithelial cell inflammation [9]. Vaginalis on the development of chronic prostatitis remains unclear [13,14]
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