ESWT for Prostatitis- Asia Pacific Forum

Chan Lung W, Tsang L, Hong Heng C. Extracorporeal shock wave therapy for chronic pelvic pain syndrome 3rd Asia-Pacific Forum on Andrology (Nanjing, China: October 10, 2009) Background: Prostatitis is one of the most common urological diseases. Chronic pelvic pain syndrome (CPPS) has an incidence of 1.5%-10% among male populations all over the world. It is accompanied by many symptoms like voiding disorders and pains in perineum, testis, penis, bladder and the back. Quality of life of the affected men is often poor. NIH classification holds that many prostate affections, especially those in which no infection can be detected, are associated with patho-physiological processes outside the prostate (neurological, neuromuscular, perineal or intrapelvic causes). The origin of CPPS is still unknown and an efficient therapy for it is still missing. Shock wave has been widely used in ESWL. Shortly after its establishment in urology, ESWL was modified and also applied as extracorporeal shock wave therapy (ESWT) with weaker energy sources in orthopaedics for the treatment of degenerative and painful arthropathies and chronic pain in soft tissue.

Good results were achieved especially in the treatment of pain. Otorhinolaryngology has discovered ESWT for the treatment of sialolithiais. The applicability of ESWT was also postulated for the treatment of Peyronie's disease. ESWT should reduce the degree of deviation and the pain of erection. Furthermore, there is clinical evidence that shock wave can relax muscles with chronic hypertension.

Aim: To investigate whether ESWT is an effective therapy for CPPS. Methods: A total of 186 patients (age 16-45, mean 26.4) with CPPS for a minimum of 6 months (average duration of CPPS complaints 21.2 months [7-143 months]) without inflammation signs in urine or seminal fluid or clinical evidence of prostate cancer were included into the study. The patient is positioned on his back and the therapy head is coupled on the perineum. At each session, 3 000 pulses of focused SW are applied at a frequency of 3.5 Hz. The treatment is effected at an energy level of 0.25 mJ per mm2. The time between individual treatments is one week. A total of four sessions in the course of four weeks is planned. Follow up was performed after 4 weeks. Specific complaints including the average urinary symptoms score, the average pain score, and the average score of quality of life were investigated by NIH-CPSI before and after the treatment. All patients completed the treatment course and were followed up.

Results: The duration of ESWT was each 13 min. No side effects occurred. NIH-CPSI improved markedly. The average NIH-CPSI score was 34.1 before treatment and 17.9 after ESWT. The average pain score of 15.8 was reduced to 8.2 after treatment. The average urinary symptoms score was 7.2 down to 3.8. The average score of quality of life was increased by 46.8%, i.e. 11.1 down to 5.9 after ESWT. Conclusion: ESWT in the prostate region can be a safe and effective treatment chronic pelvic pain syndrome. It was an easily performable treatment showing no side effects at all.

ESWT achieved a reduction of CPPS related pain and complaints followed by better quality of life.

Author Affiliation: University Hospital of Macau Chong Hong Heng, Satish Shrestha Urology Care of Hong Kong, Hong Kong and University Hospital, Macau University of Science and Technology, Avenida Wai Long, Macau, China