CUA 2018: External Shock Wave Therapy for Pelvic Pain in Men: A Long Term Treatment Option

Halifax, Nova Scotia ( Chronic pelvic pain syndrome (CPPS) is a frequent outpatient urological diagnosis with increasing incidence, reported around 15% especially younger generations and all ethnic origins. It affects around 50% of men throughout their lifetime and can cause urinary and erectile dysfunction if left untreated affecting their quality of life. Currently, there is a lack of guidelines for the management of CPPS. 

External shock wave lithotripsy therapy is considered one of the recently accepted treatment methods worldwide for CPPS. Kareim Khalafalla, MD presented a study that was aimed at evaluating the long-term efficacy of ESWT as a treatment modality for patients with CPPS. 

Authors performed a prospective self-controlled study between June 2016 and June 2017. A total of 37 patients with CPPS who failed medical and other treatment modalities underwent ESWT. Patients were scheduled to receive four sessions of ESWT one week apart using Duolith SD1 Ultra Device (Karl Storz Medical, inc., Switzerland). 

All patients were asked to complete the National Institute of Health Chronic Prostatitis Symptom index (NIH-CPSI) questionnaire is handed on the 1st day of therapy before starting the scheduled treatment, then re-administered at the end of the treatment sessions and during follow up at 3 and 6 months after the treatment sessions were completed. 

Of 37 patients, 34 completed the study. The remaining three were excluded because patients received additional physiotherapy treatment. In comparison to the pretreatment baseline questionnaire score, 1-month post-operative follow demonstrated a total score improvement of 9.7, mean pain score improvement was 5.3, mean urinary symptom score improvement of 0.1 and mean quality of life score improvement of 3.5 with all (100%) of patients showing improvement in pain symptoms. At 6 months follow up, the total mean score improvement was 8 (SD=81.) Mean pain score improvement was 3.8 (SD=4.9), urinary symptom score improvement of 0.8(SD=2.6), mean quality of life improvement of 3.5 (SD=3.1) with 79.5% of patients maintained improvement compared to 1 month follow up (Figure 1). 

Khalafalla concluded that ESWT is an effective and safe short and long-term treatment modality for patients with chronic pelvic pain syndrome. Indeed, the results of the study are encouraging and provide a foundation for future studies to explore this treatment modality in patients with chronic pelvic pain. When all other treatment modalities fail to address the pain symptoms, ESWT can be a viable treatment option. Further studies are needed to validate the initial findings of this study and further develop the technique for ESWT in this category of patients. 

Figure 1.
UroToday CUA 2018 External Shock Wave Therapy For Pelvic Pain in Men A Long Term Treatment Option  

Presented by: Kareim Khalafalla, MD, Ahmed Majzoub, Haitham Elbardisi, Sami Alsaid, Ardalan Ghofaouri, Riadh Alzubaidi, Khalid Al-Rumaihi, Mohamed Arafa. 
Author Information: Department of Urology, Hamad General Hospital, HMC, Doha, Qatar 

Written By: Zhamshid Okhunov (Twitter: @OkhunovZham), (Department of Urology, University of California-Irvine) medical writer for at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia