Objective: This study aimed to compare the efficacy of Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT) and oral therapy combination compared to sole oral therapy for reducing symptoms in CP/CPPS patients. Material & Methods: A systematic search was conducted from the electronic database including PubMed, Clinicaltrial.gov, and Cochrane Library, published up to July 2020 following the PRISMA guideline. We screened RCTs with the inclusion criteria and assessed the quality with the Cochrane Risk of Bias tool. The primary outcome was the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and subgroup analysis for triple therapy users was conducted to improve interpretability. The analysis was performed using Review Manager 5.3. Results: A total of 2 RCTs consisted of 91 CP/CPPS patients were analyzed. Pooled analysis showed that compared to the oral therapy only group, combination therapy had a significant lower NIH-CPSI total score at the endpoint of the treatment (MD -7.46, 95% CI -9.85 to -5.07, p<0.001) and NIH-CPSI component pain score (MD -3.48, 95% CI -5.04 to -1.93, p<0.0001), urinary symptoms score (MD -0.96, 95% CI -1.47 to -0.45, p<0.001), and quality of life (QoL) impact score (MD -2.94; 95% CI -3.68 to -2.20, p=<0.001). Conclusion: This review revealed that patients undergoing combination Li-ESWT therapy have lower total NIH-CPSI scores than patients receiving oral therapy alone, this finding is consistent with each component of the score: pain, urinary symptoms, and impact on QoL.
Li-ESWT, oral therapy, chronic prostatitis
Partin AW, Wein AJ, Kavoussi LR, Peters CA, Dmochowski RR. Campbell Walsh Wein Urology, E-Book. Elsevier Health Sciences; 2020.
Pontari M. Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); 2020.
Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis. 2016; 19(2): 132–8.
Nickel JC, Freedland SJ, Castro-Santamaria R, Moreira DM. Chronic prostate inflammation predicts symptom progression in patients with chronic prostatitis/chronic pelvic pain. J Urol. 2017; 198(1): 122–8.
Yuan P, Ma D, Zhang Y, Gao X, Liu Z, Li R, 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. Neurourology and Urodynamics. 2019: 38(6); 1457-1466.
Rychtář J, T. Taylor D. Estimating the sample variance from the sample size and range. Stat Med. 2020: 39; 4667-4686.
Engeler D, Baranowski AP, Borovicka J, Cottrell A, Dinis-Oliveira P, Elneil S, et al. EAU guidelines on chronic pelvic pain. Eur Urol; 2018. p. 1–82.
Marszalek M, Berger I, Madersbacher S. Low-Energy Extracorporeal Shock Wave Therapy for Chronic Pelvic Pain Syndrome: Finally, the Magic Bullet? European Urology. 2009: 56; 425-426.
Marszalek M, Wehrberger C, Temml C, Ponholzer A, Berger I, Madersbacher S. Chronic Pelvic Pain and Lower Urinary Tract Symptoms in Both Sexes: Analysis of 2749 Participants of an Urban Health Screening Project. Eur Urol. 2009: 55(2); 499-507.
Lawler AC, Ghiraldi EM, Tong C, Friedlander JI. Extracorporeal shock wave therapy: current perspectives and future directions. Curr Urol Rep. 2017; 18(4): 25.
Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, 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: 64(3); 431-439.
Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. European Urology. 2017: 71(2); 223-233.
Schmitz C, Császár NBM, Milz S, Schieker M, Maffulli N, Rompe JD, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database. Br Med Bull. 2015: 116(1); 115-38.
Elmansy HE, Lingeman JE. Recent advances in lithotripsy technology and treatment strategies: A systematic review update. Int J Surg. 2016; 36: 676–80.
Yuan J, Zhang R, Yang Z, Lee J, Liu Y, Tian J, et al. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: A systematic review and network meta-analysis. European Urology. 2013: 63(5); 902-12.
Milisic E, Hiros M, Begic E. Variations in nitric oxide and endothelin serum levels in extracorporeal shock wave lithotripsy-treated patients. Int J Appl Basic Med Res. 2019; 9(2): 80.
Pajovic B, Radojevic N, Dimitrovski A, Vukovic M. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). Aging Male. 2016: 19(3); 202-207.
Lee MH, Seo DH, Lee C, Choi JH, Lee SW, Jeh SU, et al. Relationship Between the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score in Middle-Aged Men According to the Presence of Chronic Prostatitis-Like Symptoms. J Mens health. 2020; 16(1): e19–26.
Salama AB, Abouelnaga WA. Effect of radial shock wave on chronic pelvic pain syndrome/chronic prostatitis. J Phys Ther Sci. 2018: 30(9); 1145-1149.
Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome in Males: A Randomised, Double-Blind, Placebo-Controlled Study. Eur Urol. 2009: 56(3); 418-24.
Tripp DA, Nickel JC, Landis JR, Yan LW, Knauss JS. Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: Findings from the National Institutes of Health Chronic Prostatitis Cohort Study. BJU Int. 2004: 94(9); 1279-82.
Kim JH, Kim JY, Choi CM, Lee JK, Kee HS, Jung KI, et al. The dose-related effects of extracorporeal shock wave therapy for knee osteoarthritis. Ann Rehabil Med. 2015: 39(4); 616-23.