Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Outcomes and clinical predictors of extracorporeal shock wave therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome: a prospective randomized double-blind placebo-controlled clinical trial

Prostate Cancer and Prostatic Diseases volume 25, pages 93–99 (2022)Cite this article

Subjects

Abstract

Objectives:

To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy.

Patients & methods:

A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT.

Results:

A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT (p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased.

Conclusion:

ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2: ROC curve of NIH-CPSI.

Similar content being viewed by others

References

  1. Doiron RC, Shoskes DA, Nickel JC. Male CP/CPPS: where do we stand? World J Urol. 2019;37:1015–22.

    Article  PubMed  Google Scholar 

  2. Zimmermann R, Cumpanas A, Hoeltl L, Janetschek G, Stenzl A, Miclea F, et al. Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int. 2008;102:976–80.

    Article  PubMed  Google Scholar 

  3. Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. 2001;165:842–5.

    Article  CAS  PubMed  Google Scholar 

  4. Collins MM, Pontari MA, O’Leary MP, Calhoun EA, Santanna J, Landis JR, et al. Quality of life is impaired in men with chronic prostatitis: the chronic prostatitis collaborative research network. Gen Intern Med J. 2001;16:656–62.

    Article  Google Scholar 

  5. Ghazi MA, Muheilan MM, Omar N, Atta M. Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis. Ann Med Surg. 2017;14:12–17.

    Article  Google Scholar 

  6. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomized, double-blind, placebo-controlled study. Eur Urol. 2009;56:418–24.

    Article  PubMed  Google Scholar 

  7. 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;55:499–508.

    Article  PubMed  Google Scholar 

  8. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. α-Blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012;110:1014–22.

    Article  CAS  PubMed  Google Scholar 

  9. Bates SM, Hill VA, Anderson JB, Chapple CR, Spence R, Ryan C, et al. A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2007;99:355–9.

    Article  CAS  PubMed  Google Scholar 

  10. Dhar NB, Shoskes DA. New therapies in chronic prostatitis. Curr Urol Rep. 2007;8:313–8.

    Article  PubMed  Google Scholar 

  11. Hu M, Wazir J, Ullah R, Wang W, Cui X, Tang M, et al. Phytotherapy and physical therapy in the management of chronic prostatitis-chronic pelvic pain syndrome. Int Urol Neph. 2019;51:1081–8.

    Article  CAS  Google Scholar 

  12. Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evid Based Complement Altern Med. 2005;2:495–501.

    Article  Google Scholar 

  13. Giubilei G, Mondaini N, Minervini A, Saieva C, Lapini A, Serni S, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments – could it represent a valid option? The physical activity and male pelvic pain trial: a double blind, randomized trial. J Urol. 2007;177:159–65.

    Article  PubMed  Google Scholar 

  14. Nickel JC, Sorensen R. Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol. 1996;155:1950–5.

    Article  CAS  PubMed  Google Scholar 

  15. Marszalek M, Berger I, Madersbacher S. Low-energy extracorporeal shock wave therapy for chronic pelvic pain syndrome: finally, the magic bullet? Eur Urol. 2009;56:425–6.

    Article  PubMed  Google Scholar 

  16. Wess OJ. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment. Urol Res. 2008;36:327–34.

    Article  PubMed  Google Scholar 

  17. Ferdinando F, Gianluca D’Anzeo, Carsten H, Andrea R, Hartwig B, et al. Predictors of individual response to placebo or tadalafil 5 mg among men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: an integrated clinical data mining analysis. PLoS One 2015;10:e0135484.

    Article  Google Scholar 

  18. Jacques Simon L, Elisabeth H, Ian G, George A. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10:1128–30.

    Article  Google Scholar 

  19. Raymond CR, Kerstin RA, Xiao NI, Andre BA. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol. 2011;60:1010–6.

    Article  Google Scholar 

  20. Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004;172:839–45.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shiao-Jin G, Jiun-Hung G, I-Ting C, Hui-Tzu L, Yung-Chin L, Yung-Shun J, et al. Efficacy of low-intensity extracorporeal shock wave therapy on men with chronic pelvic pain syndrome refractory to 3-As Therapy. Am J Men Heal. 2017;12:441–52.

    Google Scholar 

  22. Shiao-Jin G, Chia-Chu L, Yung-Shun J, Ching-Chia L, Chia-Chun T. The 12-month follow-up of the low-intensity extrcorporeal shockwave therapy in the treatment of patients with chronic pelvic pain syndrome refractory to 3-As medications. J Aging Male. 2019:23:1–9.

    Google Scholar 

  23. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. a study in rabbits. J Ortho Res. 2003;21:984–9.

    Article  Google Scholar 

  24. Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Cur. Med Chem. 2009;16:2366–72.

    CAS  Google Scholar 

  25. Li HJ, Kang DY. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis. World J Urol. 2016;34:1009–17.

    Article  PubMed  Google Scholar 

  26. Al Edwan GM, Muheilan MM, Atta ON. Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis. Ann Med Surg. 2017;14:12–17.

    Article  Google Scholar 

  27. El-Enen MA, Abou-Farha M, El-Abd A, El-Tatawy H, Tawfik A, El-Abd S, et al. Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach. Arab J Urol. 2015;13:94–99.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zeng XY, Liang C, Ye ZQ. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: A prospective, randomized and sham-controlled study. Chin Med J. 2012;125:114–8.

    PubMed  Google Scholar 

  29. 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;94:1279–82.

    Article  PubMed  Google Scholar 

  30. Naliboff BD, Stephens AJ, Lai HH, Griffith JW, Clemens JQ, Lutgendorf S, et al. Clinical and psychosocial predictors of urologic chronic pelvic pain symptom change over one year: a prospective study from the MAPP research network. J Urol. 2017;198:848–57.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kang Sup K, Yong Sun C, Woong Jin B, Hyuk Jin C, U-Syn HA, Sung-Hoo Hong, et al. Efficacy of Low-intensity extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome IIIb: a prospective-randomized, double-blind, placebo-controlled study. World J Men Health. 2021;4:1–8. Jul2021

    Google Scholar 

  32. Ioannis M, Dimitrios K, Filimon Z, Paraskevi K, Agrippina F, Evangelos P, et al. Evaluation of a low-intensity shockwave therapy for chronic prostatitis type IIIb/chronic pelvic pain syndrome: a double-blind randomized sham-controlled clinical trial. Prost Can Prost Dis. 2021;24:370–9.

    Article  Google Scholar 

  33. Ana Carolina F, Omero Benedito P, José de Souza C, Jaime Eduardo C, Flávia de Lima O. Associations between chronic pelvic pain and psychiatric disorders and symptoms. Arch Clin Psychiatr 2015;42:25–30.

    Article  Google Scholar 

  34. Flávia de Lima O, Ana Carolina F, Mariana F, André LMoreno, Omero Polli-Neto. Chronic pelvic pain, psychiatric disorders and early emotional traumas: Results of a cross sectional case-control study. World J Psychiatr 2016;6:339–44.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Ahmed M. Sakr, Amr M. Fawzi, Mostafa Kamel & Maged M. Ali

Authors
  1. Ahmed M. Sakr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amr M. Fawzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mostafa Kamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maged M. Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AMS: Project development. AMF: Manuscript writing. MK: Data collection. MMA: Manuscript writing, data collection, data analysis, and revision.

Corresponding author

Correspondence to Maged M. Ali.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakr, A.M., Fawzi, A.M., Kamel, M. et al. Outcomes and clinical predictors of extracorporeal shock wave therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome: a prospective randomized double-blind placebo-controlled clinical trial. Prostate Cancer Prostatic Dis 25, 93–99 (2022). https://doi.org/10.1038/s41391-021-00464-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-021-00464-8

This article is cited by

Search

Advanced search

Quick links