預測低能量震波對於慢性骨盆腔發炎治療成效的因子
陳俞安1 廖俊厚1,2 姜秉均1
1.天主教耕莘醫院泌尿部, 2.天主教輔仁大學醫學院
The predictors for effectiveness of ESWT on patients with chronic pelvic pain syndrome
Chen Yu An, Liao Chun-Hou1,2, Chiang Bing-Juin1
1Division of Urology, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
2Division of Urology, Department of Surgery, Fu Jen Catholic University Hospital, Taipei, Taiwan
Purpose: to investigate the predictors for satisfactory treatment outcome of Extracorporeal Shock Wave Therapy (ESWT) on chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) patients.
Materials and Methods:
We retrospectively included patients diagnosed of chronic prostatitis/ chronic pelvic pain syndrome by patients self-reported chronic pain and refractory to medication treatment in the urology clinic of Cardinal Tein hospital from January 2017 to September 2018. A total number of 18 patients received Extracorporeal Shock Wave Therapy (ESWT). The protocol was 3000 pulses per each treatment session; with energy flow density: 0.25 mJ/mm2 and a Frequency of 4 Hz. One treatment session per week, and totally 4 sessions.
Pain assessment:
Subjectively, we interview each patient one week after each session on how they feel about the CP/CPPS symptoms. Improved, stable, or worse.
Objectively, we evaluated the need of pain control medicine. Either decrease, stable, or increase the need of analgesics. Also, basic biochemical blood test was taken at the first clinic visit. Including random blood glucose, renal function, prostate specific enzyme and serum testosterone was also taken.
Results:
After 44 sessions of ESWT, 11 (61.1%)patients either expressed improvement on the symptoms (reduced pain) or tapered the analgesics prescribed.
We further divided the patients into two groups, those with improvement or not. We found that those with improvement on CP/CPPS symptoms comparing to those without improvement had higher pre-treatment testosterone level (519.69 ± 352.8 ng/ml vs 229.06 ± 23.1 ng/ml, p=0.2), younger age (50.00 ± 12.14 vs 48.86 ± 18.8) and a shorter time from diagnosis of CP/CPPS to ESWT treatment (6.64 ± 10.52 months vs 8.00 ±7.37 months).
Conclusion:
Extracorporeal Shock Wave Therapy (ESWT) may be an effective and promising treatment options for patients with CP/CPPS who do not respond well to medical treatment.
A younger patient age and higher pre treatment might predict better treatment outcome. Earlier offering the ESWT to patient refractory to medical treatment may achieve better treatment efficacy.