低能量體外震波：針對3A治療無效的慢性骨盆疼痛症候群之挽救治療
蔡嘉駿1,2、古筱菁1、劉家駒1,3、王起杰1、阮雍順1,2、吳文正1,2
1高雄醫學大學附設中和紀念醫院 泌尿科
2高雄市立大同醫院 泌尿科
3衛生福利部 屏東醫院 泌尿科
Low-intensity Extracorporeal Shockwave: A Salvage Therapy for Men with Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy
Chia-Chun Tsai1,2, Shiao-Jin Guu1, Chia-Chu Liu1,3,Chii-Jye Wang1,
Yung-Shun Juan1,2,Wen-Jeng Wu1,2
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
2Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
3Department of Urology, Ministry of Health and Welfare Ping-Tung Hospital, Pingtung, Taiwan
Purpose: Managing patients with chronic pelvic pain syndrome (CPPS) who failed to respond to traditional 3-As therapy (antibiotics, alpha blockers and anti-inflammatories) is still a challenging task. Low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported recently to be able to improve clinical symptoms of CPPS. We evaluated whether adjuvant LI-ESWT can restore clinical disability and quality of life (QoL) in patients who were refractory to 3-As therapy.
Materials and Methods: This was an open-label single-arm prospective study conducted in Kaohsiung Medical University-affiliated hospitals. CPPS patients who could not have more than 6 point decline in the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score under a maximal dosage of 3-As therapy were enrolled. Socio-demographic information, personal habits, and detailed medical history were recorded. LI-ESWT treatment consisted of 3000 shock waves once weekly for 4 weeks (Duolith SD1 T-Top). All patients continued or taped their regular therapy. Clinical symptoms were re-assessed using NIH-CPSI score, Visual Analogue Scale (VAS), International Index of ErectileFunction-5 items version (IIEF-5) and International Prostate Symptom Score (IPSS) at 1, 4 and 12 weeks after a complete course of LI-ESWT.
Results: A total of 33 patients were enrolled. After LI-ESWT treatment, 27 of 33 patients (81.82%) had a successful response of LI-ESWT, with a decline of 3.29 in VAS and 5.97 in total IPSS, at the 3-month follow-up. Waist circumference was the only significant predictor of a successful response of LI-ESWT. No adverse effect associated with LI-ESW was found in any patients.
Conclusions: LI-ESWT can serve as a salvage therapy for CPPS patients who were refractory to traditional 3-As therapy. Waist circumference was an important predictor of a successful response. Further studies are still needed to determine an adequate therapeutic protocol and important predictors in patients with different etiologies of CPPS.