低能量體外震波治療將3A藥物治療無反應的慢性骨盆疼痛症候群患者改善成有反應者的預測因子
古筱菁1、蔡嘉駿1,2、耿俊閎1,3、李永進1,3、阮雍順1,2、劉家駒1,4、王起杰1、吳文正1,2
高雄醫學大學附設中和紀念醫院 泌尿科1
高雄市立大同醫院 泌尿科2
高雄市立小港醫院 泌尿科3
衛生福利部 屏東醫院 泌尿科4
The predictor of low-intensity extracorporeal shockwave therapy to convert non-responder to responder of 3- As medicines in patient with chronic pelvic pain syndrome
Shiao-Jin Guu1,Chia-Chun Tsai1,2, Jiun-Hung Geng1,3, Yung-Chin Lee1,3, Yung-Shun Juan1,2, Chia-Chu Liu1,4, Chii-JyeWang1, 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, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
4Department of Urology, Ministry of Health and Welfare Ping-Tung Hospital, Pingtung, Taiwan
Purpose: It is a challenging task to manage patients with chronic pelvic pain syndrome (CPPS) refractory to the traditional 3- As Therapy (antibiotic, alpha- blockers, and anti-inflammatories). Recently, applying low- intensity extracorporeal shockwave therapy (LI- ESWT) has been reported to improve symptoms of CPPS. This study is aimed to evaluate the important predictors of LI-ESWT to convert non- responder to responder in patients with CPPS.
Materials and Methods: This was an open- label, single- arm prospective study. Patients with CPPS underwent a maximal dose of 3- As therapy and who failed more than a 6 point decrease in the National Institutes of Health- Chronic prostatitis Symptom Index (NIH-CPSI) were enrolled. The socio-demographic information and detailed medical history, personal habits were recorded. The LI- ESWT treatment consisted of 3000 shock waves once weekly for 4 weeks (Duolith SD1 T-Top). All patients continued or tapered their regular therapy. After a complete course of of LI- ESWT, clinical symptoms were re-assessed at 1, 3, 6 and 12 months using NIH- CPSI score, Visual Analogue Scale (VAS), International Index of Erectile Function- 5 items version (IIEF-5) and International Prostate Symptom Score (IPSS).
Results: A total of 43 patients were enrolled. 31 of the 43 patients (72.1%) had a successful response at the 1- month follow up after the LI- ESWT treatment. Clinical symptoms showed significant improvement at 1,3,6 and 12 months after a complete course of LI-ESWT. A comparison of clinical characteristics between patients with and without response to LI-ESWT, showed that those with psychological disorders were the significant predictors of a successful response.
Conclusions: LI- ESWT can serve as a salvage therapy for patients with CPPS who failed to respond to 3- As therapy. Those with psychological disorders were the main predictors of a successful response.