低能量體外震波治療對慢性骨盆疼痛症候群患者的長期效果：十二個月追蹤研究
古筱菁1、蔡嘉駿1,2、阮雍順1,2、李經家1、何峻旋3、黃品嘉3、劉家駒1,4、王起杰1
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
高雄市立大同醫院 管理室3
衛生福利部 屏東醫院 泌尿科4
Is low- intensity extracorporeal shockwave therapy still effective for patients with chronic pelvic pain syndrome in the long term? A 12 month follow-up
Shiao-Jin Guu1, Chia-Chun Tsai1,2, Yung-Shun Juan1,2, Ching-Chia Li1, Jiun-Shiuan He3, Pin-Chia Huang3, Chia-Chu Liu1,4, Chii-Jye Wang1
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan1
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan2
Department of Management, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan3
Department of Urology, Ministry of Health and Welfare Ping-Tung Hospital, Pingtung, Taiwan4
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. The current study was performed to evaluate the efficacy of LI-ESWT in the treatment of patients with CPPS who failed to respond to 3-As medicines at 12 months follow-up.
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 Erectile Function-5 items version (IIEF-5) and International Prostate Symptom Score (IPSS) at 1, 3, 6 and 12 months after a complete course of LI-ESWT.
Results: A total of 43 patients were enrolled. After LI-ESWT treatment, 31 of the 43 patients (72.1%) had a successful response of LI-ESWT at the 1-month follow-up. NIH-CPSI score, VAS and IPSS were significantly improved at 1, 3, 6 and 12 months after a complete course of LI-ESWT. 26 of the 37 patients (70.3%) could still maintain the therapeutic efficacy at the 12-month follow-up (missing cases: 6 of 43, 13.9%). In 31 patients with successful response at the 1-month follow-up, 26 patients could maintain their response at the 6 and 12-month follow-up (missing cases: 4 of 31, 12.9%). 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 failed to respond to traditional 3-As therapy. A significant portion of patients who responded to LI-ESWT could maintain their effect up to 12-months follow-up. Further longer follow-up studies are still needed to eradicate the long-term effect of LI-ESWT in the treatment of CPPS.