Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study

Joe K C Lee; Terence Y X Law; Liang Shen; Gregory X W Pek; Qi Y Lim; Yi Q Tan; Jun Y Chia; Man K Li

doi:10.1016/j.prnil.2023.11.001

Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study

Prostate Int. 2024 Mar;12(1):27-34. doi: 10.1016/j.prnil.2023.11.001. Epub 2023 Nov 7.

Authors

Joe K C Lee¹, Terence Y X Law¹, Liang Shen², Gregory X W Pek¹, Qi Y Lim¹, Yi Q Tan¹, Jun Y Chia¹, Man K Li^{1

3}

Affiliations

¹ Department of Urology, National University Hospital, Singapore, Singapore.
² Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
³ Li Man Kay Urology Associates Mount Elizabeth Novena Hospital, Singapore, Singapore.

Abstract

Background: Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS.

Methods: Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King's Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks.

Results: Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King's Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period.

Conclusions: ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.

Keywords: Chronic pelvic pain syndrome; Extracorporeal shockwave therapy; Perineum; Tender point; Trigger point.