Shockwave therapy in patients with chronic abacterial prostatitis: clinical efficacy of different modes

Introduction. Chronic abacterial prostatitis (CAP) / category III according to the classification of the American National Institute of Health (NIH-NIDDK USA, 1995), is diagnosed in the majority of patients with prostatitis and according to the data of a number of publications can reach 95%, which together with epidemiologic data of 10 – 45% in the population makes this problem socially significant.

Objective. To evaluate the clinical efficacy of different modes of shock wave therapy (SWT) in patients with CAP.

Materials & methods. We analyzed the dynamics of LUTS and pain syndrome used the IPSS and NIH-CPSI in 62 patients with CAP. Patients received standard therapy of CAP and were randomized according to the technique of SWT into control (n = 30, 12 sessions of SWT once a week according to the standard technique) and main (n = 32, SWT 36 sessions 3 times a week by fractionation up to 1/3 of the maximum pulse energy) groups. There were no differences in age, prostate volume, uroflowmetric data and symptomatology assessed by IPSS, IIEF5, LANNS, NIHCPSI, urinary diary (p > 0.05). Clinical dynamics was evaluated at 2, 4, 8, 12, 16, 20 and 24 weeks, i.e. for 12 weeks on the background and 12 weeks after treatment. Differences were considered reliable when the probability of occurrence was more than 95%.

Results. Patients of both groups before the start of therapy had clinically pronounced symptomatology of CAP according to NIH-CPSI questionnaire and moderately pronounced symptomatology according to IPSS with no intergroup differences (p > 0.05). Further dynamics of CAP symptoms according to NIH-CPSI pain and NIH-CPSI urination domains in the main group was characterized by progressive reduction of symptoms from 23 ± 6 points to 5 ± 2 points by the end of the course of SWT. The control group showed an increase in symptoms from 19 ± 7 to 25 ± 4 points at the start (week 2), with a tendency to decrease to 11 ± 3 points at week 12; there were significant intergroup differences (p < 0.05) throughout this time interval. It is encouraging that after the end of SWT in the control group there was a regression of symptomatology, comparable to the main observation group with stabilization of the effect up to 12 weeks (p > 0.05). The dynamics of LUTS according to IPSS was characterized by the growth of symptomatology in the control group against the background of SWT therapy from moderate to severe symptoms and subsequent reduction to mild symptoms. In the main group no similar effect on SWT therapy was observed (p < 0.05).

Conclusion. Thus, energy reduction during SWT by fractionation of the maximum pulse power to 1/3 of the standard one is accompanied by more pronounced symptomatology according to IPSS and NIH-CPSI questionnaires.

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