Low-Intensity Shock Wave Therapy May Improve Urinary Symptoms and Pelvic Pain in Men, Study Finds

The study, conducted by Haruhiko Wakita from the Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Japan, and colleagues, evaluated the clinical efficacy and safety of Li-ESWT using the Morenova system in men experiencing LUTS, including chronic prostatitis/chronicpelvic pain syndrome (CP/CPPS). The researchers also investigated whether pretreatment clinical characteristics could predict symptom severity following therapy.

LUTS in men can involve difficulties with urination, increased urinary frequency, urgency, and pelvic discomfort, potentially affecting daily activities and quality of life. Chronic prostatitis/chronic pelvic pain syndrome is another condition associated with persistent pelvic pain and urinary symptoms. Li-ESWT has emerged as a potential non-invasive treatment approach for these conditions.

For the study, published in the International Journal of Urology, the researchers conducted a retrospective analysis of 61 men who underwent Li-ESWT at a single centre. Participants received treatment once weekly for six consecutive weeks using the Morenova system.

Symptom severity was assessed before treatment and one month after completion using four validated assessment tools: the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Benign Prostatic Hyperplasia Impact Index (BII), and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

The findings revealed significant improvements across multiple urinary and pain-related symptoms following treatment:

• The mean total IPSS decreased from 11.1 before treatment to 7.3 after treatment, indicating an improvement in overall urinary symptoms.
• The OABSS declined from 3.8 to 2.8, suggesting improvements in storage-related symptoms, including urinary urgency and frequency.
• The BII score decreased from 4.9 to 2.7, indicating a reduced impact of urinary symptoms on patients' daily lives and well-being.
• The total NIH-CPSI score improved from 11.8 to 7.0, demonstrating a significant reduction in chronic prostatitis-related symptoms.
• Among patients who experienced pain at baseline, pain scores decreased significantly from 4.1 to 1.8.
• Post-micturition dribbling also improved in approximately one-third of the patients.
• Higher baseline prostate-specific antigen (PSA) levels and lower baseline OABSS were independently associated with lower post-treatment NIH-CPSI scores after adjustment for baseline NIH-CPSI.
• No adverse events were reported during the study.

The researchers noted that the findings indicate potential benefits of Li-ESWT across several symptom domains, including voiding difficulties, bladder storage symptoms, pelvic pain and quality of life.

However, the study had important limitations. Its retrospective, single-centre design and relatively small sample size limit the generalisability of the findings. Additionally, symptom assessments were conducted only one month after treatment, leaving the long-term effectiveness and durability of the improvements uncertain.

The researchers concluded that Li-ESWT using the Morenova system may offer a promising treatment option for men with LUTS, including those with CP/CPPS. However, larger prospective controlled studies are needed to establish its clinical efficacy, safety, and long-term benefits.