Presentation Authors: Andrea Cocci*, Gianmartin Cito, Nicola Mondaini, Florence, Italy, Girolamo Morelli, Pisa, Italy, Graziano Vignolini, Riccardo Campi, Francesco Sessa, Fabrizio Di Maida, Simone Morselli, Florence, Italy, Giuseppe Morgia, Catania, Italy, Mauro Gacci, Sergio Serni, Andrea Minervini, Florence, Italy, Giorgio Ivan Russo, Catania, Italy
Introduction: The treatment of chronic pelvic pain syndrome (CPPS) is still discussed since its multifactorial pathogenesis. Several treatment modalities including antimicrobial drugs, muscle relaxants, a-blockers, biofeedback physical therapy such as monotherapy or combination therapy have been proposed and investigated. Recently, many reports have indicated that extracorporeal shock-wave therapy (ESWT) for CPPS can significantly improve the symptoms of pelvic pain and urination. The aim of the study is to evaluate the effects of combining transperineal ESWT and therapy (anti-inflammatory and antibiotics), versus therapy alone for the treatment of non-inflammatory CPPS
Methods: From April 2017 to April 2018, 125 consecutive patients were treated with ESWT + therapy or therapy alone. Adjustment variables consisted of age and IPSS questionnaire at baseline using 1:1 propensity-score matching. Overall, 32 patients were considered subdivided into the following: 16 patients who received ESWT + therapy (group A) and 25 who received therapy alone (group B). Patients were administered ESWT with protocol treatment of one session per week for 8 weeks, 3000 shockwaves with 0.25 mJ/mm2 of energy and 5 HZ of frequency.
Results: Overall, the mean age was 52.7 (SD 13.7), mean IPSS was 16.8 (SD 5.37), mean IPSS-QoL was 3.75 (SD 0.9), mean prostate volume was 35.8 (SD 15.4) and mean peak flow was 9.7 (SD 2.3). The mean change of IPSS was -5.75 (SD 4.31) in Group B and -9.81 (SD 5.06) in Group A (p=0.04) and the mean change of IPSS-QoL was -1.0 (SD 1.59) and -3.4 (SD 0.63) (p=0.04) while the difference for Qmax was not statistically different (-6.8 vs. -6.5; p=0.7).
Conclusions: Based on the findings of this a population-based propensity score adjusted analysis ESWT + therapy was superior than therapy alone in ameliorating symptoms and quality of life. Although the design was not a randomized study, the propensity score matching is able to estimate the effect of a treatment by accounting for the covariates that predict receiving the treatment. These translate our findings into clinical practice with high level of evidence but should be confirmed with greater sample size.