Extracorporeal shock-wave therapy and CPPS

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Extracorporeal shock-wave therapy and CPPS

Post by webslave »

Aging Male. 2016 Jul 5:1-6. [Epub ahead of print]

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

Pajovic B (1), Radojevic N (2), Dimitrovski A (3), Vukovic M (1).
1 Urology and Nephrology Clinic, Clinical Centre of Montenegro , Podgorica , Montenegro .
2 Center of Pathology and Forensic Medicine, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro , Podgorica , Montenegro , and.
3 Urology Clinic, Clinical Centre of Kragujevac , Kragujevac , Serbia


The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

PMID: 27380504
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Re: Extracorporeal shock-wave therapy and CPPS

Post by European »

I tried this modality in 2012, but unfortunately after 1st session it inflicted huge flare-up, so I abandoned further treatment. I consider this approach too risky, there is a lot of delicate structures in the pelvis to be targeted with shock waves.
Age: 41 | Onset Age: 36 | Symptoms: Chronic pain in the penis, groin, pubic area and pelvic muscles, mainly ischiocavernosus area | Helped By: Elavil, PT | Worsened By: Stress, ejaculation, depression | Other comments:
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Re: Extracorporeal shock-wave therapy and CPPS

Post by Luxemburger1977 »

It did not bring any major improvement for me but the fact is: you have to find someone who is able to use ESWT properly.
I got treatment from a very knowledgeable specialist in Munich earlier this year and he first checked to find the muscles he had to target in priority. Contrary to the way it is used by some, ESWT is not to target the perineum only but all muscles involved. It is thought to be effective to instantly release trigger points in deep muscles (with focused ESWT) and to release tension in the fascia (with radial ESWT).
In my case, he found tension and trigger points mostly in adductors, later in thighs all around, including quadriceps and trochanter (all mostly left), partly also in other locations around the pelvic girdle and in obturator internus, later in rectus abdominis. By then, all urinary issues were long gone but I still had pain/discomfort sitting as well as in left thigh (quadriceps). No other (above all front) pelvic muscles involved :smile:
Some of his patients apparently recovered after only 4/6 sessions but I got only slight improvement after 6 sessions and discontinued treatment, mostly for practical reasons but also because I felt I had an unusual set of symptoms he could not deal with :sad:
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Re: Extracorporeal shock-wave therapy and CPPS

Post by CMT23 »

Luxemburger, are you able to post more info on this doctor? I'm in Thailand where the equipment to do this exists, but as I understand they use it for breaking up kidney stones and will probably think I'm crazy talking about using it on muscles. Did you experience some benefit from the treatment?
Age: 39 | Onset Age: 17 | Symptoms: Constant feeling of needing to urinate felt in the tip of penis. Frequency. Urgency. None of the typical pain associated with CPPS. | Helped By: Valium, Klonopin, and very hot baths, followed by lying down still/doing relaxation. Also made almost symptom free for a few seconds following a bowel movement. | Worsened By: stress, anxiety, skipping meals, lack of sleep, extended sitting, coffee, alcohol. NO other pain or discomfort although after ejaculation symptoms will usually get worse unless I lie still for 20 minutes or so. | Other comments: Symptoms began at the moment of ejaculation, disappeared after a few months and then returned a few months later and have not gone away since.
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Re: Extracorporeal shock-wave therapy and CPPS

Post by Luxemburger1977 »

Hi CMT23,
I can certainly post more information on this doctor. However, I am not sure how far ESWT (pretty expensive treatment by the way) was helpful for me. As I previously wrote, I only felt slight improvement and I have come to the conclusion that dry needling has proved more (cost-)effective so far. On the whole, I also regard PT as the cornerstone of any successful treatment.
After you have considered all the above, I can provide you with contact info to the doctor I have seen for ESWT if you ever want to give it a try :thumbup:
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Re: Extracorporeal shock-wave therapy and CPPS

Post by CMT23 »

Hi Luxemburger,

Thanks for the reply. I'm sorry you've had to deal with these very difficult symptoms.

I'm confused on one point, how does ESWT differ from Low-Intensity Shock Wave Therapy (LISWT) or are they two names for the same thing?

I've got another thread running under 'Frequency and Urgency' that's been going for years now. I've tried a lot over the past 20 years including 15 months of the Wise/Anderson protocol and multiple visits with Tim Sawyer and Dr. Wise. Tim has examined me many times and has confirmed that points in the anterior pelvic floor, high up and adjacent to the prostate exactly replicate my symptoms when pressed. Apparently they see this often.

Symptoms started during ejaculation and my hips, legs, and back are all very tight and started acting up at the same time that my urinary symptoms started. So I am rather certain that this is a muscular / tension issue, but I have yet to find the means to release the muscles to their normal state.

The idea that a machine could assist with a few sessions is of course of some interest to me. I understand you didn't come to a 'cure' with ESWT and I am sorry to hear that - I know how tough it can be, but I am wondering if it is still worth considering. Best case scenario is someone here in Thailand has the machine and some basic knowledge. But it may be possible at some point that I travel to Europe. If I had unlimited resources, I'd be flying around the world talking to anyone who may be able to help. Unfortunately that's not my situation just yet.

I am focusing now on Nutritious Movement and Dynamic Contraction Technique, and have started the internal PT with the wand again twice a week. I have also started 30 minutes a day of different meditations on the Headspace app. I may be wrong and I know Dr. Wise disagrees with me, but I personally think it's all about getting into a relaxed state with little attention paid to thoughts regardless of the method. (I find that the MP4 player that Dr. Wise supplied at least back a few years ago is just extremely cumbersome to use. Headspace on my iPhone is much, much easier to dial up).

Anyway, yes I am interested in the name of the Doctor in Munich and any other details that you've found in your search. Until this is resolved, I will be continually searching. Thanks much.
Age: 39 | Onset Age: 17 | Symptoms: Constant feeling of needing to urinate felt in the tip of penis. Frequency. Urgency. None of the typical pain associated with CPPS. | Helped By: Valium, Klonopin, and very hot baths, followed by lying down still/doing relaxation. Also made almost symptom free for a few seconds following a bowel movement. | Worsened By: stress, anxiety, skipping meals, lack of sleep, extended sitting, coffee, alcohol. NO other pain or discomfort although after ejaculation symptoms will usually get worse unless I lie still for 20 minutes or so. | Other comments: Symptoms began at the moment of ejaculation, disappeared after a few months and then returned a few months later and have not gone away since.
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Re: Extracorporeal shock-wave therapy and CPPS

Post by Luxemburger1977 »

Hi CMT23,

Don't feel sorry for my rather unlucky experience with ESWT. I have found my luck with PT and dry needling and I have been doing better. This is to say there is still some way to go but I found therapy that works for me and I am confident I will get symptom-free in a few months' time.

Back in late spring, I experienced two different types of shockwaves: focused and radial shockwaves. Focused shockwaves are supposed to release deep trigger points in muscles and tissues but evidence is lacking as to how effective they actually prove to be. What I have heard from different PT's later on is that they work fine for tendons but studies on muscles were mostly sponsored by manufacturers and might be biased.

Radial shockwaves work mostly on upper layers of the tissues and pressure applied is surely much higher than with manual therapy or self-release (foam roll and the like). Low-Intensity Shock Wave Therapy (LISWT) is a kind of therapy I have not heard of a single time, so that I really cannot answer your question unfortunately.

On the whole, I should add that the place I went to was very expensive to me and had I know beforehand that results would be so poor, I would not even have considered the option. This being said, the doctor I saw definitely had an idea of what pelvic pain is about. Here his website:
http://www.schmerzzentrum-nymphenburg.de/

If I may comment on the Wise/Anderson protocol, I should say that it is, to me, limited to muscles most commonly associated with CCPS but leaves out others that might also be relevant. In my case, quadriceps were very much an issue but are not mentioned a single time in their book. Hence the best advice I could give you is to see an (other) experienced PT either in your own country or abroad.

Frequency and urgency seem to be caused by lack of control of your pelvic floor and can be addressed by performing so called "pelvic floor drops" as long as it might take for your pelvic floor to return to normal, proper functionning. Any therapy that does not address this very important issue would most probably fail to resolve the frequency and urgency issue you still have.

Here is some more information on that:
http://www.pelvicpainrehab.com/pelvic-p ... t-my-pain/

Hope I could provide you with some useful information for now ...
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Re: Extracorporeal shock-wave therapy and CPPS

Post by CMT23 »

Thanks for this info and glad you feel you are on the right track.

Here's the thread about LISWT
viewtopic.php?f=11&t=8574&p=50379&hilit ... SWT#p50379

Seems like there was no follow up post advising of results.

I will get in touch with the doctor in Munich. Thanks for the information. When they are treating muscles of the pelvic floor, do they use the device on the perineum? Is it painful? Did you meet any other people who had success with this?

I agree Wise/Anderson protocol possibly neglects some of the other muscles that can contribute to this syndrome. They zero in on the pelvic floor, but perhaps there are many other muscles leading into the pelvic floor where the real problem starts.

Also, at least when I went, they were advising of basic static stretching (which I did daily for 15 months). From what I have learned about stretching since then, static stretching is of little use - you actually want to work the muscle as it is being stretched.

Thanks for the info on Pelvic Floor Drops. I don't think the importance of that has been stressed to me before. I will add them to the daily routine.

Thanks again and please keep us updated. I hope you have a swift recovery!
Age: 39 | Onset Age: 17 | Symptoms: Constant feeling of needing to urinate felt in the tip of penis. Frequency. Urgency. None of the typical pain associated with CPPS. | Helped By: Valium, Klonopin, and very hot baths, followed by lying down still/doing relaxation. Also made almost symptom free for a few seconds following a bowel movement. | Worsened By: stress, anxiety, skipping meals, lack of sleep, extended sitting, coffee, alcohol. NO other pain or discomfort although after ejaculation symptoms will usually get worse unless I lie still for 20 minutes or so. | Other comments: Symptoms began at the moment of ejaculation, disappeared after a few months and then returned a few months later and have not gone away since.
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Re: Extracorporeal shock-wave therapy and CPPS

Post by Luxemburger1977 »

To briefly answer your question, the device is applied on perineum but not only. In my case, it was applied to the location where adductors somehow connect to the pelvis and to the lower belly to treat iliopsoas and lower part of rectus abdominis. Overall it was rather painfull but intensity has to be adjusted to what your muscles can stand and it can be increased over time as your muscles get used to it. I read stories of patients that did report improvement or even full resolution of symptoms with just only a few sessions but never met any such patient in person I have to say.

As I wrote earlier, I could not recommend ESWT but if you ever wanted to invest time (and money!) into it, then this doctor in Munich has a very good idea of what CCPS is all about and how to treat it with shockwaves.

Thanks for kind words btw. I also wish you good luck with any therapy you try out in the next future :thumbup:
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Re: Extracorporeal shock-wave therapy and CPPS

Post by CMT23 »

Thank you for this. Please excuse my extreme delay in replying. Usually when I am feeling ok, I try to stay off the forum and when I have a massive flair, then here I am again looking for answers. Is this basically the same concept?

https://www.storzmedical.com/en/discipl ... t-top.html

How much money are we talking per treatment?

Thanks again!
Age: 39 | Onset Age: 17 | Symptoms: Constant feeling of needing to urinate felt in the tip of penis. Frequency. Urgency. None of the typical pain associated with CPPS. | Helped By: Valium, Klonopin, and very hot baths, followed by lying down still/doing relaxation. Also made almost symptom free for a few seconds following a bowel movement. | Worsened By: stress, anxiety, skipping meals, lack of sleep, extended sitting, coffee, alcohol. NO other pain or discomfort although after ejaculation symptoms will usually get worse unless I lie still for 20 minutes or so. | Other comments: Symptoms began at the moment of ejaculation, disappeared after a few months and then returned a few months later and have not gone away since.
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Re: Extracorporeal shock-wave therapy and CPPS

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CMT23 wrote: Tue Jan 24, 2017 1:41 pm Thank you for this. Please excuse my extreme delay in replying. Usually when I am feeling ok, I try to stay off the forum and when I have a massive flair, then here I am again looking for answers. Is this basically the same concept?

https://www.storzmedical.com/en/discipl ... t-top.html

How much money are we talking per treatment?

Thanks again!
We offer it in our clinic at a "cash" price of $300 per treatment. It is not FDA approved in the United States and therefore not covered by insurance. For pelvic pain, we have been doing weekly treatment for 4 weeks. Our numbers are too small to quote meaningful statistics but it clearly helps some people a lot and others not at all. Those with predominantly urinary symptoms rather than pain seem to be helped the least.
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Re: Extracorporeal shock-wave therapy and CPPS

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Re: Extracorporeal shock-wave therapy and CPPS

Post by webslave »

Another supportive study
Managing patients with chronic pelvic pain syndrome (CPPS) refractory to the traditional 3-As therapy (antibiotics, alpha-blockers, and anti-inflammatories) is a challenging task. Low-intensity extracorporeal shock wave therapy (LI-ESWT) was recently reported to be able to improve pain, urinary symptoms, and even sexual function by inducing neovascularization and anti-inflammation, reducing muscle tone, and influencing nerve impulses.
https://pubmed.ncbi.nlm.nih.gov/29072124
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Re: Extracorporeal shock-wave therapy and CPPS

Post by Chriss »

Hi Mark
there is contradiction between the conclusion of this two paper:
1- http://pubmed.ncbi.nlm.nih.gov/25097599
Although, ESWT therapy as a safe and effective therapy in CPPS in short-term follow-up has been established, its long-term efficacy was not supported by this study
2- https://pubmed.ncbi.nlm.nih.gov/29072124
The evidence in this study would support the safety and efficacy of ESWT in refractory cases of CPPS at least for one year post treatment.
How it can be interpreted?
Age: 37 | Onset Age: 30 (May 2010) | Symptoms: Pain, Itching, Burning, Shooting Pain Sometimes, throbbing, in Perineum, Scrotum, Sphincter, Coccyx, Lumbar, Sacral, ED, Reduced Libido, | Helped By:Headache in the Pelvis, Internal PT, External PT, Gluten Diet, Relaxation, Vacation, | Worsened By:Stress/Anxiety/Suspense, Gluten Alcoholic Drink, Tadalafil, Viagra, Sexual Excitement or Arousal, Pelvic Floor Muscles Clenching| Other comments: Nerves Block (Ganglion Impar, Iliohypogastric, Ilioinguinal, Genitofemoral, Pudendal Nerve block with no effect, Quercetin, Pollen Aid, with Limited Effect, My Story is here : http://www.ucpps.men/forum ... =37&t=8634
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Re: Extracorporeal shock-wave therapy and CPPS

Post by webslave »

Irananian researchers may have used different technique to Taiwanese researchers.
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