Efficacy of Extracorporeal Shockwave Therapy of the Perineum for Chronic Pelvic Pain Syndrome in Male Patients: A Pilot Study

Abstract

Chronic pelvic pain syndrome (CPPS) is a complex, multifactorial condition that significantly impairs the quality of life. It is a challenging condition for urologists, as there are no established treatment options and it requires a multimodal approach. This single-arm, prospective study was conducted in a tertiary-level hospital. Men >18 years of age with pelvic discomfort for at least 3 months, without urological abnormalities, a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score >15, and failure of various pharmacological therapies were enrolled. All patients underwent eight sessions of perineal Low-Intensity Shockwave Therapy (LiSWT) over four weeks, with each session delivering 2400 impulses (frequency of 12 Hz). Treatment response was assessed using the NIH-CPSI score immediately after therapy and at 4, 8, and 12 weeks of follow-up. Twenty-one patients (mean age 42.8 ± 7.9 years) with a mean symptom duration of 12.8 ± 3.2 months, with baseline NIH-CPSI scores of 12 ± 1.58 for pain, 6.8 ± 1.5 for urinary symptoms, 9.35 ± 1.18 for quality of life, and 29.15 ± 2.94 in total. Clinical improvement was observed in 42.8% of patients at four weeks, increasing to 66.7% at eight weeks and 80.9% at twelve weeks. Urinary symptoms showed early improvement, while pain, quality-of-life, and total scores demonstrated improvement by eight and twelve weeks (p < 0.05). The perineal LiSWT is a safe, feasible, and potentially effective treatment option for patients with CPPS.