SHOCK WAVE THERAPY OF CHRONIC ABACTERIAL PROSTATITIS, COMPLIANCE ISSUES

To date, very encouraging results have been obtained in the treatment of chronic abacterial prostatitis (CAP) using extracorporeal shock wave therapy (ESWT). However, it is not yet possible to draw final conclusions about the place of ESWT in the treatment of CAP. Objective. To evaluate the clinical tolerability of various modes of shock wave therapy (ESWT) in patients with CAP. Materials and Methods. We analyzed the dynamics of chronic prostatitis symptoms based on the NIH-CPSI questionnaire in 62 patients with CAP. The patients received standard CAP therapy and were randomized according to the ESWT method into a control group (n = 30) and a main group (n = 32). There were no differences in age, prostate volume, uroflowmetric data, and symptoms assessed by the IPSS, IIEF5, LANNS, NIH-CPSI questionnaires, and urine diary between the groups (p> 0.05). The clinical dynamics were assessed at 2, 4, 8, 12, 16, 20 and 24 weeks. Differences were considered reliable if the probability of an event was greater than 95%. Results. Before starting therapy, patients in both groups had clinically pronounced symptoms of CAP according to the NIH-CPSI questionnaire with no differences (p> 0.05). The dynamics of CAP symptoms in the pain and urination domains of NIH-CPSI in the main group was characterized by a progressive decrease in symptoms from 23±6 points to 5±2 points by the end of the ESWT course. In the control group, an increase in symptoms from 19±7 to 25±4 points (week 2) was observed at the beginning, with a tendency to decrease to 11±3 points at week 12; there were reliable differences (p<0.05) throughout this time interval. Direct evaluation of pain syndrome and urination disorders after a session of shock wave therapy using the Shock Wave Therapy Side Effects Symptom Scale revealed severe symptoms in the control group, which significantly exceeded similar indicators in the main group. Conclusion. Thus, reducing the maximum pulse and fractionating the session dose to 1/3 of the standard during shock wave therapy are accompanied by positive dynamics in relation to the symptoms of chronic prostatitis according to the NIH-CPSI questionnaire. The proposed Shock Wave Therapy Side Effects Symptom Scale is an effective way to diagnose unwanted side effects of shock wave therapy.