Disponemos de avances en el tratamiento de la prostatitis. Nuevas evidencias científicas avalan el tratamiento con ondas de choque focales para la mejora en el 50% de los pacientes con esta patología.
Evidence
Treatment Efficacy Present knowledge on the efficacy and tolerability of LISWT
in CP/CPPS treatment is based on 5 low-to-moderate quality studies (Table 2); of these, 4 are sham-controlled RCTs,45e48 and 1 is a trial comparing LISWT to medical therapy with anti-inflammatory agents and a-blockers.49 The results of these trials are summarized in Table 5.
In men with CP/CPSS, LISWT showed an improvement of prostatitis-like symptoms and pain after 12 weeks of follow- up.45e48 The degree of the improvement after 12 weeks was quite consistently reported throughout the sham-controlled studies lasting 12 weeks (see Table 4 for details). In particular, the decrease in NIH-CPSI total score was between 17e33% among the LISWT-treated group and almost null or even increased in the sham-treated men,43e45 whereas the pain mea- sures decreased between 30e50% in the LISWT group, without any change in the sham-treated group.43e45 However, these findings were not sustained after 24 weeks, as reported by the longest sham procedureecontrolled trial.48 In particular in the latter study, initial improvement in prostatitis-like symptoms, including pain, was reported, with a maximum effect after 12 weeks (NIH-CPSI total score 19.74 ± 1.65 vs 26.81 ± 2.91 in LISWT and sham treatment procedure, respectively; P < .0001; NIH-CPSI pain domain 9.15 ± 0.92 vs 13.89 ± 1.47 in LISWT and sham treatment procedure, respectively; P < .0001), which was not sustained over time (after 24 weeks: NIH-CPSI total score 26.41 ± 1.53 vs 27.00 ± 1.01 in LISWT and sham treatment procedure, respectively; P 1⁄4 .184; NIH-CPSI pain domain 13.58 ± 2.12 vs 13.59 ± 1.76 in LISWT and sham treatment procedure, respectively; P 1⁄4 .982).48
Using the primary criterion, all the subjects (100%) responded in Group I compared to 18 of 20 (90%) in Group II. Whereas, 24 of 25 subjects (96%) responded in Group I compared to 15 of 20 (75%) in Group II (Table 1). Both groups showed statistically significant improve- ment (p < .001) in VAS, NIH-CPSI, QOL, IPSS, and IIEF-5 scores at 4 weeks and 8 weeks compared with baseline (Table 2). For between-group comparisons, NIH-CPSI (p = .006) and IIEF-5 (p = .02) scores dem- onstrated significant differences between the two groups at 8 weeks (Table 2).
An open-label, single-arm prospective study reported that for patients with severe CPPS who are nonresponsive to traditional 3-As therapy (antibiotics, α-blockers, and anti-inflammatories), fESWT has proved to be able to allow these patients to become responders (Zimmermann et al., 2008). The patients had concomitant α-blocker and anti-inflammatory drug use during and after fESWT. After 12 weeks of fESWT treatment, up to 72.7% of patients could taper 3-As medication and only 36.4% of patients still needed anti-inflammatory drugs. The con- clusions of this study are consistent with their research, and rESWT may replace the drug treatment of CPPS. Therefore, it can circumvent many side effects of drugs, such as postural hypotension, palpitation, and gastroin- testinal complaint. The study conducted by Pajovic et al. (2016) indicates that 12 weeks of a combination of triple therapy (α-blocker, anti-inflammatory agent, and muscle relaxant) and fESWT showed significantly better results than the triple therapy group in all aspects of NIH-CPSI scores in the 24-week posttreatment follow-up. However, there are no reports on the comparison of ESWT and drugs. The 3-month follow-up results in this study sug- gested that the recurrence rate of the rESWT (4%) group is significantly lower than that of the drug group (50%), clearly indicating the advantage of the rESWT to the drugs.
Pide cita ahora con el Dr. en Urología D. Patricio Navarro, tu urólogo de confianza en Las Palmas de Gran Canaria.
