Extracorporeal Shock Wave Therapy in the Treatment of Chronic Calculous Prostatitis
Authors: Gorpynchenko Ihor , Nurimanov Kamil , Nedogonova Olena , Poroshina Tetyana , Savchenko Viktoriia , Leonenko Andrii , Drannik Heorhii 
Published: November 2023

Extracorporeal shock wave therapy (ESWT) is known as an effective method for inflammatory diseases treatment of various localization. It is actual and perspective treatment methos for chronic calculous prostatitis (CCP).
The objective: to evaluate the dynamics and interrelationships of clinical symptoms, twinkling artifact, the levels of leukocytes and cytokines in the ejaculate during the use of ESWT for the treatment of patients with CCP.
Materials and methods. The study included 37 patients with aged 18–45 years with CCP after ESWT in the projection of the prostate gland (PG). The participants of the study were assessed for prostatitis symptoms according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), depression symptoms - Patient Health Questionnaire-9 (PHQ-9); anxiety symptoms – Generalized Anxiety Disorder-7 (GAD-7), sexual dysfunction symptoms – International Index of Erectile Function (IIEF).
Patients had ultrasonographic examination of the pelvic organs with the determination of a twinkling artifact. The levels of IL-1β and IL-10 in ejaculate before and after treatment were determined using enzyme immunoassay. For the analysis of the treatment results, the patients with a significant reduction in the activity of symptoms of PG (by 6 or more points on the NIH-CPSI scale) were included in subgroup A. The patients with insufficient efficacy were involved in subgroup B.
Results. A clinically significant reduction in the severity of prostatitis symptoms (by 6 or more NIH-CPSI points) as a result of treatment was observed in 27 (72.9%) patients. The total prostatitis symptom score (NIH-CPSI) (p<0.05), as well as domains of pain, dysuria and impact on patients’ quality of life, intensity of symptoms of depression, anxiety and erectile dysfunction changed significantly. Changes in the IL-1β and IL-10 concentrations in the ejaculate did not depend on the clinical improvement of the patients’ condition.
Before treatment, the concentration of IL-1β in the ejaculate was positive correlated with the index of depression symptoms (r=0.381, р=0.020) and negative correlated with the indicators of erection, orgasm and sexual desire (r=–0.326, р=0.049; r=-0.329, р =0.046; r=–0.389, p=0.017, respectively). After treatment, the concentration of IL-1β in the ejaculate was positive correlated with the general assessment of prostatitis symptoms, quality of life and anxiety symptoms (r=0.339, р=0.040; r=0.358, р=0.029; r=0.334, р=0.044, respectively), and also negative correlated with indicators of orgasm and sexual desire (r=–0.421, p=0.009; r=–0.455, p=0.005, respectively).
A decrease in the frequency of twinkling artifact in the PG projection was found. At the same time, no significant changes in the presence of echo-positive inclusions were detected. Before treatment, a significant correlation of the presence of twinkling artifact was determined with the total score of prostatitis symptoms (r=0.448, p=0.005), domains of pain (r=0.404, p=0.013) and quality of life (r=0.331, p=0.045), orgasm (r =–0.469, p=0.003) and sexual desire (r=–0.350, p=0.034). No correlation was found with other investigated indicators.
Conclusions. The results of the study demonstrated that ESWT provides a significant reduction in symptoms of prostatitis, anxiety, depression and erectile dysfunction through a dosed anti inflammatory and anticalcification effect on the PG. The use of Doppler twinkling artifact can be useful for characterizing and monitoring the treatment of PG calcifications.