Have You Read? January 2021

By: Daniel A. Shoskes, MD | Posted on: 29 Jan 2021

Mykoniatis I, Kalyvianakis D, Zilotis F et al: Evaluation of a low-intensity shockwave therapy for chronic prostatitis type IIIb/chronic pelvic pain syndrome: a double-blind randomized sham-controlled clinical trial. Prostate Cancer Prostatic Dis 2020; doi:10.1038/s41391-020-00284-2.

While multimodal therapy based on patient phenotype helps the majority of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), new treatments, especially for those with pelvic floor spasm and, that do not require specialized training are welcome. While low intensity shockwave therapy (LiST) is primarily known in urology as a therapy for erectile dysfunction, it has been used for years as a treatment for trigger points, chronic pain and poorly healing wounds.

In this study patients with CP/CPPS were randomized in this prospective, sham controlled, double-blind study either to the active group who received 5,000 shockwaves per session with energy flux density 0.1 mJ/mm 2 or to the sham group who received 5,000 shockwaves from a visually identical sham probe. All groups underwent 6 weekly sessions. LiST effects on pain, micturition, quality of life (QoL) and erectile function were evaluated at 4, 12 and 24 weeks after treatment. Overall, 45 men were randomized to the active (30) and sham groups (15). Regarding impact of LiST in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total, pain and QoL subdomains scores a clear and persistent improvement was found in all follow-up timepoints compared to sham treatment. The mean difference between the LiST and sham group in the change of the NIH-CPSI pain-domain score (Q1–4) from baseline to 12 weeks after final treatment, which was 3.3 (95% CI 1.8–4.7). Perineal LiST was easy and safe to perform without anesthesia or any side effects.

The authors conclude that LiST seems to be a safe and effective treatment option for CP/CPPS, considerably improving pain and quality of life. Lack of any side effects and the potential for repetition make LiST a promising treatment choice for CP/CPPS patients.

Knoll P, Rai S, Talluri S et al: A survey of usage of penile prosthesis. J Sex Med 2020; 17: 2287–2290.

Penile prosthesis is a highly effective treatment for erectile dysfunction (ED). Given the propensity for ED with advancing age and comorbidities, the surgery is not without risks. How many men who have the surgery actually use the device long term? In this study the authors conducted a survey of 144 men who underwent an inflatable penile prosthesis (IPP) implantation by a single surgeon during a 6-year period. The factors determining patient selection for IPP implantation included suitability for general anesthesia, manual dexterity to use the device by the patient or their partner on a demonstration device and presence of refractory erectile dysfunction, HbA1c lower than 8.5 or need for a revision of a previously placed IPP.

Universally, a 3-piece AMS 700 Series implant was placed via the penoscrotal approach. The survey participation rate was 97%. The mean age of patient was 64 years (range 34–83), and the mean time between surgery and completion of survey was 2.98 years (range 0.25–7.4). Of all patients 68% were using the IPP at 5 years after implantation. Using the age of 70 years as a cutoff, 18 (22%) patients younger than 70 years and 14 (42%) patients older than 70 years discontinued using the IPP (p=0.029). The most common reasons for discontinuation were poor health to engage in sexual activity (2.6%), loss of companion (19%), loss of interest in sex (2.6%) and device malfunction with no further interest in revision of prosthesis (14%).

The authors conclude that they had a high rate (28%) of nonusage of IPP, more so in men older than the age of 70 years in the first 5 years of implantation.

Berajoui MB, Aditya I, Herrera-Caceres JO et al: A prospective randomized controlled trial of irrigation “bag squeeze” to manage pain for patients undergoing flexible cystoscopy. J Urol 2020; 204: 1012-1018.

This trio of articles on men's health concludes with the ultimate low tech intervention. Can giving the fluid bag a squeeze decrease pain while introducing a flexible cystoscope into the prostatic urethra? This single-center, prospective, double-blind, randomized controlled trial recruited 200 consenting participants who were ambulatory outpatient males who had undergone previous cystoscopy and were not expected to require any secondary procedures. Participants were randomized to undergo cystoscopy with the bag squeeze (group A) or the sham bag squeeze procedure (group B). After cystoscopy, participants completed a pain questionnaire (visual analogue scale). A total of 10 participants were ineligible because they required secondary procedures. Among the 190 eligible patients, 97 were randomized to bag squeeze (group A) and 93 to sham bag squeeze (group B) with mean pain scores of 1.91 and 3.39, respectively (p <0.005).

The authors conclude that a clinically meaningful decrease in pain for men undergoing flexible cystoscopy was seen when the irrigation bag squeeze technique was used vs placebo bag squeeze. Accordingly, this useful, simple and free method to improve patient comfort during flexible cystoscopy should be adopted.

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