A randomized controlled trial evaluating low-intensity shockwave therapy for treatment of persistent storage symptoms following transurethral surgery for benign prostatic obstruction

• Published in: Prostate cancer and prostatic diseases 2024-06, Vol.27 (2), p.305-311
• Main Authors: Hegazy, Mohammed, Sheir, Khaled Z., Gaballah, Mohamed A., Elshal, Ahmed M.
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/699/2768/1753; Aged; Angiogenesis; Biomedical and Life Sciences; Biomedicine; Bladder; Cancer Research; Clinical outcomes; Clinical trials; Diaries; Double-Blind Method; Effectiveness; Extracorporeal Shockwave Therapy - methods; Follow-Up Studies; Humans; Inflammation; Male; Medical treatment; Middle Aged; Parameters; Patients; Postoperative Complications - etiology; Postoperative Complications - therapy; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Prostatic Hyperplasia - therapy; Quality of Life; Regeneration; Reproductive Medicine; Shock waves; Side effects; Solifenacin Succinate - administration & dosage; Solifenacin Succinate - therapeutic use; Surgery; Transurethral Resection of Prostate - adverse effects; Transurethral Resection of Prostate - methods; Treatment Outcome; Urinary Bladder, Overactive - etiology; Urinary Bladder, Overactive - therapy
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-024-00820-4

Background Low-intensity shockwave therapy (Li-SWT) can improve bladder function through enhancement of angiogenesis and nerve regeneration and suppression of inflammation and overactivity. In this trial, we aimed to evaluate the efficacy of Li-SWT on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO). Methods Between July 2020 and July 2022, 137 patients with persistent storage symptoms; urgency episodes/24 h ≥ 1 and daytime frequency ≥8, for at least three months after TUS for BPO were randomly allocated to Li-SWT versus sham versus solifenacin 10 mg/day in 3:1:1 ratio. The primary end point was the percent reduction from baseline in overactive bladder symptom score (OABSS) at 3-month follow-up. The changes in 3-day voiding diary parameters, quality of life (QoL) score, peak flow rate and residual urine at 3 and 6-month follow-up were compared. Treatment-related adverse effects were also evaluated. Results Baseline data were comparable between groups. The percent reduction from baseline in OABSS at 3-month follow-up was significantly higher in Li-SWT compared to sham (−55% versus −11%), and it was comparable between Li-SWT and solifenacin-10 (−55% versus −60%). Li-SWT achieved significant improvement like solifenacin-10 in 3-day voiding diary parameters and QoL score at 3-month follow-up. This improvement remained comparable between Li-SWT and solifenacin-10 at 6-month follow-up. No adverse effects related to Li-SWT were noted apart from tolerable pain during the procedure. Solifenacin-10 was associated with bothersome adverse effects in 73% of the patients with 11.5% discontinuation rate. Conclusions Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with comparable efficacy and better tolerance compared to solifenacin.