Introduction. Chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) are the most prevalent urological disorders, affecting up to 14% of men and significantly reducing quality of life. The limited effectiveness of conventional treatment regimens increases interest in physiotherapeutic approaches, including extracorporeal shock wave therapy (ESWT), and in the use of enzymatic preparations.
Objective. To evaluate the efficacy of ESWT, bovhyaluronidase azoximer (BA) as part of a treatment regimen in patients with Category II CP and Categories IIIA–IIIB CPPS.
Materials and Methods. The randomized, open-label, placebo-uncontrolled study included 116 men aged 20–65 years (mean 45,5±9,5; disease duration 20,8±7,7 months). There were 3 study groups. Group 1 (n = 37) received ESWT + «3-As» therapy (antibiotic, NSAID, α-blocker); Group 2 (n = 38): ESWT monotherapy; Group 3 (n = 41): ESWT + BA (3000 IU). Efficacy was assessed at baseline and at weeks 7, 10, 18, 30, and 54 using the NIH-CPSI, IPSS, IIEF-5, and VAS scores, uroflowmetry, transrectal ultrasound with elastography and Doppler, and laboratory tests.
Results. All patients completed treatment without adverse effects. Improvement at week 7 was most pronounced in Group 1 according to NIHCPSI, IPSS, VAS, and uroflowmetry (p < 0.05). By weeks 10–54, positive dynamics were observed in all groups, with the most stable and pronounced effect in Group 3, where ESWT combined with BA reduced the number and size of calcifications and fibrotic areas, increased normal elasticity regions, and improved prostatic blood flow. Intergroup analysis confirmed the superiority of Groups 1 and 3 over Group 2, with no significant differences between Groups 1 and 3. In patients with non-inflammatory CP/CPPS (IIIB), a significant improvement in erectile function (IIEF-5) was also recorded.
Conclusions. ESWT, particularly when combined with BA, provides a significant reduction in CP/CPPS symptoms, improves uroflowmetry and ultrasound parameters of the prostate, and demonstrates superiority over standard therapy.
