Low Intensity Pulsed Ultrasound  (LIPUS) Therapy for Male Pelvic Pain


Low intensity pulsed ultrasound (LIPUS) therapy is a painless, non-invasive treatment, which can help relieve pelvic pain due to pelvic floor muscle tension (chronic pelvic pain syndrome or, CPPS).


What are the Symptoms of CPPS?

Pain is the dominant symptom and can be felt in the groin, scrotum, supra-pubic and perineal regions. Urinary dysfunction is commonly experienced - typically more frequent and urgent urination.  Sexual dysfunction, particularly pain after ejaculation or erectile dysfunction is seen in a minority of cases. The symptoms of CPPS often wax and wane over several months and can cause great distress and impairment in quality of life.

The causes of have not been completely explained. In the past it was thought to be due to prostatic infection.  Current understanding is that it originates within the pelvic floor muscles causing increased muscle tension leading to the symptom complex.


How does LIPUS therapy work?

There are several possible mechanisms of action including reducing muscle tone, interrupting the flow of nerve impulses, hyper-stimulating pain receptors and by influencing pain memory.


Who is LIPUS therapy appropriate for?

Men with persistent and bothersome pelvic pain may gain relief from LIPUS therapy.


What does LIPUS therapy Involve?

Soundwaves are applied to different areas on the perineum using a small hand held probe (Storz Duolith SD1 ultra). Anaesthesia or other pain relieving medications are not needed.  There are few side effects aside from mild skin redness. A course of treatment involves one fifteen-minute session per week for four weeks.


What effect might it have?

It may reduce pain intensity and frequency. The treatment is well tolerated with no significant side effects. The duration of benefit is uncertain. The first sham-controlled study reported efficacy at 12 weeks (1). One study showed loss of effect at 24 weeks (2) and another showed persistence of benefit to one year (3). The treatment may be repeated.


What else can be done to help improve pain?

There are several lifestyle measures that can be adopted to improve pelvic floor muscle function. These include daily exercise to maintain fitness, strength and flexibility and keeping weight in a healthy range. A specialised pelvic physiotherapist can provide an exercise program to help improve pelvic muscle function and reduce discomfort.


How can treatment be arranged?

Bookings are made through Urology Care Wellington: PH 04 920 0162

Our urology nurse will contact you to arrange an appointment where you will fill in a health questionnaire, have weight and blood pressure measured and treatment planned.


What is the follow-up?

A questionnaire on pelvic pain is sent out three months following treatment & our practise nurse Anna will speak to you on the telephone four months following treatment.


Evidence:

1. Extracorporeal Shock Wave Therapy for the treatment of Chronic Pelvic Pain Syndrome in Males: A Randomised, Double-Blind, Placebo-Controlled Study.

Zimmermann et al, European Urology 2009.

Sixty patients were randomised to sham versus real treatment. Patients received once weekly treatment for four weeks. Three months following treatment those in the treatment group had experienced a significant improvement in pain, quality of life, and voiding compared to the placebo group.

2. Long Term Effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J ResMed Sci. 2014 Apr;19(4):293-296

3. Long-term efficacy of extracorporeal shock wave therapy (ESWT) for treatment of refractory chronic abacterial prostatitis. Ann Med Surg (Lond). 2017 Jan;14:12-17