Factors Related To Effectiveness Of Low-intensity Extracorporeal Shockwave Therapy For Chronic Prostatitis/Chronic Pelvic Pain Syndrome & Development Of The Prediction Nomogram

Background and Objectives: Chronic Prostatitis/Chronic Pelvic Pain Syndrome(CP/CPPS)is a common disease in urology.It accounts for up to a quarter of patients in urology clinics.The etiology of CP/CPPS is diverse,the mechanism is complex,and the heterogeneity of the disease is high.At present,although drug therapy is mostly the first choice,there are few widely used cures,and improving symptoms is still the common expectation of doctors and patients.In recent years,more and more clinical trials have confirmed the safety and efficacy of low intensity extracorporeal shock wave therapy(Li-ESWT)in CP/CPPS applications.Our team also found in previous studies that Li-ESWT showed reliable efficacy in patients with drug-refractory CP/CPPS,but there were still significant individual differences in symptom improvement.The purpose of this study is to further evaluate the risk factors affecting the efficacy of Li-ESWT during treatment,so as to assist CP/CPPS patients to maximize the benefits and promote the promotion of Li-ESWT.Material and Method: This study retrospectively analyzed the clinical data of patients with drug-refractory CP/CPPS who received Li-ESWT treatment in our center from August 2020 to June 2021,including NIH-CPSI scores and self-made questionnaire information before and after treatment.The content of the self-made questionnaire are regarded as the independent variables,covering the reported susceptibility factors of CP/CPPS.At the same time,combined with the clinical experience of the center,it is divided into three major sections:1.Personal basic information;2.Lifestyle,eating habits,sexual habits and mental state during treatment;3.Previous infection/inflammation/immune history.In order to evaluate the effect of susceptibility factors on the efficacy of Li-ESWT in detail,this study quantified data such as sedentary and dietary intake.All data were recorded by an independent investigator after treatment.Based on the results of previous clinical trials,this study selected the efficacy of Li-ESWT at the time node with the highest improvement rate(4 weeks after the end of treatment)as the dependent variable.According to the NIH-CPSI score decreased by ≥ 6 points,it was defined as an effective treatment standard,and the included subjects were divided into effective group and ineffective group.Univariate logistic regression analysis was used to compare the differences to evaluate the independent variables that could be included in the multivariate logistic regression model(P < 0.05).With P value greater than 0.1 as the elimination standard,the risk factors that can independently predict the efficacy of Li-ESWT were screened by stepwise forward regression method.Further,a visual nomogram prediction model was constructed by integrating clinically meaningful indicators and risk factors.The clinical discrimination,predictive efficacy and benefit threshold range of the prediction model were evaluated by ROC curve,calibration curve and decision curve,respectively.Results: The results showed that the baseline NIH-CPSI total score(≤ 29 vs.>2 9;(OR: 0.195,95% CI: 0.047-0.808),habitual urine holding behavior(OR: 4.325,95% CI: 1.271-14.722),drinking behavior(OR: 4.665,95% CI: 1.419-15.339),immediate urination after ejaculation behavior(OR: 0.211,95% CI: 0.063-0.709)can be used as independent predictors of the efficacy of Li-ESWT.In addition,subgroup analysis found that age is also a potential confounding factor affecting the efficacy of Li-ESWT.Based on the above five variables,this study constructed a nomogram comprehensive prediction model that can predict the efficacy of Li-ESWT in the treatment of CP/CPPS(AUC: 0.809,95% CI: 0.717-0.901;Hosmer-Lemeshow test P value: 0.936;model clinical decision probability range: > 0.30).Conclusions: This study showed for the first time that CP/CPPS patients with higher age(≥ 34 years old)and severe disease(NIH-CPSI > 29 points)have a higher probability of benefiting from Li-ESWT.However,during the treatment of Li-ESWT,urine holding behavior,drinking behavior and delayed urination after sexual life will reduce the efficacy of Li-ESWT.The nomogram constructed based on the above factors is suitable for predicting the clinical efficacy of Li-ESWT and guiding the behavior patterns of CP/CPPS patients during treatment to improve the efficacy,but its universality still needs to be verified in larger samples.