Acupuncture for chronic prostatitis/ chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.     

The DABBEC phenotyping system: towards a mechanistic understanding of CP/CPPS

There is an urgent need to elucidate the mechanistic basis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), as the current methods of symptom-based diagnosis and treatment have failed. Here, we propose a phenotyping system that bridges the gap between the symptom-based diagnosis and treatment of the present and the mechanistic approach of the future. Our phenotyping system uses the Chronic Prostatitis Collaborative Research Network (CPCRN)-recommended algorithm in combination with the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) as a basis for diagnosis, while incorporating novel domains for quantitative assessment and stratification of CP/CPPS patients. We believe this novel system will serve to help advance our understanding of the roles of the patient's genome and proteome in the etiology of CP/CPPS. We predict that, as we begin to understand the mechanistic basis of CP/CPPS pathology and progression, we will develop specific treatments that will aim to cure the disease, rather than merely quell the symptoms.     

Chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: Are they related?

Interstitial cystitis and chronic prostatitis/chronic pelvic pain syndrome are clinical syndromes characterized by pelvic pain with or without voiding symptoms such as urgency and frequency. There are many similarities in their epidemiology, adverse effect on quality of life, etiology/pathophysiology, natural history, and response to similar treatments. However, overlapping clinical definitions and similar entrance criteria for large-scale cohort studies make comparisons problematic. Newer efforts to classify pelvic pain syndromes should help in our recognition that interstitial cystitis and chronic prostatitis/chronic pelvic pain syndrome likely are not organ-specific syndromes but urogenital manifestations of regional or systemic abnormalities.     

The treatment of prostatitis

PURPOSE: Prostatitis are frequently recognized in general practice and often are a diagnosis and therapeutic challenge. We review here the updated knowledge on diagnosis and therapy of prostatitis. CURRENT KNOWLEDGE AND KEY POINTS: Prostatitis are divided into acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic prostatitis/ chronic pelvic pain syndrome (III) and asymptomatic inflammatory prostatitis. Chronic prostatitis/ chronic pelvic pain syndrome are divided into : inflammatory (IIIA) and noninflammatory (IIIB). Treatment of prostatitis should follow evidence based guidelines recently published. Acute prostatitis should be treated by ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or cotrimoxazole 960 mg bid for 4 weeks (CIII). When bacteremia occurs third generation cephalosporin with gentamicin should be used (CIII). In chronic bacterial prostatitis ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or norfloxacine 400 mg bid or cotrimoxazole 960 mg bid for 4 weeks may be used (BIII). FUTURE PROSPECTS AND PROJECTS: Molecular techniques should improve the etiological diagnosis of prostatitis and their treatment.     

Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, α-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.     

Saw palmetto and finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is a common entity for which a standardized management has not been established. Patients often have a significant symptom complex and impact on quality of life, but very little is known about the efficacy of second- and third-line treatments, such as the use of herbal supplements. Many treatments studied in recent literature include antibiotics, á-blockade, anti-inflammatory agents, and cognitive behavioral interventions such as biofeedback and psychotherapy.     

Treatment response to conventional and novel therapies in chronic prostatitis

Chronic prostatitis is a common and poorly understood condition that significantly impacts quality of life. Conventional therapy usually consists of prolonged courses of antibiotics; however, the efficacy of this approach is defined better by clearance of bacteria than by improvement in symptoms. Newer therapies with some evidence for efficacy include α blockers, anti-inflammatory drugs, phytotherapy (quercetin, bee pollen), physiotherapy, neuroleptics, and others with unique actions (finasteride, pentosan polysulfate). The National Institutes of Health Chronic Prostatitis Symptom Index is a validated symptom score that, in preliminary use, appears to be responsive to patient improvement. As more well-designed clinical trials in chronic prostatitis and chronic pelvic pain syndrome come to completion, physicians will be able to make rational treatment choices for patients with this common and frustrating condition.     

Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome

Category III chronic prostatitis/chronic pelvic pain syndrome is a syndrome rather than a specific disease and the cause can be multifactorial. In clinical practice, monotherapy often has proven ineffective. Multimodal therapy, which sequentially or simultaneously can address infection, inflammation, and neuromuscular spasm appears to have the greatest potential for symptom improvement, especially in patients with longstanding symptoms.     

Chronic pelvic pain syndrome and voiding dysfunction

Chronic prostatitis/chronic pelvic pain syndrome is a disease that is mainly characterized by three parameters: pain in the suprapubic and pelvic area, presence or absence of white blood cells in expressed prostatic secretions, and voiding disorders of various degrees. The causative factors underlying this very common condition are poorly understood. Therapeutic options (ie, antimicrobial treatment) often are based on the presence of an inflammatory reaction in the expressed prostatic secretions, but the benefit of recurring or prolonged courses of antimicrobial agents is highly variable. Observations have been made regarding functional and structural changes in the lower urinary tract that are suggestive to have an impact on the pathogenesis of chronic pelvic pain syndrome.     

Is there a role for urodynamics in chronic nonbacterial prostatitis?

The etiology of chronic nonbacterial chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is unclear. That may be why treatment with antibiotics and anti-inflammatory drugs often fail. The use of urodynamic testing in evaluating any patient with both pelvic/perineal pain coexistent with voiding symptoms can help identify voiding dysfunction. If identified, urodynamic voiding disorders, such as bladder neck obstruction and pseudodyssynergia, should be specifically treated to ameliorate symptoms. Through more research of nonbacterial CP/ CPPS, we will be able to further define the successful role of videourodynamics in men with this disease. The etiology of chronic nonbacterial chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is unclear. That may be why treatment with antibiotics and anti-inflammatory drugs often fail. The use of urodynamic testing in evaluating any patient with both pelvic/perineal pain coexistent with voiding symptoms can help identify voiding dysfunction. If identified, urodynamic voiding disorders, such as bladder neck obstruction and pseudodyssynergia, should be specifically treated to ameliorate symptoms. Through more research of nonbacterial CP/ CPPS, we will be able to further define the successful role of videourodynamics in men with this disease.     

Prostatitis: Epidemiology of inflammation

Approximately 8 million prostatitis-related outpatient visits per year have been reported worldwide. Only a small percentage presents with bacterial prostatitis. Chronic pelvic pain syndrome/prostatodynia is a frustrating disease for patients and caregivers. This paper is an attempt to analyze causes and types of inflammation and to determine if inflammation may have an impact on treatment and outcome. Is inflammation even a relevant factor in the diagnosis of chronic pelvic pain syndrome? Do we need to begin to look for different factors involved in the development of this often crippling disease?     

Economic impact of chronic prostatitis

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.     

Complications of Chronic Prostatitis

Chronic prostatitis (CP) is a pelvic condition in men that needs to be distinguished from other forms of prostatitis, such as acute and chronic bacterial prostatitis. CP is characterized by pelvic or perineal pain lasting longer than 3 months without evidence of urinary tract infection. Symptoms may wax and wane and pain may radiate to the back and perineum, causing discomfort while sitting. Dysuria, frequency, urgency, arthralgia, myalgia, unexplained fatigue, abdominal pain, and burning sensation in the penis may be present. Post-ejaculatory pain, mediated by nerves and muscles, is a hallmark of the condition and serves to distinguish CP/chronic pelvic pain syndrome (CPPS) patients from men with benign prostatic hyperplasia and healthy men. Some patients report low libido, sexual dysfunction, and erectile difficulties. The symptoms of CP/CPPS appear to result from interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. Some researchers have suggested that CPPS is a form of painful bladder syndrome/interstitial cystitis (PBS/IC). Therapies shown to be effective in treating IC/PBS (eg, quercetin) have shown some efficacy in CP/CPPS. Recent research has focused on genomic and proteomic aspects of the related conditions. There are no definitive diagnostic tests for CP/CPPS. This is a poorly understood disorder, even though it accounts for 90% to 95% of prostatitis diagnoses. Its peak incidence is in men 35 to 45 years old. In 2007, the National Institute of Diabetes and Digestive and Kidney Diseases began using the umbrella term urologic chronic pelvic pain syndromes to refer to pain syndromes associated with the bladder (eg, IC/PBS) and prostate gland (eg, CP/CPPS). The prognosis for CP/CPPS has improved greatly with the advent of multimodal treatment, including phytotherapy, pelvic nerve myofascial trigger point release, anxiety control, and chronic pain therapy.     

Etiologic theories of chronic prostatitis/chronic pelvic pain syndrome

The etiology of chronic prostatitis/chronic pelvic pain syndrome is unknown. Whereas infection causes category I and II prostatitis, the evidence for an ongoing infection in category III patients is lacking. Immunologic, neurologic, and psychologic factors likely play a role in the development and maintenance of symptoms in these men. The traditional concept of pain as a simple response to a noxious stimulus has some merit, but modern research indicates that the response is much more complex, and we must look at a patient’s physiology and psychology to be able to interpret each individual’s pain response. It is some advance in the field to realize that we probably need to look beyond the prostate and address the entire biopsychosocial problem to be able to offer successful treatment to these men.     

Variability of the symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome during intermittent therapy with rectal prednisolone foam for ulcerative colitis

We describe the response of symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/PPS) in a man treated with rectal prednisolone for concomitant ulcerative colitis. The temporal relationship of the symptoms of CAP/PPS to starting and stopping the topical corticosteroid over 2 treatment cycles lends further anecdotal support to our hypothesis that treatment of the immune-mediated response in this chronic condition has a beneficial effect upon symptomatic outcome.     

Chronic pelvic pain syndrome and the overactive bladder: The inflammatory link

Although the causes of chronic prostatistis/chronic pelvic pain syndrome, painful bladder syndrome/interstitial cystitis, and overactive bladder remain unclear, inflammation may explain some of the causative and propagating features. Cytokines may play a role by recruiting inflammatory cells and ultimately in inducing symptoms. This paper reviews the role of cytokines in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome, overactive bladder, and painful bladder syndrome/interstitial cystitis.     

Self-reported history of sexually transmitted infection and chronic prostatitis symptoms: a cross-sectional study of a Nigerian undergraduate population

The aetiology of chronic prostatitis is poorly understood. A cross-sectional study of a population of male undergraduates in Nigeria, using a questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and some other relevant sex-related questions, was conducted. A total of 14.9% of the population had chronic prostatitis symptoms (CPSs) defined as a pain score of four or more on the NIH-CPSI pain subscale. Approximately 26 or 12% of the population had at least one, or ≥ 2 location(s) of pain, respectively. The presence of CPS was found to correlate with a self-reported history of sexually transmitted infection (STI) (r = +0.237; P < 0.05) and 73% of those with a self-reported history of STI had CPS. Both voiding scores and quality-of-life scores were significantly higher in subjects with CPS, compared with those without CPS. Self-reported history of STI may be an important aetiological factor for chronic prostatitis/chronic pelvic pain symptoms.     

Prostatitis and urinary tract infection in men: what's new; what's true?

Urinary tract and prostatic infections are common in men, and most are treated by primary providers. Acute bacterial prostatitis is caused by uropathogens, presents with a tender prostate gland, and responds promptly to antibiotic therapy. Chronic bacterial prostatitis is a subacute infection, may present with a variety of pelvic pain and voiding symptoms, and is characterized by recurrent urinary tract infections. Effective treatment may be difficult and requires prolonged antibiotic therapy. Nonbacterial prostatitis and chronic pelvic pain syndrome are more common than bacterial prostatitis, and their etiologies are largely unknown. Treatment for both nonbacterial disorders is primarily symptomatic. An underlying anatomic or functional condition usually complicates urinary tract infections in men, but uncomplicated infections occur, often related to sexual activity. Gram-negative bacilli cause most urinary tract and prostate infections. Therapy for prostatic infections requires an agent that penetrates prostatic tissue and secretions, such as trimethoprim-sulfamethoxazole or, preferably, a fluoroquinolone. Duration of antibiotic therapy is typically 1 to 2 weeks for cystitis, 4 weeks for acute bacterial prostatitis, and 6 to 12 weeks for chronic bacterial prostatitis. Long-term suppressive antibiotic therapy and nonspecific measures aimed at palliation may be useful in selected patients with recurrent bacteriuria or persistent symptoms of chronic bacterial prostatitis.     

慢性前列腺炎／慢性骨盆疼痛综合征的相关危险因素分析

目的探讨慢性前列腺炎／慢性骨盆疼痛综合征（CP/CPPS）发病的危险因素。方法选择360例临床确诊的CP/CPPS患者及年龄匹配的非CP/CPPS患者360例（对照组）,采用自行设计调查表进行病例对照研究,内容主要包括吸烟及饮酒情况、受教育程度、居住地、婚姻状况,采用非条件多元Logstic回归模型测量各因素与CP/CPPS发病的相关性。结果与不吸烟者比较,吸烟者发生CWCPPS的危险性升高,吸烟量和吸烟时间均与CP/CPPS发病率呈明显正相关;与不饮酒者相比,饮酒者发生CP/CPPS的危险性降低,随饮酒量和时间增长,CP/CPPS发病危险有下降趋势;CP/CPPS发病危险性受教育程度为初中以下者高于初中以上者,居住农村者高于居住城区者,已婚者高于未婚者。结论吸烟是CP/CPPS发病的危险因素,饮酒为保护性因素,文化程度低、居住条件差及已婚等因素可增加CP／CPPS发病的危险性。