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.     

Quercetin for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition with a heterogeneous origin that responds best to multimodal therapy. The bioflavonoid quercetin has antioxidant and antiinflammatory effects that have proven useful for treating this condition. Using the clinical phenotype system UPOINT, quercetin can be helpful for those with organ-specific complaints (bladder or prostate) and pelvic floor spasm. This article discusses the current understanding of CP/CPPS and how treatment with quercetin can be used alone or as part of multimodal therapy.     

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.     

Update on minimally invasive therapy for chronic prostatitis/chronic pelvic pain syndrome

Once primary treatment fails, the diverse causes and symptoms of chronic pelvic pain syndrome require clinicians to consider several secondary approaches. Multimodal therapy addresses unique symptoms and targets illness origin. However, once medical modalities fail, minimally invasive therapies should be considered, including transurethral needle ablation hyperthermia, cooled thermotherapy, electromagnetic chair, prostatic massage, and intraprostatic botulinum toxin A injection. Low evidence levels exist for all approaches, but we anticipate promising results of larger trials for cooled thermotherapy and look forward to the emergence of experimental techniques using botulinum toxin A.     

Chronic prostatitis/chronic pelvic pain syndrome

In the 20th century, the term "prostatitis" traditionally referred to inflammation in the prostate, often attributed to infection. Prostatitis in this century usually refers to a chronic pain syndrome for which the presence of inflammation and involvement of the prostate are not always certain. This article discusses chronic prostatitis/chronic pelvic pain syndrome and the various factors associated with diagnosis and treatment.     

Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome is a prevalent and multifactorial condition. Many patients have the condition for years despite conventional therapies. We assess the outcomes of multimodal therapy in patients with long-standing chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: A total of 53 patients with chronic prostatitis treated at our clinic with a minimum followup of 6 months were assessed by the National Institutes of Health-Chronic Prostatitis Symptom Index and by a global assessment score. Treatments included antibiotics, prostatic massage, anti-inflammatory phytotherapy, alpha-blockers and neuromuscular agents. RESULTS: Mean age patient was 45 years and median symptom history was 3.5 years. Based on localizing cultures, and microscopy of urine and prostatic fluid 13% of the cases were category II, 41% were category IIIa and 46% were category IIIb. Mean followup from the last visit was 417 days (range 185 to 1,247). Mean changes +/- SE from the initial to the final score on the National Institutes of Health-Chronic Prostatitis Symptom Index were 10.4 +/- 3.3 to 5.9 +/- 4.4 for pain, 4.2 +/- 2.9 to 2.0 +/- 2.7 for urinary, 8.2 +/- 2.9 to 4.7 +/- 3.4 for quality of life and 22.7 +/- 6.6 to 13.2 +/- 9.5 for total score (p <0.0001). Based on a global subjective assessment 43 of the patients (80%) were better, 8 were the same and 3 were worse. At final assessment 39% of the patients were on no therapy, 22% were on an alpha-blocker, 37% were on quercetin, 13% were on neuromuscular agents and 9% were on antibiotics. CONCLUSIONS: An approach using stepwise therapy with antibiotics, anti-inflammatories and neuromuscular agents can be successful in the majority of patients with long-standing chronic prostatitis.     

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.     

可多华、戴芬联合治疗慢性前列腺炎/慢性盆底疼痛综合征

目的 探讨可多华和戴芬联合治疗慢性前列腺炎，慢性盆底疼痛综合征的疗效。方法 将123例慢性前列腺炎，慢性盆底疼痛综合征的患者，随机分成3组，即可多华组、戴芬组和可多华＋戴芬联合治疗组，每组均治疗12周。治疗前以及在治疗12周后分别检测慢性前列腺炎症状积分指数（NIH—CPSI）。结果 有115名患者完成了12周的治疗并最终接受评估，可多华组39例，NIH—CPSI总分由治疗前的24．1&#177;2．2下降到治疗后的18．51&#177;1．67，平均下降5．59分（23％）（P〈0．001）；戴芬组37例，NIH-CPSI总分由治疗前的23．95&#177;2．17下降到治疗后的18．14&#177;1．69，平均下降5．81（24％）（P〈0．001）；可多华＋戴芬组39例，NIH—CPSI总分由治疗前的23．82&#177;1．72下降到治疗后的16．77&#177;1．37，平均下降7．05分（30％）（P〈0．001）。结论 可多华、戴芬均能有效缓解慢性前列腺炎，慢性盆底疼痛综合征患者的症状，改善患者的生活质量，但可多华＋戴芬联合治疗组疗效优于单一治疗组。     

Mechanisms in prostatitis/chronic pelvic pain syndrome

PURPOSE: We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS: National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS: The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.     

体外热电场治疗在男性慢性盆腔疼痛综合征中的应用

目的从多方面评估体外热电场治疗对男性慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)患者症状的改善情况并进行疗效分析,进而判断其临床应用价值。方法回顾性收集2018年4月至2019年3月,57例使用LR-2005体外热电场治疗机进行治疗的CP/CPPS患者的临床资料,并对其治疗前后所填评分量表进行统计学分析。患者20~50岁,病程3个月~7年,其中行1个疗程治疗17例,2个疗程32例,3个疗程8例。所用评分量表包括:NIH-CPSI评分、PUF评分、VAS评分、QOL评分、SAS评分、SDS评分等。结果治疗前与治疗后,患者NIH-CPSI总评分分别为(25.05±6.32)vs(19.54±6.16)、PUF症状评分为(10.86±4.41)vs(8.46±4.11)、PUF困扰评分为(5.35±2.88)vs(4.03±2.33)、VAS评分为(3.97±2.40)vs(2.03±1.85)、QOL评分为(4.89±1.27)vs(3.95±1.25)、SAS评分为(37.35±8.76)vs(34.00±8.14)、SDS评分为(34.41±7.43)vs(32.05±4.78),治疗后均下降且与治疗前比较差异具有显著统计学意义(P<0.01)。治疗后NIHCPSI评分轻中度人数增加,重度人数明显减少,治疗前后差异具有显著统计学意义(P<0.01)。患者治疗后未见特殊不适或不良反应发生。结论体外热电场治疗能够有效减轻CP/CPPS患者炎症和疼痛反应,改善排尿症状,降低焦虑抑郁程度,提高患者生活质量。其临床疗效显著,治疗有效率高,符合WHO倡导的“无痛、无创、非介入”的治疗模式,患者容易接受,值得临床推广。     

慢性前列腺炎/慢性盆腔疼痛综合征的针刺治疗临床评价与中枢神经机制研究进展

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)是男科常见病之一,其临床症状主要表现为长期、反复的盆骨区域疼痛或不适。针刺以其显著的疗效被广泛应用于缓解CP/CPPS盆骨区域疼痛不适的临床治疗当中,具有起效快、疗效持久的特点,与西药合用可以提高单纯西药治疗的疗效。目前关于针刺治疗CP/CPPS的机制有免疫调节、改善炎症反应等多种理论,但这些理论并不能完全解释其作用机制。近年来随着神经成像技术的发展,有研究发现CP/CPPS患者存在脑结构和脑功能改变,并且大量研究证实了针刺治疗可改善慢性疼痛疾病的脑区功能和结构。本文将综述针刺治疗CP/CPPS以及其中枢神经机制的研究进展,为理解针刺治疗CP/CPPS疼痛症状的中枢机制提供理论依据,从而进一步优化临床CP/CPPS针刺治疗方案。     

生物反馈和电刺激联合治疗慢性前列腺炎/慢性骨盆疼痛综合征

目的:通过临床试验的方法,探讨生物反馈和电刺激联合治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的效果。方法:收集湘雅医院门诊诊断为CP/CPPS符合研究标准患者140例。将患者随机分为对照组、生物反馈组、电刺激组和生物反馈加电刺激组;对照组20例,生物反馈组、电刺激组和生物反馈加电刺激组各40例。采用Laborie-Urostym生物反馈电刺激治疗仪,生物反馈组行生物反馈治疗,电刺激组行电刺激治疗,生物反馈加电刺激组行生物反馈电刺激治疗;每周5次,连续2周;对照组不予上述治疗,随诊1个月。治疗前后进行NIH-CPSI评分以及尿流率检查。结果:生物反馈组、电刺激组和生物反馈加电刺激组治疗后NIH-CPSI疼痛与不适评分、NIH-CPSI排尿症状评分、NIH-CPSI生活质量评分、NIH-CPSI总评分、最大尿流率较治疗前均有显著改善(P<0.05);治疗前各组积分及最大尿流率比较无显著差异(P>0.05);治疗后上述参数生物反馈组、电刺激组比较没有显著差异(P>0.05),生物反馈加电刺激组与生物反馈组、电刺激组比较有显著差异(P<0.05)。而对照组治疗前后的以上各组评分及最大尿流率比较无显著差异(P>0.05)。结论:生物反馈和电刺激治疗能明显改善CP/CPPS患者疼痛与不适症状,排尿症状,提高生活质量,以及提高最大尿流率。生物反馈和电刺激联合治疗CP/CPPS有协同作用。     

体外冲击波治疗慢性盆腔疼痛综合症临床效果的Meta分析

目的:系统评价体外冲击波疗法(EWSWT)治疗慢性前列腺炎/慢性盆腔疼痛综合症(CP/CPPS)的临床疗效,为CPPS的治疗提供循证医学证据。方法:计算机检索PubMed、The Cochrane Library、EMbase、CNKI、VIP、WanFang Data和CBM数据库,手工检索《临床泌尿外科杂志》、《中华泌尿外科杂志》,收集关于体外冲击波疗法(ESWT)治疗慢性盆腔疼痛综合症(CP/CPPS)的RCT,检索时限为建库至2019年2月1日。由2名研究者严格按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用RevMan5.3软件进行Meta分析。结果:纳入12篇文献,共838例CPPS患者。Meta分析结果显示,与对照组相比,ESWT能提高患者治疗总体有效率[OR=8.75,95%CI(5.16～14.86),P0.000 01],降低患者慢性前列腺炎症状评分(NIH-CPSI)[MD=-5.10,95%CI为(-6.13～-4.06),P0.000 01]。亚组分析发现,较高的体外冲击波脉冲数(脉冲数≥2 000)具有更好的临床疗效[2 000脉冲组MD=-4.79,95%CI(-6.20～-3.38),P0.000 01;2 000脉冲组MD=-5.76,95%CI(-7.09～-4.42),P0.000 01]。结论:ESWT能提高CPPS患者治疗总体有效率,改善慢性前列腺炎症状。受纳入研究数量和质量的限制,上述结论还需更多高质量、设计严谨的研究予以验证。     

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.     

Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), or NIH category III prostatitis, is a common clinical syndrome characterized by genital/pelvic pain and lower urinary tract symptoms in the absence of urinary tract infection. There is also growing recognition of the association of sexual dysfunction with CP/CPPS including erectile dysfunction, ejaculatory pain, and premature ejaculation. In this review, we discuss the association between CP/CPPS and sexual dysfunction, potential mechanisms for sexual dysfunction, and treatment strategies for erectile dysfunction in CP/CPPS.     

Controversies in chronic abacterial prostatitis/pelvic pain syndrome

Chronic abacterial prostatitis (or prostatitis Category III according to the National Institutes of Health terminology) is subject to re-evaluation. Organizations such as the International Continence Society, the International Association for the Study of Pain and the European Association of Urology have been involved in a continuous endeavour to design a more accurate taxonomy system. The term prostate pain syndrome (PPS), as a subcategory of chronic pelvic pain syndromes, has recently been suggested as the most relevant. This condition is common, very bothersome and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased there have been no real breakthroughs; controversies and many unanswered questions remain. Examples of pertinent issues are as follows: the criteria that need to be fulfilled for a diagnosis; the significance or lack of significance of leucocytes in expressed prostatic secretion; and the association between erectile dysfunction and PPS. The fundamental question remains: is the prostate really involved in the majority of men with PPS? This article focuses on some of the controversies.     

慢性前列腺炎/慢性骨盆疼痛综合征药物治疗进展

慢性前列腺炎(chronic prostatitis.CP)是泌尿外科门诊中最常见的一种疾病,流行病学调查显示:CP在男性人群发病率高达2.5%～16.0%,慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)是CP中最常见也是疗效最差的类型,其发病机制目前不是很清楚.治疗没有规范和标准.本文就近年来国内外有关CWCPPS药物治疗方面的新进展作一综述,并探讨目前治疗所面临的主要问题及可能原因.