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Naiyila X, Li J, Huang Y, Chen B, Zhu M, Li J, Chen Z, Yang L, Ai J, Wei Q, Liu L, Cao D. A Novel Insight into the Immune-Related Interaction of Inflammatory Cytokines in Benign Prostatic Hyperplasia. J Clin Med 2023; 12:jcm12051821. [PMID: 36902608 PMCID: PMC10003138 DOI: 10.3390/jcm12051821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common male condition that impacts many men's quality of life by generating lower urinary tract symptoms (LUTS). In recent years, inflammation has become very common in the prostate, and BPH with inflammation has a higher International Prostate Symptom Score (IPSS) score and an enlarged prostate. Chronic inflammation leads to tissue damage and the release of pro-inflammatory cytokines, which play an important role in the pathogenesis of BPH. We will focus on current advancements in pro-inflammatory cytokines in BPH, as well as the future of pro-inflammatory cytokine research.
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Affiliation(s)
- Xiaokaiti Naiyila
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Mengli Zhu
- Research Core Facility, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zeyu Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (L.L.); (D.C.); Tel./Fax: +86-28-8542-2451 (L.L. & D.C.)
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (L.L.); (D.C.); Tel./Fax: +86-28-8542-2451 (L.L. & D.C.)
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Cai T, Gallelli L, Cione E, Verze P, Palmieri A, Mirone V, Bonkat G, Wagenlehner FM, Bjerklund Johansen TE. The efficacy and tolerability of pollen extract in combination with hyaluronic acid and vitamins in the management of patients affected by chronic prostatitis/chronic pelvic pain syndrome: a 26 weeks, randomized, controlled, single-blinded, phase III study. Minerva Urol Nephrol 2022; 74:780-788. [PMID: 33781014 DOI: 10.23736/s2724-6051.21.04141-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains a challenging clinical condition to manage. Here, we evaluate the efficacy and tolerability of a new treatment option (suppositories) containing pollen extract in combination with hyaluronic acid and vitamins in the management of patients with CP/CPPS. METHODS In this prospective, randomized, controlled, single-blinded, phase-III study we enrolled CP/CPPS patients between March and December 2019. Participants were randomized (1:1) to the following treatment groups: 1) pollen extract suppositories 1 daily for 10 days; or 2) ibuprofen 600 mg 1 tablet in the morning for 10 days. At the enrolment time and at the follow-up evaluations (3, 6 months), all patients completed baseline questionnaires ([National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and Quality of Well-Being [QoL]) and underwent urological examination and microbiological evaluation. The primary endpoint was the quality-of-life assessment with Patients' Reported Outcomes (PROs). RESULTS One hundred and eighty-seven patients were screened. Finally, one hundred and twenty-four patients (mean age 34.6±3.9 years) were randomly allocated to the new pollen extract treatment (N.=63) or ibuprofen (N.=61) groups. At the end of follow-up examinations 56/63 group 1 patients (88.8%) showed a significant reduction of the NIH-CPSI total score, compared with 17/61 (27.8%) in group 2 (P<0.0001). Group 1 patients also reported a higher improvement in terms of PROs, when compared with the control group and group 1 patients reported a significant reduction of leucocyte count at the Meares-Stamey Test (-12; -4; P<0.001). Only mild adverse events were reported in the two groups and adverse events were less frequent in the pollen extract suppositories group. CONCLUSIONS The combination of pollen extract with hyaluronic acid and vitamins is more effective than ibuprofen in improving symptoms and Quality of Life in patients affected with CP/CPPS and has less side effects.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy - .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway -
| | - Luca Gallelli
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy.,Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, Catanzaro, Italy
| | - Erika Cione
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Paolo Verze
- Scuola Medica Salernitana, Unit of Urology, AOU San Giovanni di Dio e Ruggi D'Aragona, University of Salerno, Salerno, Italy
| | - Alessandro Palmieri
- Unit of Urology, AOU Federico II, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, AOU Federico II, University of Naples Federico II, Naples, Italy
| | - Gernot Bonkat
- Alta Uro AG, Center of Biomechanics and Calorimetry, Merian Iselin Klinik, University of Basel, Basel, Switzerland
| | - Florian M Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH, Justus Liebig University, Giessen, Germany
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Urology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Algethami JS, El-Wahed AAA, Elashal MH, Ahmed HR, Elshafiey EH, Omar EM, Naggar YA, Algethami AF, Shou Q, Alsharif SM, Xu B, Shehata AA, Guo Z, Khalifa SAM, Wang K, El-Seedi HR. Bee Pollen: Clinical Trials and Patent Applications. Nutrients 2022; 14:nu14142858. [PMID: 35889814 PMCID: PMC9323277 DOI: 10.3390/nu14142858] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 02/06/2023] Open
Abstract
Bee pollen is a natural cocktail of floral nectar, flower pollen, enzymes, and salivary secretions produced by honeybees. Bee pollen is one of the bee products most enriched in proteins, polysaccharides, polyphenols, lipids, minerals, and vitamins. It has a significant health and medicinal impact and provides protection against many diseases, including diabetes, cancer, infectious, and cardiovascular. Bee pollen is commonly promoted as a cost-effective functional food. In particular, bee pollen has been applied in clinical trials for allergies and prostate illnesses, with a few investigations on cancer and skin problems. However, it is involved in several patents and health recipes to combat chronic health problems. This review aimed to highlight the clinical trials and patents involving bee pollen for different cases and to present the role of bee pollen as a supplementary food and a potential product in cosmetic applications.
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Affiliation(s)
- Jari S. Algethami
- Department of Chemistry, College of Science and Arts, Najran University, P.O. Box 1988, Najran 11001, Saudi Arabia;
| | - Aida A. Abd El-Wahed
- Department of Bee Research, Plant Protection Research Institute, Agricultural Research Centre, Giza 12627, Egypt;
| | - Mohamed H. Elashal
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Kom 32512, Egypt; (M.H.E.); (H.R.A.); (E.H.E.)
| | - Hanan R. Ahmed
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Kom 32512, Egypt; (M.H.E.); (H.R.A.); (E.H.E.)
| | - Esraa H. Elshafiey
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Kom 32512, Egypt; (M.H.E.); (H.R.A.); (E.H.E.)
| | - Eslam M. Omar
- Plant Protection Department, Faculty of Agriculture, Assiut University, Assiut 71526, Egypt;
| | - Yahya Al Naggar
- Zoology Department, Faculty of Science, Tanta University, Tanta 31527, Egypt;
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle, Germany
| | - Ahmed F. Algethami
- Alnahalaljwal Foundation Saudi Arabia, P.O. Box 617, Al Jumum, Makkah 21926, Saudi Arabia;
| | - Qiyang Shou
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China;
| | - Sultan M. Alsharif
- Biology Department, Faculty of Science, Taibah University, Al Madinah P.O. Box 887, Saudi Arabia;
| | - Baojun Xu
- Food Science and Technology Program, BNU-HKBU United International College, Zhuhai 519087, China;
| | - Awad A. Shehata
- Avian and Rabbit Diseases Department, Faculty of Veterinary Medicine, University of Sadat City, Menoufia 22857, Egypt;
- PerNaturam GmbH, An der Trift 8, 56290 Gödenroth, Germany
- Prophy-Institute for Applied Prophylaxis, 59159 Bönen, Germany
| | - Zhiming Guo
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China;
| | - Shaden A. M. Khalifa
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, S-106 91 Stockholm, Sweden;
| | - Kai Wang
- Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing 100093, China
- Correspondence: (K.W.); (H.R.E.-S.); Tel.: +86-10-6259-6625 (K.W.); +46-70-043-4343 (H.R.E.-S.)
| | - Hesham R. El-Seedi
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Kom 32512, Egypt; (M.H.E.); (H.R.A.); (E.H.E.)
- Pharmacognosy Group, Department of Pharmaceutical Biosciences, Uppsala University, Biomedical Centre, P.O. Box 591, SE 751 24 Uppsala, Sweden
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu Education Department, Jiangsu University, Nanjing 210024, China
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Correspondence: (K.W.); (H.R.E.-S.); Tel.: +86-10-6259-6625 (K.W.); +46-70-043-4343 (H.R.E.-S.)
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Ouango M, Romba R, Drabo SF, Ouedraogo N, Gnankiné O. Indigenous knowledge system associated with the uses of insects for therapeutic or medicinal purposes in two main provinces of Burkina Faso, West Africa. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2022; 18:50. [PMID: 35790988 PMCID: PMC9254572 DOI: 10.1186/s13002-022-00547-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Some insects are harmful to humans, plants and animals, but some of them can also be a source of proteins, fats, vitamins and minerals and be of therapeutic value. The therapeutic potential requires that medicinal insects and their derived products need to be scrutinized. This study highlights the indigenous knowledge related to their use of medicinal insects in peri-urban and urban areas of Burkina Faso. METHODS The survey was carried out among 60 traditional healers spread across two phytogeographical zones of Burkina Faso. The questionnaire focused on medicinal insects used by experienced traditional healers. Chi-square tests and principal component analysis were performed to test for significant differences regarding knowledge of how insects in phytogeographically different areas were used therapeutically in connection with different disease categories. RESULTS A total of 19 species of medicinal insects belonging to 6 orders were cited in connection with treatments of at least 78 pathologies and symptoms. Most frequently mentioned was gastroenteritis. Our study showed that 48.78% of the insects and their products were associated with 46 plant species for the treatment of pathologies. In addition, honey, beeswax and nests were the most widely insect products used. CONCLUSION The current study allows us to identify medicinal insects as well as their products used in the treatment of pathologies and symptoms, suggesting the presence of a considerable diversity of therapeutically important insect species. These insects are used alone and/or with their products but often in association with medicinal plants. The results constitute a useful database for future studies of medicinal insects in central and western parts of Burkina Faso.
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Affiliation(s)
- Mamadou Ouango
- Laboratoire d'Entomologie Fondamentale et Appliquée, Unité de Formation et de Recherche en Sciences de la vie et de la Terre (UFR-SVT), Université Joseph KI ZERBO, 03 BP, 7021, Ouagadougou, Burkina Faso
| | - Rahim Romba
- Laboratoire d'Entomologie Fondamentale et Appliquée, Unité de Formation et de Recherche en Sciences de la vie et de la Terre (UFR-SVT), Université Joseph KI ZERBO, 03 BP, 7021, Ouagadougou, Burkina Faso
| | - Samuel Fogné Drabo
- Laboratoire d'Entomologie Fondamentale et Appliquée, Unité de Formation et de Recherche en Sciences de la vie et de la Terre (UFR-SVT), Université Joseph KI ZERBO, 03 BP, 7021, Ouagadougou, Burkina Faso
| | - Noufou Ouedraogo
- Institut de Recherche en Sciences de la Santé, (IRSS), 03 BP, 7192, Ouagadougou, Burkina Faso
| | - Olivier Gnankiné
- Laboratoire d'Entomologie Fondamentale et Appliquée, Unité de Formation et de Recherche en Sciences de la vie et de la Terre (UFR-SVT), Université Joseph KI ZERBO, 03 BP, 7021, Ouagadougou, Burkina Faso.
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Csikós E, Horváth A, Ács K, Papp N, Balázs VL, Dolenc MS, Kenda M, Kočevar Glavač N, Nagy M, Protti M, Mercolini L, Horváth G, Farkas Á. Treatment of Benign Prostatic Hyperplasia by Natural Drugs. Molecules 2021; 26:molecules26237141. [PMID: 34885733 PMCID: PMC8659259 DOI: 10.3390/molecules26237141] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/08/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy.
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Affiliation(s)
- Eszter Csikós
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Adrienn Horváth
- Department of Pharmaceutical Biology, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary;
| | - Kamilla Ács
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Nóra Papp
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Viktória Lilla Balázs
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Marija Sollner Dolenc
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Maša Kenda
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Nina Kočevar Glavač
- University of Ljubljana, Department of Pharmaceutical Biology, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia;
| | - Milan Nagy
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University in Bratislava, SK-832-32 Bratislava, Slovakia;
| | - Michele Protti
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Laura Mercolini
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Györgyi Horváth
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Ágnes Farkas
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
- Correspondence:
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Mărgăoan R, Stranț M, Varadi A, Topal E, Yücel B, Cornea-Cipcigan M, Campos MG, Vodnar DC. Bee Collected Pollen and Bee Bread: Bioactive Constituents and Health Benefits. Antioxidants (Basel) 2019; 8:antiox8120568. [PMID: 31756937 PMCID: PMC6943659 DOI: 10.3390/antiox8120568] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 12/22/2022] Open
Abstract
Bee products were historically used as a therapheutic approach and in food consumption, while more recent data include important details that could validate them as food supplements due to their bioproperties, which support their future use as medicines. In this review data, data collected from bee pollen (BP) and bee bread (BB) essays will be discussed and detailed for their nutritional and health protective properties as functional foods. Dietary antioxidants intake derived from BP and BB have been associated with the prevention and clinical treatment of multiple diseases. The beneficial effects of BP and BB on health result from the presence of multiple polyphenols which possess anti-inflammatory properties, phytosterols and fatty acids, which play anticancerogenic roles, as well as polysaccharides, which stimulate immunological activity. From the main bioactivity studies with BP and BB, in vitro studies and animal experiments, the stimulation of apoptosis and the inhibition of cell proliferation in multiple cell lines could be one of the major therapeutic adjuvant effects to be explored in reducing tumor growth. Tables summarizing the main data available in this field and information about other bio-effects of BP and BB, which support the conclusions, are provided. Additionally, a discussion about the research gaps will be presented to help further experiments that complete the tree main World Health Organization (WHO) Directives of Efficiency, Safety and Quality Control for these products.
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Affiliation(s)
- Rodica Mărgăoan
- Advanced Horticultural Research Institute of Transylvania, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania;
| | - Mirela Stranț
- Association Health with CasaBIO, 400015 Cluj-Napoca, Romania; (M.S.); (A.V.)
| | - Alina Varadi
- Association Health with CasaBIO, 400015 Cluj-Napoca, Romania; (M.S.); (A.V.)
| | - Erkan Topal
- Apiculture Section, Aegean Agricultural Research Institute, İzmir 35661, Turkey;
| | - Banu Yücel
- Department of Animal Science, Faculty of Agriculture, Ege University, İzmir 35100, Turkey;
| | - Mihaiela Cornea-Cipcigan
- Faculty of Horticulture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
- Correspondence: (M.C.-C.); (M.G.C.)
| | - Maria G. Campos
- Observatory of Drug-Herb Interactions, Faculty of Pharmacy, University of Coimbra, Heath Sciences Campus, Azinhaga de Santa Comba, 3000-370 Coimbra, Portugal
- Coimbra Chemistry Centre (CQC, FCT Unit 313) (FCTUC), University of Coimbra, Rua Larga, 3000-370 Coimbra, Portugal
- Correspondence: (M.C.-C.); (M.G.C.)
| | - Dan C. Vodnar
- Department of Food Science, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania;
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Macchione N, Bernardini P, Piacentini I, Mangiarotti B, Del Nero A. Flower Pollen Extract in Association with Vitamins (Deprox 500®) Versus Serenoa repens in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Comparative Analysis of Two Different Treatments. Antiinflamm Antiallergy Agents Med Chem 2019; 18:151-161. [PMID: 30488800 PMCID: PMC6751341 DOI: 10.2174/1871523018666181128164252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 01/10/2023]
Abstract
Objective: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is re-ported in the literature ranging from 1 to 14.2%. The aim of the present study was to as-sess the impact on patient’s quality of life and symptoms of Flower pollen extract in asso-ciation with vitamins (Deprox 500®) in comparison with Serenoa repens 320 mg (Permix-on 320 mg® by Pierre Fabre) in patients with CP/CPPS. Methodology: All consecutive patients, with a diagnosis of CP/CPPS, referred to our center from January to August 2016, were screened to be enrolled in this single-center, random-ized, controlled trial. The main outcome measure was the evaluation of IPSS/NIH-CPSI (International Prostatic Symptom Score/NIH-Chronic Prostatitis Symptom Index) score variation and the assessment of the quality of life and symptoms at the end of the thera-py. The second outcome measure was the evaluation of the comorbidity role in the CP/CPPS therapy. 63 patients were analyzed; patients were randomized into two groups: 29 patients were treated with Deprox 500® 2 tablets/day for 6 weeks and 34 patients with Serenoa repens 320 mg, 1 tablet/day for 6 weeks. Results: The mean score variation for IPSS was -12.7 ± 4.3 in the Deprox 500® group and -7.8 ± 4.7 in the Serenoa repens group (p=0.0005) while for NIH-CPSI was -17.3±3.1 in the Deprox 500® group and -13.6±4.8 in the Serenoa repens group (p=0.0016). By ac-counting only the symptoms part of NIH-CPSI questionnaire, the mean score variation reported was -11.5±2.5 in the Deprox 500® group and -9.02±4.0 in the Serenoa repens group (p=0.009321). Furthermore, analyzing the comorbidity subgroups, in patients with hypertension, the mean IPSS score variation was -14.3±3.2 in the Deprox 500® group and -9.02±4.0 in the Serenoa repens group. Conclusion: In conclusion, in patients with CP/CPPS, Deprox 500® improves IPSS and NIH-CPSI scores up to 74.5% and 84.5% respectively. Furthermore, in patients with hypertension, the antioxidant effect of Deprox 500® reduces the mean IPSS score of 82.7%.
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Affiliation(s)
- Nicola Macchione
- ASST Santi Paolo e Carlo, University of Milan, Via Antonio di Rudini 8, 20100 Milano, Italy
| | - Paolo Bernardini
- ASST Santi Paolo e Carlo, University of Milan, Via Antonio di Rudini 8, 20100 Milano, Italy
| | - Igor Piacentini
- ASST Santi Paolo e Carlo, University of Milan, Via Antonio di Rudini 8, 20100 Milano, Italy
| | - Barbara Mangiarotti
- ASST Santi Paolo e Carlo, University of Milan, Via Antonio di Rudini 8, 20100 Milano, Italy
| | - Alberto Del Nero
- ASST Santi Paolo e Carlo, University of Milan, Via Antonio di Rudini 8, 20100 Milano, Italy
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8
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Guan Q, Zheng Y, Wei X, Wang S, Su B, Yu S. The Effect of Flavonoids on Chronic Prostatitis: A Meta-analysis of Published Randomized Controlled Trials. J Natl Med Assoc 2019; 111:555-562. [PMID: 31130294 DOI: 10.1016/j.jnma.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effect of flavonoids on chronic prostatitis, a meta-analysis of randomized controlled trials was performed. METHODS Through using subject word and random word, PubMed, Scopus, Web of Science, and Cochrane Library were searched for related records up to July 2018. The response rate and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) were used to evaluate the therapeutic efficacy of the flavonoids. The Cochrane handbook for systematic reviews of interventions version was used to evaluate the quality of included studies. The model of determining odds ratio (OR) was chose according to the value of I2. RESULTS A total of 11 studies involving 975 subjects (experiment 516, control 459) were included. The overall OR of response rate was 0.31 (95%CI 0.11-0.89, P = 0.03). At the subgroup analysis, the OR of response rate of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) was 0.57 (95%CI 0.18-1.77, P = 0.33), while the OR of response rate of chronic bacterial prostatitis (CBP) was 0.08 (95%CI 0.02-0.33, P = 0.0005). The OR of response rate of CP/CPPS (control was placebo) was 0.29 (95%CI 0.16-0.52, P < 0.0001). The overall OR of baseline NIH-CPSI was -0.1 (95%CI -0.61-0.41, P = 0.70). The overall OR of posttreatment NIH-CPSI was -6.96 (95%CI -8.32∼ -5.60, P < 0.00001). CONCLUSIONS This meta-analysis indicates that the flavonoids may be clinically beneficial through significantly improving the response rate and NIH-CPSI in chronic prostatitis patients and short-lasting antibiotics therapy in association with the flavonoids could be a better choose for CBP. Moreover, the flavonoids therapy has an excellent safety profile with minor adverse effects.
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Affiliation(s)
- Qiangdong Guan
- School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan 250012, PR China
| | - Yunhe Zheng
- Gansu Provincial Center for Disease Control and Prevention, Institute for Communicable Disease Control and Prevention, 230 Donggang Road West Lanzhou, Gansu 730000, PR China
| | - Xiaomin Wei
- Department of Outpatient, Department of Public Health, Jinan Central Hospital, Jinan 250033, PR China
| | - Shue Wang
- School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan 250012, PR China
| | - Benyu Su
- School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan 250012, PR China
| | - Sufang Yu
- School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan 250012, PR China.
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Sacco E, Totaro A, Marangi F, Pinto F, Racioppi M, Gulino G, Volpe A, Gardi M, Bassi P. Prostatitis Syndromes and Sporting Activities. Urologia 2018. [DOI: 10.1177/039156031007700209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Prostatitis-like syndromes are high prevalent health problems and frequently considered by patients and physicians as strictly correlated to sports causing perineal compression. These syndromes and their relationships with sporting activities have been discussed in this report. Methods We reviewed peer-reviewed scientific articles published by May 2009 and searched according to the following term selection: prostatitis, pudendal nerve, sport, cycling. Results Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major healthcare burden heavily affecting patients’ Quality of Life. No clear evidence of any direct etiologic relationship has been found in literature between prostatitis, either bacterial or non-bacterial, and sports activities. On the other hand, some types of sport causing perineal compression, such as cycling, can exacerbate symptoms of acute and chronic prostatitis; a temporary sport discontinuation is justified in these patients. CP/CPPS may be often caused by pudendal nerve entrapment (PNE). Prostatitis-like urogenital neuropathic pain together with voiding and sexual dysfunctions are the hallmark of PNE. A common feature is that flexion activities of the hip, such as climbing, squatting, cycling provoke or worsen urogenital pain or pelvic pain. Many of the patients with PNE are cyclists, played American football, lifted weights, or wrestled as teenagers and young adults. PNE represents the most common bicycling associated urogenital problems. Conclusions Overall, studies show that no causal relationship has been demonstrated between prostatitis and sporting activities. Conversely, urologists should be aware that sports involving vigorous hip flexion activities or prolonged perineal compression are a potential and not an infrequent cause of uroand rological symptoms caused by pudendal nerve entrapment.
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Affiliation(s)
- E. Sacco
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Totaro
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - F. Marangi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - F. Pinto
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - M. Racioppi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - G. Gulino
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Volpe
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - M. Gardi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - P.F. Bassi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
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Cai T, Verze P, La Rocca R, Palmieri A, Tiscione D, Luciani LG, Mazzoli S, Mirone V, Malossini G. The Clinical Efficacy of Pollen Extract and Vitamins on Chronic Prostatitis/Chronic Pelvic Pain Syndrome Is Linked to a Decrease in the Pro-Inflammatory Cytokine Interleukin-8. World J Mens Health 2017; 35:120-128. [PMID: 28497911 PMCID: PMC5583369 DOI: 10.5534/wjmh.2017.35.2.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We aim to evaluate the efficacy of pollen extract in association with vitamins in patients affected by chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to evaluate the level of the pro-inflammatory mediators interleukin (IL)-6, IL-8, and IL-10. MATERIALS AND METHODS Patients diagnosed with CP/CPPS between January and December 2015 were enrolled in this study. Participants were randomly assigned to receive oral capsules of pollen extract and vitamins (group A) or bromelain (group B) for 3 months. At the enrolment time and 3 months after enrolment, all patients completed questionnaires (the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and the Short Form-36 and underwent urological examinations and microbiological evaluation. Levels of IL-6, IL-8, and IL-10 were evaluated in seminal plasma. RESULTS Sixty-five male patients (mean age of 32.7±4.7 years) were analysed (group A, n=32; group B, n=33). At the follow-up examination, 24 of the 32 patients in group A showed a significant reduction in the NIH-CPSI total score compared with 8 of the 33 patients in the bromelain group (p<0.001). Moreover, the mean level of IL-8 was significantly lower in the pollen extract and vitamins group when compared with the bromelain group (298 pg/mL vs. 736 pg/mL, respectively; p<0.001). In group A we found a statistically significant reduction in the levels of IL-8 between enrolment and the follow-up visit (878 pg/mL vs. 298 pg/mL, respectively; p<0.001). CONCLUSIONS Treatment with pollen extract and vitamins improved the quality of life in CP/CPPS patients by reducing the levels of pro-inflammatory IL-8.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
| | - Paolo Verze
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | | | - Daniele Tiscione
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | | | - Sandra Mazzoli
- STD Centre, Santa Maria Annunziata Hospital, Florence, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | - Gianni Malossini
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
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11
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Cai T, Verze P, La Rocca R, Anceschi U, De Nunzio C, Mirone V. The role of flower pollen extract in managing patients affected by chronic prostatitis/chronic pelvic pain syndrome: a comprehensive analysis of all published clinical trials. BMC Urol 2017; 17:32. [PMID: 28431537 PMCID: PMC5401347 DOI: 10.1186/s12894-017-0223-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is still a challenge to manage for all physicians. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of flower pollen extract would be helpful for physicians who are considering a phytotherapeutic approach to treating patients with CP/CPPS. METHODS A comprehensive search of the PubMed and Embase databases up to June 2016 was performed. This comprehensive analysis included both pre-clinical and clinical trials on the role of flower pollen extract in CP/CPPS patients. Moreover, a meta-analysis of available randomized controlled trials (RCTs) was performed. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and Quality of Life related questionnaires (QoL) were the most commonly used tools to evaluate the therapeutic efficacy of pollen extract. RESULTS Pre-clinical studies demonstrated the anti-inflammatory and anti-proliferative role of pollen extract. 6 clinical, non-controlled studies including 206 patients, and 4 RCTs including 384 patients were conducted. The mean response rate in non-controlled studies was 83.6% (62.2%-96.0%). The meta-analysis revealed that flower pollen extract could significantly improve patients' quality of life [OR 0.52 (0.34-.0.81); p = 0.02]. No significant adverse events were reported. CONCLUSION Most of these studies presented encouraging results in terms of variations in NIH-CPSI and QoL scores. These studies suggest that the use of flower pollen extract for the management of CP/CPPS patients is beneficial. Future publications of robust evidence from additional RCTs and longer-term follow-up would provide more support encouraging the use of flower pollen extracts for CP/CPPS patients.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
| | - Paolo Verze
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | - Umberto Anceschi
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples, Federico II, Naples, Italy
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12
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Adhikari KB, Tanwir F, Gregersen PL, Steffensen SK, Jensen BM, Poulsen LK, Nielsen CH, Høyer S, Borre M, Fomsgaard IS. Benzoxazinoids: Cereal phytochemicals with putative therapeutic and health-protecting properties. Mol Nutr Food Res 2015; 59:1324-38. [DOI: 10.1002/mnfr.201400717] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/23/2014] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
Affiliation(s)
| | - Fariha Tanwir
- Department of Molecular Biology and Genetics; Aarhus University; Slagelse Denmark
| | - Per L. Gregersen
- Department of Molecular Biology and Genetics; Aarhus University; Slagelse Denmark
| | | | | | - Lars K. Poulsen
- Allergy Clinic; Copenhagen University Hospital; Gentofte Denmark
| | - Claus H. Nielsen
- Department of Infectious Medicine and Rheumatology; University of Copenhagen; Rigshospitalet Denmark
| | - Søren Høyer
- Department of Pathology; Aarhus University Hospital; Skejby Denmark
| | - Michael Borre
- Department of Urology; Aarhus University Hospital; Aarhus Denmark
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13
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Guan X, Zhao C, Ou ZY, Wang L, Zeng F, Qi L, Tang ZY, Dun JG, Liu LF. Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Asian J Androl 2015; 17:120-3. [PMID: 25248659 PMCID: PMC4291855 DOI: 10.4103/1008-682x.138189] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/22/2014] [Accepted: 07/15/2014] [Indexed: 12/20/2022] Open
Abstract
The urinary, psychosocial, organ-specific, infection, neurological/systemic and tenderness (UPOINT) phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CP/CPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re-examined after 6 months. A minimum 6-point drop in National Institutes of Health-Chronic Prostatitis Symptoms Index (NIH-CPSI) was set to be the primary endpoint. Finally, 140 patients were enrolled in the study. The percentage of patients with each domain was 59.3%, 45.0%, 49.3%, 22.1%, 37.9%, and 56.4% for the UPOINT, respectively. The number of positive domains significantly correlated with symptom severity, which is measured by total NIH-CPSI scores (r = 0.796, P< 0.001). Symptom duration was associated with a greater number of positive domains (r = 0.589, P< 0.001). With 6 months follow-up at least, 75.0% (105/140) had at least a 6-point improvement in NIH-CPSI after taking the therapy. All NIH-CPSI scores were significantly improved from original ones: pain 10.14 ± 4.26 to 6.60 ± 3.39, urinary 6.29 ± 2.42 to 3.63 ± 1.52, quality of life 6.56 ± 2.44 to 4.06 ± 1.98, and total 22.99 ± 7.28 to 14.29 ± 5.70 (all P< 0.0001). Our study indicates that the UPOINT system is clinically feasible in classifying Chinese patients with CP/CPPS and directing therapy.
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Affiliation(s)
- Xiao Guan
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Cheng Zhao
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhen-Yu Ou
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zheng-Yan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jin-Geng Dun
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Long-Fei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
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14
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Cai T, Wagenlehner FME, Luciani LG, Tiscione D, Malossini G, Verze P, Mirone V, Bartoletti R. Pollen extract in association with vitamins provides early pain relief in patients affected by chronic prostatitis/chronic pelvic pain syndrome. Exp Ther Med 2014; 8:1032-1038. [PMID: 25187793 PMCID: PMC4151652 DOI: 10.3892/etm.2014.1861] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/30/2014] [Indexed: 11/06/2022] Open
Abstract
The therapeutic efficacy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is currently unsatisfactory. The aim of the present study was to assess the safety and efficacy of pollen extract in association with vitamins (DEPROX 500®) in males with CP/CPPS. All patients with a diagnosis of CP/CPPS attending the same urologic centre between March and October 2012 were enrolled in this randomised controlled phase III study. Participants were randomised to receive oral capsules of DEPROX 500® (two capsules every 24 h) or ibuprofen (600 mg, one tablet three times a day) for four weeks. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score and Quality of Well-Being (QoL) questionnaires were used. In the intention-to-treat analysis, 87 males (25 class IIIa and 62 class IIIb) with a mean age of 33.6±5.9 years were randomly allocated to the DEPROX 500® (n=41) or ibuprofen (n=46) treatment groups. At the follow-up examination (following one month of treatment), in the DEPROX 500® group, 31/41 patients (75.6%) reported an improvement in quality of life, defined as a reduction of the NIH-CPSI total score by ≥25%, compared with 19/46 (41.3%) in the control group (P=0.002). The greater improvement in the DEPROX 500® group compared with the ibuprofen group was statistically significant (treatment difference in the NIH-CPSI pain domain, −2.14±0.51, P<0.001; QoL scores, P=0.002). All patients were negative at the Meares-Stamey test evaluation. Adverse events were less frequent in the DEPROX 500® group than in the ibuprofen group. The DEPROX 500® treatment significantly improved total symptoms, pain and quality of life compared with ibuprofen in patients with CP/CPPS, without severe side-effects.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Florian M E Wagenlehner
- Clinic and Polyclinic for Urology, Child Urology and Andrology, University Hospital of Giessen und Marburg, Justus-Liebig University, Giessen, Germany
| | | | - Daniele Tiscione
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Gianni Malossini
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Paolo Verze
- Department of Urology, University Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II, Naples, Italy
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16
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Estevinho LM, Rodrigues S, Dias T, da Silva JP, Feás X. WITHDRAWN: Botanical, nutritional and microbiological characterisation of honeybee-collected pollen from Portugal. Food Chem Toxicol 2011:S0278-6915(11)00592-8. [PMID: 22107992 DOI: 10.1016/j.fct.2011.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/27/2011] [Accepted: 11/07/2011] [Indexed: 10/15/2022]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Leticia M Estevinho
- CIMO - Mountain Research Center, Agricultural College of Bragança, Polytechnic Institute of Bragança, Campus Santa Apolónia, E 5301-855 Bragança, Portugal
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17
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Bread from common cereal cultivars contains an important array of neglected bioactive benzoxazinoids. Food Chem 2011. [DOI: 10.1016/j.foodchem.2011.02.070] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Wagenlehner FME, Bschleipfer T, Pilatz A, Weidner W. Pollen extract for chronic prostatitis-chronic pelvic pain syndrome. Urol Clin North Am 2011; 38:285-92. [PMID: 21798390 DOI: 10.1016/j.ucl.2011.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostatitis syndrome is a frequent condition in men. It is not known in most patients if the prostate is the only organ involved. Therefore, the disease is characterized as chronic prostatitis-chronic pelvic pain syndrome (CP-CPPS). Although many studies have been performed in patients with CP-CPPS, current trial evidence is conflicting and therapeutic options are controversial. Given the need for long-term treatment in CP-CPPS patients, phytotherapeutics, such as pollen extract, are an option due to few side effects. Preclinical studies on pollen extract have shown effects on smooth muscles of the bladder and urethra, strong antiinflammatory effects, and antiproliferative effects.
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Affiliation(s)
- Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH, Justus Liebig University, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany.
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19
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Abstract
Primary care physicians can and should diagnose, classify, and treat patients presenting with acute and chronic prostatitis syndromes. Although the chronic syndromes are a challenge to manage, this review article provides the necessary background to allow primary care physicians to take on this task. Patients who are unfortunate to be diagnosed with a prostatitis syndrome have the best chance for successful therapy at initial presentation. Those patients will ultimately benefit from an informed and educated physician.
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Affiliation(s)
- Naji J Touma
- Department of Urology, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7, Canada.
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20
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Abstract
IMPORTANCE OF THE FIELD Prostatitis is a prevalent and morbid condition with a significant impact on a patient's quality of life. The four distinct prostatitis syndromes have different pathophysiologies, therapy and prognosis. Acute and chronic bacterial prostatitis is best treated with appropriate antibiotics that penetrate the prostate and kill the causative organisms. The most challenging category to treat is category III or chronic prostatitis/chronic pelvic pain syndrome. AREAS COVERED IN THE REVIEW This review covers the categories of prostatitis and currently recommended therapies, as well as novel approaches on the horizon. WHAT THE READER WILL GAIN Knowledge of the current framework for the diagnosis and management of the diverse prostatitis spectrum. TAKE HOME MESSAGE Prostatitis is a diverse group of syndromes. Chronic prostatitis/chronic pelvic pain syndrome is a multifactorial syndrome that requires a multimodal approach to effectively treat the patient. The UPOINT technique is used to clinically phenotype these patients and drive the selection of multimodal therapy.
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Affiliation(s)
- Devon C Snow
- Glickman Urological and Kidney Institute, Cleveland Clinic, Desk Q10-1, 9500 Euclid Ave, Cleveland, OH 44195, USA
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21
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Fariello JY, Moldwin RM. Update on the Use of Phytotherapy for Voiding Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol 2010; 184:2339-45. [PMID: 20952019 DOI: 10.1016/j.juro.2010.08.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Indexed: 12/30/2022]
Abstract
PURPOSE Patients with chronic prostatitis-chronic pelvic pain syndrome are difficult to treat due to the unknown etiology and complex clinical presentation. Clinical phenotyping may better correlate with multimodal treatment concepts than a current diagnosis. We evaluated a novel clinical phenotyping system in a database of patients with chronic prostatitis-chronic pelvic pain syndrome at 2 European institutions and correlated it with patient symptoms. We also investigated the addition of a sexual dysfunction domain in regard to symptom correlation and system internal consistency. MATERIALS AND METHODS We retrospectively classified 937 patients from Milan, Italy, and 290 from Giessen, Germany, with chronic prostatitis-chronic pelvic pain syndrome into a 6-domain phenotyping system, consisting of urinary, psychosocial, organ specific, infection, neurological and muscle tenderness domains, termed UPOINT. Symptom severity was assessed by the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score. RESULTS There was significant correlation between the number of positive UPOINT domains and Chronic Prostatitis Symptom Index/International Prostate Symptom Score symptoms in the total and Italian cohorts but not in the German cohort. After adding a sexual dysfunction domain to create the modified UPOINTS system phenotypic domains also correlated significantly with Chronic Prostatitis Symptom Index symptoms in the German cohort. CONCLUSIONS Consistency of the UPOINT chronic prostatitis-chronic pelvic pain syndrome clinical phenotyping system was generally confirmed by our study and further refined by adding a sexual dysfunction domain. The treatment effect of clinical phenotyping with UPOINT(S) must be extensively evaluated in prospective treatment studies.
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[Urethral syndrome in men--chronic pelvic pain syndrome]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:81-9. [PMID: 19504994 DOI: 10.2298/aci0901081c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic pelvic pain syndrome (CPPS) is defined as pelvis minor pain of nonmalignant nature repeating in different time intervals. Urethral syndrome (US) represents a most poorly defined entity within CPPS. OBJECTIVE The estimation of US influence on quality-of-life as well as the determination of the way of treatment and therapy optimal length. MATERIAL AND METHODS A prospective one-year study included 166 men with CPPS, median age of 54 years; they were monitored clinically. During the patient monitoring the NIH-CPSI questionnaire (National Institute of Health-Chronic Prostatis Symptom Index) was used. US was diagnosed in 79 patients (47%), and according to the most intensive pain localization they were divided into three groups. All the patients were treated with alpha adrenergic blockers and non-steroidal anti-inflammatory drugs, and the treatment of the patients with positive urethral smear also included antibiotherapy. The values of total NIH-CPSI, as well as of its individual components were analyzed after three and six months of treatment. RESULTS AND DISCUSSION The therapy application had a significant influence on the decrease of total NIH-CPSI--23.3% (p < 0.01), pain symptoms (p < 0.0) and urinary difficulties (p < 0.01), and the point values of quality-of-life score were diminished by 0.7 to 1.9 points depending on the group of those monitored (p < 0.01). CONCLUSION Our study indicated a significant influence of CPPS on quality-of-life and a necessity of a serious approach to patients and their treatment.
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Wagenlehner FME, Schneider H, Ludwig M, Schnitker J, Brähler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 2009; 56:544-51. [PMID: 19524353 DOI: 10.1016/j.eururo.2009.05.046] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 05/25/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND National Institutes of Health (NIH) category III prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent condition for which no standardised treatment exists. OBJECTIVES To assess the safety and efficacy of a standardised pollen extract in men with inflammatory CP/CPPS. DESIGN, SETTING, AND PARTICIPANTS We conducted a multicentre, prospective, randomised, double-blind, placebo-controlled phase 3 study comparing the pollen extract (Cernilton) to placebo in men with CP/CPPS (NIH IIIA) attending urologic centres. INTERVENTION Participants were randomised to receive oral capsules of the pollen extract (two capsules q8h) or placebo for 12 wk. MEASUREMENTS The primary endpoint of the study was symptomatic improvement in the pain domain of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). Participants were evaluated using the NIH-CPSI individual domains and total score, the number of leukocytes in post-prostatic massage urine (VB3), the International Prostate Symptom Score (IPSS), and the sexuality domain of a life satisfaction questionnaire at baseline and after 6 and 12 wk. RESULTS AND LIMITATIONS In the intention-to-treat analysis, 139 men were randomly allocated to the pollen extract (n=70) or placebo (n=69). The individual domains pain (p=0.0086) and quality of life (QoL; p=0.0250) as well as the total NIH-CPSI score (p=0.0126) were significantly improved after 12 wk of treatment with pollen extract compared to placebo. Response, defined as a decrease of the NIH-CPSI total score by at least 25% or at least 6 points, was seen in the pollen extract versus placebo group in 70.6% and 50.0% (p=0.0141), respectively. Adverse events were minor in all patients studied. CONCLUSIONS Compared to placebo, the pollen extract significantly improved total symptoms, pain, and QoL in patients with inflammatory CP/CPPS without severe side-effects.
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Affiliation(s)
- Florian M E Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig-University of Giessen, Giessen, Germany.
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Abstract
The National Institutes of Health (NIH) has redefined prostatitis into four distinct entities. Category I is acute bacterial prostatitis. It is an acute prostatic infection with a uropathogen, often with systemic symptoms of fever, chills and hypotension. The treatment hinges on antimicrobials and drainage of the bladder because the inflamed prostate may block urinary flow. Category II prostatitis is called chronic bacterial prostatitis. It is characterized by recurrent episodes of documented urinary tract infections with the same uropathogen and causes pelvic pain, urinary symptoms and ejaculatory pain. It is diagnosed by means of localization cultures that are 90% accurate in localizing the source of recurrent infections within the lower urinary tract. Asymptomatic inflammatory prostatitis comprises NIH category IV. This entity is, by definition, asymptomatic and is often diagnosed incidentally during the evaluation of infertility or prostate cancer. The clinical significance of category IV prostatitis is unknown and it is often left untreated. Category III prostatitis is called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It is characterized by pelvic pain for more than 3 of the previous 6 months, urinary symptoms and painful ejaculation, without documented urinary tract infections from uropathogens. The syndrome can be devastating, affecting 10-15% of the male population, and results in nearly 2 million outpatient visits each year. The aetiology of CP/CPPS is poorly understood, but may be the result of an infectious or inflammatory initiator that results in neurological injury and eventually results in pelvic floor dysfunction in the form of increased pelvic muscle tone. The diagnosis relies on separating this entity from chronic bacterial prostatitis. If there is no history of documented urinary tract infections with a urinary tract pathogen, then cultures should be taken when patients are symptomatic. Prostatic localization cultures, called the Meares-Stamey 4 glass test, would identify the prostate as the source for a urinary tract infection in chronic bacterial prostatitis. If there is no infection, then the patient is likely to have CP/CPPS. For healthcare providers, the focus of therapy is symptomatic relief. The first therapeutic measure is often a 4- to 6-week course of a fluoroquinolone, which provides relief in 50% of men and is more efficacious if prescribed soon after symptoms begin. Second-line pharmacotherapy involves anti-inflammatory agents for pain symptoms and alpha-adrenergic receptor antagonists (alpha-blockers) for urinary symptoms. Potentially more effective is pelvic floor training/biofeedback, but randomized controlled trials are needed to confirm this. Third-line agents include 5alpha-reductase inhibitors, glycosaminoglycans, quercetin, cernilton (CN-009) and saw palmetto. For treatment refractory patients, surgical interventions can be offered. Transurethral microwave therapy to ablate prostatic tissue has shown some promise. The treatment algorithm provided in this review involves a 4- to 6-week course of antibacterials, which may be repeated if the initial course provides relief. Pain and urinary symptoms can be ameliorated with anti-inflammatories and alpha-blockers. If the relief is not significant, then patients should be referred for biofeedback. Minimally invasive surgical options should be reserved for treatment-refractory patients.
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Affiliation(s)
- Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM. Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 2007; 70:235-8. [PMID: 17826477 DOI: 10.1016/j.urology.2007.04.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 03/06/2007] [Accepted: 04/16/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Prostatic calcification is common in asymptomatic elderly men. However, young men with chronic pelvic pain syndrome (CPPS) often have significantly calcified prostates. We studied the incidence and significance of prostatic calcification in men with CPPS. METHODS From July 2005 to August 2006, 130 new patients with CPPS were seen at our clinic. Of these 130 patients, 47 underwent transrectal ultrasonography. Prostatic calcification correlated with symptoms (National Institutes of Health chronic prostatitis symptom index score), examination findings, and culture results. The variables were compared using the Student t test, Wilcoxon unpaired test, or chi-square test. RESULTS The 47 men who had undergone transrectal ultrasonography had symptoms identical to those who had not but were older (range 46.1 to 41.6 years, P = 0.02) and had had symptoms longer (median 60 versus 12 months, P = 0.0001). Of the 47 patients, 22 (47%) had significant calcification. The symptoms with or without calcification were identical (chronic prostatitis symptom score 23.7 versus 23.9). Men with calcification had had symptoms longer (median 84 versus 27 months, P = 0.05) but were similar in age (49 versus 45 years, P = 0.21) and had a similar prostate size (21.7 cm3 for both groups). Men with calcification were less likely to have pelvic floor tenderness (50% versus 85%, P = 0.03) but were more likely to have bacteria in the prostatic fluid (P = 0.05) and had a higher median white blood cell count (3.5 versus 0 white blood cells per high power field, P = 0.058). CONCLUSIONS Prostatic calcification is common in patients with CPPS and is associated with greater inflammation, bacterial colonization, and symptom duration. Pelvic floor spasm is more common in patients without calcification. This might be an important parameter with which to stratify clinical trials.
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Affiliation(s)
- Daniel A Shoskes
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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McClure MW. Chronic Prostatitis. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology 2006; 67:60-3. [PMID: 16413333 DOI: 10.1016/j.urology.2005.07.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 07/15/2005] [Accepted: 07/21/2005] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of the pollen extract preparation Prostat/Poltit in the treatment of patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome. METHODS In a double-blind study, 60 patients between 20 and 55 years old with chronic nonbacterial prostatitis/chronic pelvic pain syndrome were randomized to receive Prostat/Poltit or placebo for 6 months. The patients had been symptomatic for more than 6 months without response to any given therapy. The patients were evaluated at the start of the treatment and after 6 months of treatment with the help of a symptom questionnaire covering the symptoms in seven pain locations, five voiding symptoms, three storage symptoms, and four sex-related symptoms. RESULTS The overall clinical evaluation of the treatment result showed that after treatment for 6 months more patients taking Prostat/Poltit were cured or improved than patients taking placebo. No adverse reactions to the treatment were found. CONCLUSIONS Prostat/Poltit is superior to placebo in providing symptomatic relief in men with chronic nonbacterial prostatitis/chronic pelvic pain syndrome.
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Affiliation(s)
- James Elist
- Cedars-Sinai Medical Center, Beverly Hills, CA 90211, USA.
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Anderson RU. Traditional therapy for chronic pelvic pain does not work: what do we do now? ACTA ACUST UNITED AC 2006; 3:145-56. [PMID: 16528287 DOI: 10.1038/ncpuro0438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 01/19/2006] [Indexed: 12/15/2022]
Abstract
The dilemma of managing patients with chronic pelvic pain syndromes continues to frustrate physicians confronted with these complaints. Multiple diagnoses traditionally label this condition in men and women and, typically, implicate a pelvic-organ system when, in fact, very little objective evidence for a pathophysiologic process exists. Traditional therapies, consisting of antibiotics, anti-inflammatories, and muscle relaxants, simply do not work, and their lack of efficacy compared with placebo has been documented by randomized clinical trials in the US that were sponsored by the NIH. What do we do now? This review article attempts to describe the clinical efforts of several investigators and to put their patients' outcomes in perspective, and thereby suggest alternative therapies to help these patients.
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Affiliation(s)
- Rodney U Anderson
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Lee CB, Ha US, Lee SJ, Kim SW, Cho YH. Preliminary experience with a terpene mixture versus ibuprofen for treatment of category III chronic prostatitis/chronic pelvic pain syndrome. World J Urol 2006; 24:55-60. [PMID: 16418872 DOI: 10.1007/s00345-005-0039-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022] Open
Abstract
To evaluate the efficacy of a terpene mixture (rowatinex) compared to ibuprofen, patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were randomly selected to either receive rowatinex 200 mg t.i.d. or ibuprofen 600 mg t.i.d. After a 6-week treatment, the decrease in the mean total NIH-CPSI score was significant in both groups from 21.4 to 15.3, (6.1 (p < 0.01) and from 21.2 to 16.8, (4.4 (p = 0.04) in the rowatinex and ibuprofen group, respectively. The rate of definite improvement as defined as 25% improvement in the total score was superior (p = 0.04) in the rowatinex group (68%) versus the ibuprofen group (40%). Judging from these results, rowatinex gave significant symptomatic relief and may be of benefit for many men diagnosed with CP/CPPS. Further, including the placebo-controlled studies are necessary to define its role in the management of this difficult to treat disease.
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Affiliation(s)
- Choong Bum Lee
- Department of Urology, St. Vincent Hospital, Catholic University College of Medicine, Suwon, Korea
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Abstract
PURPOSE OF REVIEW To investigate the relationship, diagnosis and treatment of the overlapping lower urinary tract symptoms experienced by men diagnosed with benign prostatic hyperplasia and prostatitis. RECENT FINDINGS Recent studies have clearly shown that men can suffer from both benign prostatic hyperplasia and prostatitis. Approximately 5-20% of men diagnosed with benign prostatic hyperplasia suffer from prostatitis-like symptoms, while over one third of men diagnosed with benign prostatic hyperplasia have had a diagnosis of prostatitis in the past. Differentiation between these two symptom-based medical conditions can be difficult because of overlapping symptoms, but pain clearly identifies those patients with chronic prostatitis. Treatment for men with co-occurring benign prostatic hyperplasia and prostatitis may include alpha-blockers, 5alpha-reductase inhibitors and phytotherapies (saw palmetto and bee pollen extract), with evidence clearly showing the benefits of alpha-blocker therapy. SUMMARY Benign prostatic hyperplasia and chronic prostatitis are a common cause of lower urinary tract symptoms and frequently co-occur in older men. The best treatment for men with lower urinary tract symptoms associated with both benign prostatic hyperplasia and prostatitis is alpha-blockers.
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Affiliation(s)
- J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada.
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Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2005; 2:495-501. [PMID: 16322807 PMCID: PMC1297501 DOI: 10.1093/ecam/neh128] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 09/12/2005] [Indexed: 11/23/2022]
Abstract
To discuss challenges concerning treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and review complementary and alternative medical (CAM) therapies being evaluated for this condition, we performed a comprehensive search of articles published from 1990-2005 using the PubMed, Medline databases. Data from the articles were abstracted and pooled by subject. Keywords cross-searched with CP/CPPS included: complementary, alternative, integrative, therapies, interventions, nutrition, antioxidants, herbs, supplements, biofeedback and acupuncture. Listed articles with no abstracts were not included. Various CAM therapies for CP/CPPS exist including biofeedback, acupuncture, hyperthermia and electrostimulation. Additionally, a variety of in vitro and in vivo studies testing herbal and nutritional supplements were found. Saw palmetto, cernilton and quercetin were the most frequently tested supplements for CP/CPPS. Although many CAM therapies demonstrate positive preliminary observations as prospective treatments for CP/CPPS, further exploratory studies including more randomized, controlled trials are necessary for significant validation as treatment options for this complex disorder.
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Affiliation(s)
- Jillian L Capodice
- Department of Urology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY 10032, USA.
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Yang J, Te AE. Saw palmetto and finasteride in the treatment of category-III prostatitis/chronic pelvic pain syndrome. Curr Urol Rep 2005; 6:290-5. [PMID: 15978232 DOI: 10.1007/s11934-005-0026-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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, alpha-blockade, anti-inflammatory agents, and cognitive behavioral interventions such as biofeedback and psychotherapy.
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Affiliation(s)
- Jennifer Yang
- Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA
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Yarnell E, Abascal K. Natural Approaches to Treating Chronic Prostatitis and Chronic Pelvic Pain Syndromes. ACTA ACUST UNITED AC 2005. [DOI: 10.1089/act.2005.11.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Eric Yarnell
- Botanical Medicine Academy, Vashon, Washington
- Bastyr University, Kenmore, Washington
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Shoskes DA, Thomas KD, Gomez E. Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol 2005; 173:474-7. [PMID: 15643213 DOI: 10.1097/01.ju.0000150062.60633.b2] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Category III chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a common debilitating condition of unclear etiology. Patients often have prostatic calcifications but a link to symptoms is controversial. Nanobacteria are implicated in stone formation in the urinary tract and, therefore, therapy to eliminate nanobacteria and the stones that they produce might have an impact on CPPS symptoms. MATERIALS AND METHODS A total of 16 men with recalcitrant CPPS refractory to multiple prior therapies were treated with comET (Nanobac Life Sciences, Tampa, Florida), which consists of 500 mg tetracycline, a proprietary nutraceutical and an ethylenediaminetetraacetic acid suppository daily. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), transrectal ultrasound, and blood and urine tests for nanobacterial antigen were performed at the start and conclusion of 3 months of therapy. One patient was lost to followup. RESULTS Mean NIH-CPSI total score +/- SD decreased from 25.7 +/- 1.6 to 13.7 +/- 2.0 (p <0.0001). Significant improvement was seen in each subscore domain. A total of 12 patients (80%) had at least 25% improvement on NIH-CPSI and 8 (53%) had at least 50% improvement. Nanobacterial antigen or antibody was found in 60% of serum and 40% of urine samples. In 10 patients who underwent transrectal ultrasound after therapy prostatic stones were decreased in size or resolved in 50%. CONCLUSIONS Therapy designed to eliminate nanobacteria resulted in significant improvement in the symptoms of recalcitrant CPPS in the majority of men, whether due to the treatment of stone producing nanobacteria or through some other mechanism. Prospective placebo controlled trials are warranted.
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Affiliation(s)
- Daniel A Shoskes
- Department of Kidney Transplantation, Cleveland Clinic Florida, Weston, Florida 33331, USA.
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Abstract
The symptom complex called prostatitis represents a multifactorial problem of unclear etiology. Standardized diagnostic and therapeutic approaches do not exist. Controlled studies which fulfil evidence-based medical criteria are missing. A review of the currently available literature leads to the conclusion that a multimodal therapy concept should be developed and examined.
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Affiliation(s)
- O Moormann
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Paracelsus-Klinik Golzheim, Düsseldorf.
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Abstract
Prostatitis results in >2 million physician office visits annually. Characterized by pelvic pain and voiding symptoms, chronic pelvic pain syndrome (CPPS) is poorly defined. The Chronic Prostatitis Collaborative Research Network (CPCRN) has put forward a uniform set of classifications for chronic prostatitis based on pain being the primary symptom. The CPCRN has also created a valid instrument for measuring symptoms: the Chronic Prostatitis Symptom Index. After nonbacterial prostatitis has been diagnosed, treatment of patients should be individualized. The condition may be caused by bladder, prostate, pelvic side wall, or seminal vesicle pathology. In addition to currently used treatments, several new therapies are being investigated after promising pilot studies. Despite the multiple approaches to management of CPPS, no hard and fast guidelines have been developed. This review provides an overview of assessment techniques and management options for men with CPPS.
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Affiliation(s)
- Anthony J Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-3008, USA.
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Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol 2004; 171:284-8. [PMID: 14665895 DOI: 10.1097/01.ju.0000101487.83730.80] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study was designed to assess the safety and efficacy of saw palmetto or finasteride in men with category III prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS A prospective, randomized, open label, 1-year study was designed to assess the safety and efficacy of saw palmetto and finasteride in the treatment of men diagnosed with CP/CPPS. Patients were randomized to finasteride (5 mg once daily) or saw palmetto (325 mg daily) for 1 year. Patients were evaluated using the National Institutes of Health Chronic Prostatitis Symptom Index, individual domains (pain, urinary symptoms, quality of life and mean pain score) and the American Urological Association Symptom Score at baseline, 3, 6 and 12 months. RESULTS A total of 64 consecutive men 24 to 58 years old (mean age 43.2) with a diagnosis of CP/CPPS were equally randomized to the 2 treatment arms. All 64 men had previously received antibiotics (duration of 3 to 93 weeks), 52 (82%) had been on alpha-blockade. There were 61, 57 and 56 patients evaluable at 3, 6 and 12 months, respectively. At 1 year mean total National Institutes of Health Chronic Prostatitis Symptom Index score decreased from 23.9 to 18.1 in the finasteride group (p <0.003), and from 24.7 to 24.6 in the saw palmetto arm (p = 0.41). In the finasteride arm the quality of life and pain domains were significantly improved at 1 year; however, urination was not. Adverse events included headache (3 cases) in the saw palmetto group and decreased libido (2 cases) in the finasteride group. At the end of the trial 13 of 32 (41%) and 21 of 32 (66%) opted to continue saw palmetto and finasteride, respectively. CONCLUSIONS CP/CPPS treated with saw palmetto had no appreciable long-term improvement. In contrast, patients treated with finasteride had significant and durable improvement in all various parameters except voiding. Further studies are warranted to ascertain the mechanism and reproducibility of these effects in a placebo controlled trial.
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Affiliation(s)
- Steven A Kaplan
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Abstract
Phytomedicines are becoming more popular all over the world. Prostate cancer patients and those with benign prostatic hyperplasia are increasingly exploring the use of complementary alternative medicine especially due to the risk of mortality and long-term morbidity associated with surgical procedures. The incidences of prostate diseases are continually rising and the effect of phytomedicines already tested do provide relief, are well comparable with that of traditional forms of treatment. This paper reviews the phytomedicines used in Africa, Western countries and China as a treatment of benign prostatic hyperplasia, prostatitis and prostate cancer. Herbals which hold potential promise are mentioned, although much research is still required.
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Affiliation(s)
- Vanessa Steenkamp
- Department of Urology, School of Medicine, Faculty of Health Sciences, University of Pretoria, PO Box 667, Pretoria 0001, South Africa.
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Talpur N, Echard B, Bagchi D, Bagchi M, Preuss HG. Comparison of Saw Palmetto (extract and whole berry) and Cernitin on prostate growth in rats. Mol Cell Biochem 2003; 250:21-6. [PMID: 12962139 DOI: 10.1023/a:1024988929454] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pharmaceuticals such as finasteride and alpha blockers are used to treat symptoms of benign prostatic hyperplasia (BPH) and are known to cause severe adverse reactions. Accordingly, a search for safer, natural products has been undertaken. Two natural agents (nutraceuticals) have come under recent scrutiny; because natural products, in general, often have evidence of long-term safety. The present study compares the in vivo effects on androgen-induced prostatic enlargement in rats of two nutraceuticals--the widely recognized Saw Palmetto (Serenoa repens) and the less well-known Cernitin (defined pollen extract). Non-castrated rats, had a mean prostate weight of 124 mg +/- 8.8 (S.E.M.) compared to the 24.5 mg +/- 1.9 (S.E.M.) of the castrated rat followed under the same regimen (p < 0.01). When castrated rats were given testosterone, the mass increased significantly to 250.0 mg +/- 31.7 (S.E.M.) (p < 0.01). In the five remaining groups, castrated rats receiving testosterone were given finasteride, an extract of Saw Palmetto, crushed whole berry derived from Saw Palmetto fruit, a water soluble and fat soluble extract of Cernitin or a combination of the Saw Palmetto extract and Cernitin. All treatments decreased the size of the prostate to roughly the same size as in the non-castrated rats, a size that was significantly smaller than castrated rats treated with testosterone in the same manner (p < 0.01). A second study examining non-castrated rats treated with very high doses of testosterone showed similar results. In both studies, the nutraceuticals generally decreased body weight. In conclusion, these studies show the ability of Saw Palmetto (whole berry and extract) and Cernitin to influence prostatic hyperplasia via effects on androgen metabolism.
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Affiliation(s)
- Nadeem Talpur
- Department of Physiology, Georgetown University Medical Center, Washington, DC 20007, USA
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Affiliation(s)
- Daniel A Shoskes
- Department of Urology, Section of Renal Transplantation, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
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Shoskes DA, Hakim L, Ghoniem G, Jackson CL. Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. J Urol 2003; 169:1406-10. [PMID: 12629373 DOI: 10.1097/01.ju.0000055549.95490.3c] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Daniel A Shoskes
- Cleveland Clinic Florida, Weston and Nova Southeastern University, Ft. Lauderdale, USA
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Preuss HG, Marcusen C, Regan J, Klimberg IW, Welebir TA, Jones WA. Randomized trial of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Int Urol Nephrol 2002; 33:217-25. [PMID: 12092634 DOI: 10.1023/a:1015227604041] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Because benign prostatic hyperplasia (BPH) is relatively common, it is important to discover safe and effective means to treat this often debilitating perturbation. Accordingly, we examined the effectiveness of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) in treating symptoms of BPH. We undertook a randomized, placebo-controlled, double-blind study. Patients were enrolled from 3 urological practices in the USA. 144 subjects were randomized for study. 17 subjects eventually withdrew, leaving 70 patients in the test group and 57 in the placebo group to complete the study. Inclusion criteria consisted of a diagnosis of BPH, no evidence of cancer, and a maximal urinary flow rate between 5 and 15 ml/second. Patients received either placebo or the combined natural products for 3 months. Evaluations were performed via the American Urological Association (AUA) Symptom Index score, urinary flow rate, PSA measurement, and residual bladder volume. Nocturia showed a markedly significant decrease in severity in patients receiving the combined natural products compared to those taking placebo (p < 0.001). Daytime frequency was also lessened significantly (p < 0.04). When the average individual total AUA Symptom Index score in the test group was compared to that in the placebo group at the end of the study, the difference proved highly significant (p < 0.014). PSA measurements, maximal and average urinary flow rates, and residual volumes showed no statistically significant differences. When taken for 3 months, a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) compared to placebo can significantly lessen nocturia and frequency and diminish overall symptomatology of BPH as indicated by an improvement in the total AUA Symptom Index score. The combination of natural products caused no significant adverse side effects.
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Affiliation(s)
- H G Preuss
- Department of Physiology and Biophysics, Georgetown University Medical Center, Washington, DC 20007, USA.
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Schaeffer AJ, Datta NS, Fowler JE, Krieger JN, Litwin MS, Nadler RB, Nickel JC, Pontari MA, Shoskes DA, Zeitlin SI, Hart C. Overview summary statement. Diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Urology 2002; 60:1-4. [PMID: 12521576 DOI: 10.1016/s0090-4295(02)01979-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Members of the Chronic Prostatitis Collaborative Research Network (CPCRN) met in a 1-day symposium to review recent findings and to debate unanswered issues in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The meeting was focused on producing an overview summary statement that would, as nearly as possible, represent the consensus views of the attendees. As discussed below, the participants agreed that a history, physical examination, and urinalysis/urine culture are mandatory for the evaluation of all patients presenting with CP/CPPS, with other assessments categorized as recommended or optional, depending on the history and physical findings. Observations and suggestions regarding first- and second-line therapies are also offered, with the recognition that randomized, placebo-controlled trials to guide selection of therapies for chronic nonbacterial prostatitis are currently lacking.
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Affiliation(s)
- Anthony J Schaeffer
- Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA.
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Abstract
Chronic prostatitis is a very common condition that is poorly understood and has a significant impact on quality of life. Given the lack of proven efficacy of conventional therapies, such as antibiotics, it is not surprising that patients have turned with increasing frequency to phytotherapy and other alternative treatments. Although alternative therapies are plentiful, few have been subjected to scientific scrutiny and prospective controlled clinical trials. This review will cover phytotherapies commonly used in prostatitis patients and focus in detail on those with published data. These treatments include zinc, cernilton (bee pollen), quercetin, and saw palmetto. Although many of these therapies appear promising in small preliminary studies, phytotherapy requires the same scientific criteria for validation and acceptance as do conventional medical therapies.
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Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol 2002. [PMID: 12131316 DOI: 10.1016/s0022-5347(05)64686-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We describe the study design of the National Institutes of Health Chronic Prostatitis Cohort (CPC) study characterizing men with chronic prostatitis/the chronic pelvic pain syndrome. MATERIALS AND METHODS All 488 men screened into the CPC study before close of recruitment on August 22, 2001 were selected for analysis. The National Institutes of Health Chronic Prostatitis Symptom Index, including subscores, was used to measure symptoms. A comprehensive history, physical examination and demographic profile were obtained from each participant. Generalized Mantel-Haenszel procedures were used to investigate baseline associations between selected factors and symptoms. RESULTS Chronic prostatitis/chronic pelvic pain syndrome is a chronic syndrome affecting men over a wide age range. The majority of CPC study participants are white, well educated and affluent. However, lower education, lower income and unemployment were associated with more severe symptoms. Patients most frequently reported pain in the perineum and tenderness in the prostate. The highest self-reported diseases were genitourinary (55%), allergies (53%), neurological (40%) and hematopoietic, lymphatic or infectious (40%). This disease has a significant negative impact on mental and physical domains of quality of life. Almost all patients (95%) reported antimicrobial drug use. Of these 488 participants 280 (57%) reported the previous or current use of 5 or more categories of prostatitis related treatments. CONCLUSIONS Chronic prostatitis/chronic pelvic pain syndrome is a multifactorial problem affecting men of all ages and demographics. Patients with the chronic pelvic pain syndrome have dismal quality of life and many have benefited only minimally from empirical, goal directed therapy. Long-term followup of this cohort may answer important questions on the natural treated history of this syndrome.
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