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Zhang Y, Peng R, Chen Z, Zhang W, Liu Z, Xu S, Zhu H, Chen J, Zheng B. Evidence for a causal effect of major depressive disorder, anxiety on prostatitis risk: A univariate and multivariate Mendelian randomization study. Prostate 2023; 83:1387-1392. [PMID: 37504798 DOI: 10.1002/pros.24601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Observational studies have shown an association between major depressive disorder (MDD), anxiety, and prostatitis. However, the causal relationship between MDD, anxiety, and prostatitis remains controversial. Therefore, we aimed to use two-sample Mendelian randomization (MR) to assess the causal effects of MDD and anxiety on prostatitis. METHODS We conducted univariable and multivariable MR analyses using summary statistics from publicly available genome-wide association studies to estimate the causal relationships between MDD, anxiety, and prostatitis risk. In the main MR analysis, the inverse-variance weighted (IVW) method was used, while secondary methods included the weighted median, weighted mode, MR-Egger regression, and MR pleiotropy residual and outlier (MR-PRESSO) tests to detect and correct for the presence of pleiotropy. RESULTS MDD had 97 independent instrumental variables (IVs) and anxiety had 15 IVs. Univariable MR analysis showed that genetically determined MDD had a detrimental causal effect on prostatitis (IVW: odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.12-1.92, p = 0.005), while no causal relationship was found between anxiety and prostatitis (IVW: OR = 0.25, 95% CI = 0.02-2.82, p = 0.26). More convincingly, after adjusting for confounding factors such as body mass index, alcohol consumption, and smoking, the genetic liability for MDD remained associated with prostatitis risk, with no strong evidence of anxiety affecting prostatitis incidence. CONCLUSION This study supports the notion that MDD has a detrimental effect on prostatitis risk, and strategies focused on addressing MDD may be one of the cornerstones for treating prostatitis. The potential preventive value of treating MDD for prostatitis should be further investigated in future research.
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Affiliation(s)
- Yong Zhang
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Institute of Urology, The Clinical Medical Research Center, The First People's Hospital of Nantong City, Nantong, Jiangsu, China
| | - Rui Peng
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Institute of Urology, The Clinical Medical Research Center, The First People's Hospital of Nantong City, Nantong, Jiangsu, China
| | - Zhan Chen
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Institute of Urology, The Clinical Medical Research Center, The First People's Hospital of Nantong City, Nantong, Jiangsu, China
| | - Wei Zhang
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Zhenmin Liu
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Siyang Xu
- Clinical Medicine, Xinglin College of Nantong University, Nantong, Jiangsu, China
| | - Hua Zhu
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jiangang Chen
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Bing Zheng
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Li ASW, Wong ALY, Matthewson M, Van Niekerk L, Garry M. Barriers in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management: perspectives from health practitioners. Scand J Pain 2023; 23:518-530. [PMID: 37186523 DOI: 10.1515/sjpain-2022-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a complex condition which causes a significant burden on the diagnosed individuals. Assessment and management are perplexing, often resulting in unsatisfactory outcomes. Existing research has only focused on patients' perspectives of pain experiences, but scant evidence is available to understand the barriers that undermine effective pain management. Using an exploratory approach, this study examined these barriers from practitioners' perspectives. METHODS Twelve semi-structured interviews were conducted with practitioners across disciplines who have experience in chronic pelvic pain management in males. Practitioners expressed their views and experiences in supporting men with CP/CPPS and what barriers they perceived when providing treatment for patients. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS Five broad and interrelated themes were identified: (1) Where to Start, (2) Insufficient Resources, (3) Prioritisation, (4) Training and Confident Practice and (5) Constraints in Help-Seeking. CONCLUSIONS Practitioners value multimodal management using a biopsychosocial approach; however, practical challenges prevent practitioners from choosing and applying this approach in clinical practice. The findings also identified some unique challenges faced by men with CP/CPPS consistent with previous evidence from patient perspective. Refining terminology, developing specific resources, and increasing psychosocial treatment options are urgently needed.
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Affiliation(s)
- Arthur Sone-Wai Li
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Aquina Lim Yim Wong
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Mandy Matthewson
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Michael Garry
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
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Stamatiou K, Trinchieri M, Trinchieri M, Perletti G, Magri V. Chronic prostatitis and related psychological problems. Which came first: The chicken or the egg? A systematic review. Arch Ital Urol Androl 2023; 95:11300. [PMID: 36943000 DOI: 10.4081/aiua.2023.11300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION/AIM A spectrum of psychological problems is commonly found in CP/CPPS patients, though it is not yet clear whether, a priori, psychological dysfunctions are the cause of these pain syndromes, or whether these pain conditions are themselves causing psychological disturbances. In this article we present the current perspective on the impact of psychological problems in chronic prostatitis syndromes and we discuss the implications thereof from a clinical perspective. MATERIALS AND METHODS A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, EMBASE, and other libraries using the key words "prostatitis syndromes", "chronic bacterial prostatitis", "chronic pelvic pain", in various combinations with the terms "psychological issues", "depression" "anxiety", "stress", "unhappiness", "cognitive status" and "personality". Two independent reviewers performed data extraction. We included clinical studies with available information on chronic prostatitis and related psychological conditions. We considered full-text written papers. We excluded reviews and case reports. In order to reduce the risk of bias we analyzed only studies including patients with confirmed CBP or CP/CPPS. Bibliographic information in the selected publications was checked for relevant records not included in the initial search. RESULTS Database search allowed us to retrieve 638 studies to which we added to 16 additional studies retrieved by hand-searching. After screening, 34 relevant papers were identified for thorough review. Most studies included patients with chronic pelvic pain and prostatitis-like symptoms, whereas a smaller number of studies included patients with methodologically con- firmed CP/CPPS including studies with a microbiologically confirmed diagnosis of CBP. The psychosocial factors examined in the selected studies include pain, catastrophizing, stress, personality factors and social aspects. Comorbid psychiatric disorders evidenced in the studies included depression, anxiety and trauma-related disorders, somatization disorders, and substance abuse. Some studies investigated the association of pain with each individual psychological disturbance, while others examined the impact of pain in association with the overall quality of life. Sample size, study design and diagnostic measures varied among studies. CONCLUSIONS Despite limitations and variations in sample size, study design and diagnostic measures in all included studies, a relation between chronic prostatitis and psychological problems is a consistent finding. The existing evidence does not permit to definitely conclude whether psychological problems are a risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease.
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Affiliation(s)
| | | | | | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
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Evans-Durán B, Tripp DA, Campbell J, Doiron RC, Nickel JC. Chronic prostatitis/chronic pelvic pain syndrome-related pain symptoms and their impact on sexual functioning. Can Urol Assoc J 2022; 16:222-227. [PMID: 35099385 PMCID: PMC9245951 DOI: 10.5489/cuaj.7607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION The present study sought to examine a new model to evaluate the mechanistic pathways between pain and sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), incorporating cognitive and emotional factors. METHODS Men with a self-reported diagnosis of CP/CPPS (n=94, 24-69 years, Mage=44.22, standard deviation 11.25) were recruited through social media, support groups, and urology clinics and completed an online questionnaire of demographic, pain, cognitive, psychological, and sexual variables. Descriptive statistics, correlation analysis, and serial mediation analyses assessed variable associations. RESULTS Almost half of participants reported mild to severe erectile dysfunction (47.4%). Sexual dysfunction was associated with greater pain symptom severity and pain catastrophizing, as well as depressive symptoms (p<0.01 for all). While pain did not independently predict levels of sexual dysfunction, the addition of pain catastrophizing and depressive symptoms into the pathway explained the association between increased pain symptoms and decreased sexual functioning (p<0.01). CONCLUSIONS Beyond generally poor sexual functioning in the current sample, it appears as if cognitive and emotional factors play a role in the association between pain symptoms and sexual functioning in these men with CP/CPPS. The findings of how pain catastrophizing and depression impact the association of pain severity and decreased sexual functioning is important for improving patient care.
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Affiliation(s)
| | - Dean A. Tripp
- Departments of Psychology, Anesthesia, and Urology, Queen’s University, Kingston, ON, Canada
| | - Jeffrey Campbell
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Mykoniatis I, Pyrgidis N, Sokolakis I, Sountoulides P, Hatzichristodoulou G, Apostolidis A, Hatzichristou D. Low‐intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta‐analysis. BJU Int 2021; 128:144-152. [DOI: 10.1111/bju.15335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ioannis Mykoniatis
- Department of Urology School of Health Sciences Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Nikolaos Pyrgidis
- Department of Urology School of Health Sciences Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Department of Urology ‘Martha‐Maria’ Hospital Nuremberg Nuremberg Germany
| | - Ioannis Sokolakis
- Department of Urology ‘Martha‐Maria’ Hospital Nuremberg Nuremberg Germany
| | - Petros Sountoulides
- Department of Urology School of Health Sciences Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Apostolos Apostolidis
- Department of Urology School of Health Sciences Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Dimitrios Hatzichristou
- Department of Urology School of Health Sciences Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
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History of Prostatitis Is an Independent Risk Factor for Erectile Dysfunction: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8964673. [PMID: 33123589 PMCID: PMC7586169 DOI: 10.1155/2020/8964673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
Purpose To determine the role of history of prostatitis (HP) as an independent risk factor for erectile dysfunction (ED) in Chinese adult males. Methods We conducted an online survey using a crowd-sourced questionnaire in Chinese adult males. The participants were separated into two groups as adult participants with HP and with no history of prostatitis (NHP) according to the medical history record. As diagnosis criteria of ED, we used the 5 questions of the International Index for Erectile Function (IIEF-5). The general data including height, weight, monthly income, academic background, smoking history, alcohol drinking, marital status, conjugal affection, and other disease history was asked and recorded. The relationship between HP and ED using the chi-square test and logistic regression analyses was investigated and analyzed. Results In total, 1873 participants answered the questionnaire. 95 participants in the HP group and 1778 participants in the NHP group were included in this study. The rate of participants with HP was 5.343%. ED was found in 68.4% of the HP group and 43% of the NHP group (p < 0.001). Regression analysis showed that participants in HP were more likely to have ED (OR 2.135, 95% CI 1.266–3.60) after adjusting for the participant's age, body mass index (BMI), monthly income, academic background, smoking history, alcohol drinking, marital status, conjugal affection, BPH, hypertension, and diabetes mellitus, when compared with NHP. Conclusions The present study indicated a high prevalence of ED in Chinese adult males with history of prostatitis, and HP is an independent risk factor for erectile dysfunction.
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Xu Y, Zhang L, Shen Y, Yao H, Yong S, You Y. Effectiveness of psychological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22151. [PMID: 32991409 PMCID: PMC7523870 DOI: 10.1097/md.0000000000022151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most common diseases in urology, which 50% of men are infected at some point in their lives. Type III CP/CPPS is the most complex and controversial of all types of prostatitis, the highest incidence rate, uncertain efficacy, the long-term treatment that affects the patient's psychopathic symptoms, increases the psychological burden of patients. Psychological intervention for patients with CP/CPPS, which is difficult to treat with drugs and physics, can effectively improve clinical efficacy and improve the psychological condition. The researchers found a high prevalence of psychosocial problems and catastrophic distress in CP/CPPS patients, such as serious mental disorders, especially depression, anxiety and stress, and the high incidence of pain-devastating illness. In this study, we will evaluate psychological interventions as an effective way to relieve chronic prostatitis. METHODS AND ANALYSIS The databases of English databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, China Biology Medicine Database, Wanfang Database, VIP Database) will be retrieved. The search strategy that will be run in the PubMed and tailored to the other database when necessary is presented in this article. RevMan 5.3 and Stata 11.0 will be used for Systematic Review and Meta-analysis. This protocol reported under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement. RESULTS The study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the third quarter of 2021. CONCLUSION This systematic review will provide more evidence to assess whether psychological is an effective intervention for patients with chronic prostatitis/chronic pelvic pain syndrome. Besides, the results will be published in a public issue journal and offer the urologists help to make clinical decisions. ETHICS AND DISSEMINATION Formal ethical approval is not required in this protocol. We will collect and analyze data based on published research. Since this research does not involve patients, personal privacy will not be affected. The results of this review will be distributed to peer-reviewed journals or submitted to relevant conferences. PROTOCOL REGISTRATION NUMBER INPLASY202080021.
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Affiliation(s)
- Yuanjie Xu
- Chengdu University of Traditional Chinese Medicine
| | - Ling Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yifeng Shen
- Chengdu University of Traditional Chinese Medicine
| | - Hangyu Yao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Shanshan Yong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yaodong You
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Edwards S, Mandeville A, Petersen K, Cambitzi J, Williams ACDC, Herron K. 'ReConnect': a model for working with persistent pain patients on improving sexual relationships. Br J Pain 2020; 14:82-91. [PMID: 32537146 PMCID: PMC7265594 DOI: 10.1177/2049463719854972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many individuals with persistent pain experience difficulties with sexual function which are exacerbated by avoidance and anxiety. Due to embarrassment or shame, sexual activity may not be identified as a goal for pain management programmes (PMPs). In addition, clinicians can feel that they lack skills and confidence in addressing these issues. METHODS We sought to develop a biopsychosocial model for helping patients return to sexual activity and manage relationships in the context of pain management, known as 'ReConnect'. The model amalgamates well-established methods from pain management and sex therapy to guide multidisciplinary team members. ReConnect comprises three components: (1) 'cognitive and myth-busting', (2) 'sensations and feelings' and (3) 'action-experimentation'. We collected self-report data from 281 women and 92 men from our specialist PMP for chronic abdomino-pelvic. pain, including questions measuring interference with and avoidance of sex due to pain, and the Multi-dimensional Sexuality Questionnaire (MSQ) to measure anxiety about sexual activity. RESULTS The results show statistically significant improvements for anxiety, avoidance of sex and sexual interference. Using the ReConnect model to structure clinical work, pain management clinicians reported increased confidence in addressing sexual activity goals. CONCLUSION By using the ReConnect model is a framework for clinicians to use to support sexual activity goals. It has demonstrated improvements in clinical outcomes such as anxiety around sex and interference of pain in sexual activity. We encourage its application in pain management services in both one-to-one and group sessions, as a method for encouraging pain patients to address this important area of life which can be adversely affected by pain.
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Affiliation(s)
- Sarah Edwards
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
| | - Anna Mandeville
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
| | - Katrine Petersen
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
| | - Julia Cambitzi
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
| | - Amanda C de C Williams
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
| | - Katherine Herron
- Pain Management Centre, National Hospital for Neurology and Neurosurgery at Cleveland Street, London, UK
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Huang T, Wang G, Hu Y, Shi H, Wang K, Yin L, Peng B. Structural and functional abnormalities of penile cavernous endothelial cells result in erectile dysfunction at experimental autoimmune prostatitis rat. JOURNAL OF INFLAMMATION-LONDON 2019; 16:20. [PMID: 31372097 PMCID: PMC6659287 DOI: 10.1186/s12950-019-0224-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/02/2019] [Indexed: 01/08/2023]
Abstract
Background There is growing recognition of the association of CP/CPPS accompany with ED. However, the specific mechanism of action remains unclear. The aim of this study was to investigate structural and functional abnormalities of cavernous endothelial cells in EAP rat, which may result in the ED. Methods we use rat prostate protein extract supplemented with immunoadjuvant to induce EAP rat, ICP and MAP were measured and inflammatory factor infiltration, Akt, eNOS, AR, nNOS and iNOS in the corpus cavernosum were tested. Subsequently, the normal rat and EAP rat cavernosum endothelial cells were purified by MACS, and the metabolism, oxidative stress, MMP, Akt, eNOS, AR and iNOS were evaluated. Results The EAP rat model was successfully constructed. The ratio of max ICP/MAP in EAP rat was significantly lower and TNF-α infiltration in corpus cavernosum was significantly higher than normal rats. Besides, Akt, eNOS and AR were decreased, iNOS was significantly increased. The growth and metabolism of endothelial cells in the EAP rats corpus cavernosum decreased and inflammatory factor mRNA was increased and intracellular oxidative stress was also increased significantly. The MMP of EAP rats cavernosum endothelial cells decreased and the expression of Akt, eNOS and AR were also significantly decreased, iNOS was significantly increased. Conclusion The prostate suffer local inflammatory infiltrate and promotes cytokines infiltrated into corpus cavernosum caused the oxidative stress increases and the metabolism or MMP decreases. In addition, AR, Akt and eNOS expression and phosphorylation are also reduced, thereby inhibiting the diastolic function of the corpus cavernosum, resulting in decreased erectile function.
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Affiliation(s)
- Tianrun Huang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Guangchun Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Yangyang Hu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Heng Shi
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Keyi Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Lei Yin
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
| | - Bo Peng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO 301 Yanchang Road, Shanghai, 200072 People's Republic of China
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Yuan P, Ma D, Zhang Y, Gao X, Liu Z, Li R, Wang T, Wang S, Liu J, Liu X. Efficacy of low-intensity extracorporeal shock wave therapy for the treatment of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis. Neurourol Urodyn 2019; 38:1457-1466. [PMID: 31037757 DOI: 10.1002/nau.24017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/29/2019] [Accepted: 04/14/2019] [Indexed: 11/08/2022]
Abstract
AIMS Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been applied in urolithiasis and some chronic diseases. We performed a systematic review and meta-analysis to assess the efficacy of Li-ESWT for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS A comprehensive search of MEDLINE, Web of Science, EMBASE, and the Cochrane Library to January 6, 2019 was performed for randomized controlled trials (RCTs) reporting on patients with CP/CPPS treated with Li-ESWT compared with the sham group. Outcomes were evaluated based on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). The quality assessment of included studies was performed by the Cochrane System. RESULTS Six publications involving five RCTs with 280 patients were assessed in this review. NIH-CPSI total score, pain domain and quality of life (QOL) were significantly better in the Li-ESWT group than those in the control group at the endpoint (P < 0.00001, P = 0.003, and P < 0.00001), 4 weeks (P < 0.00001, P = 0.0002 and P < 0.00001) and 12 weeks (P < 0.00001, P < 0.00001, and P = 0.0002) after the treatment. For urinary score, significant difference existed at 12 weeks after the treatment (P = 0.006). At 24 weeks after treatment, there was no significant difference between the two groups in NIH-CPSI total score (P = 0.26), pain domain (P = 0.32), urinary score (P = 0.07), and QOL (P = 0.29). CONCLUSIONS Li-ESWT showed great efficacy for the treatment of CP/CPPS at the endpoint and during the follow-up of 4 and 12 weeks, though the efficacy of 24-week follow-up was not significantly different due to insufficient data. Generally, Li-ESWT is a promising minimal invasive method for the treatment of CP/CPPS.
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Affiliation(s)
- Penghui Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintao Gao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chronic Scrotal Content Pain: an Updated Review on Diagnosis and Management. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pereira R, Margarida Oliveira C, Nobre P. Sexual Functioning and Cognitions During Sexual Activity in Men With Genital Pain: A Comparative Study. JOURNAL OF SEX & MARITAL THERAPY 2016; 42:602-615. [PMID: 26548315 DOI: 10.1080/0092623x.2015.1113582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Male genital pain is frequently associated with sexual dysfunction, and some studies suggest it is influenced by cognitive factors. However, there is little evidence on how these factors discriminate male genital pain from other sexual problems. This study intends to explore differences on sexual functioning and self-reported cognitions during sexual activity between men with genital pain, men with sexual dysfunction, and sexually healthy men. A total of 134 men divided in three groups based on their clinical condition (i.e., genital pain, sexual dysfunction, or no sexual/pain complaints) and matched for demographic variables completed measures of sexual functioning (IIEF) and thoughts during sexual activity (SMQ). Findings showed that men with genital pain and men with sexual dysfunctions reported significantly lower levels of overall satisfaction with sexual life, compared to men without sexual problems. Additionally, men with genital pain and men with sexual dysfunctions presented significantly more failure anticipation thoughts in comparison to sexually healthy men. Overall, findings emphasize the role of negative cognitions as a common factor associated with male genital pain and sexual dysfunctions, suggesting that genital pain should be regarded as a sexual problem and that clinical interventions should include sex therapy techniques as well as cognitive-behavioral procedures.
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Affiliation(s)
- Raquel Pereira
- a University of Porto, Faculty of Psychology and Educational Sciences , Porto , Portugal
| | | | - Pedro Nobre
- a University of Porto, Faculty of Psychology and Educational Sciences , Porto , Portugal
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Abstract
Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 1–4% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. Although knowledge of the physiology of the DE has increased in the last two decade, our understanding of the different pathophysiological process of the causes of DE remains limited. To provide a systematic update on the pathophysiology of DE. A systematic review of Medline and PubMed for relevant publications on ejaculatory dysfunction (EjD), DE, retarded ejaculation, inhibited ejaculation, and climax was performed. The search was limited to the articles published between the January 1960 and December 2015 in English. Of 178 articles, 105 were selected for this review. Only those publications relevant to the pathophysiology, epidemiology and prevalence of DE were included. The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. Despite the many publications on this disorder, there still is a paucity of publications dedicated to the subject.
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Affiliation(s)
- Juza Chen
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel
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Takayanagi A, Kobayashi K, Fukuta F, Matsuki M, Matsuda Y, Mori M, Masumori N. Changes of sexual function and perception in Japanese men: A 15-year cross-sectional community-based study. Int J Urol 2016; 23:941-945. [PMID: 27520708 DOI: 10.1111/iju.13184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the longitudinal changes of sexual function of Japanese men. METHODS From 1992 to 1993, we carried out a cross-sectional community-based study on sexual function in Japanese men aged 40-79 years. After 15 years, a follow-up study was carried out to determine longitudinal changes of their sexual function. Of the 319 participants in the initial study, 135 participated again in the follow-up study. Sexual function was assessed using the same validated questionnaire in the two studies. RESULTS Erectile rigidity declined in men of each age decade at baseline (40s, 50s, 60s and 70s) of the initial study (P < 0.01, <0.01, <0.01 and <0.05). The frequency of sexual drive was significantly decreased in men aged in their 40s, 50s and 60s (P < 0.05, <0.01 and <0.01). Men aged in their 40s were dissatisfied with their decreased sexual function (P < 0.05). In contrast, men aged in their 70s were satisfied with their sexual life (P < 0.01). CONCLUSIONS Over a 15-year period, the sexual function of Japanese men declined in each age decade. However, the perception of this decline differed among different age group. Most elderly Japanese men did not worry about their impaired sexual function.
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Affiliation(s)
- Akio Takayanagi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Fumimasa Fukuta
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masahiro Matsuki
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Matsuda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mitsuru Mori
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Zhang Y, Zheng T, Tu X, Chen X, Wang Z, Chen S, Yang Q, Wan Z, Han D, Xiao H, Sun X, Deng C. Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Outcomes from a Multi-Center Study and Risk Factor Analysis in a Single Center. PLoS One 2016; 11:e0153054. [PMID: 27120096 PMCID: PMC4847827 DOI: 10.1371/journal.pone.0153054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/23/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the prevalence of erectile dysfunction (ED) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and explore the influence of UPOINT domains, National Institutes of Health-CP symptom index (NIH-CPSI) and other factors on ED prevalence. This was a prospective study of consecutive patients with CP/CPPS seen at 11 tertiary hospitals during January–July 2014. ED was diagnosed as a score of<21 on the International Index of Erectile Function (IIEF-5). Patients from one center were evaluated by the UPOINT system and NIH-CPSI. Each patient was assessed using clinical examination, asocio-demographic questionnaire, the Patient Health Questionnaire (PHQ), the Pain Catastrophizing Scale (PCS), NIH-CPSI and IIEF-5.1406 patients from 11 centers (mean age, 32.18 years; range 18–60 years) were enrolled. ED was found in 638/1406 patients (45.4%), and was categorized as mild in 291(45.6%), moderate in 297(46.6%) and severe in50(7.7%). 192 patients from one center(mean age,31.3 years; range 18–57 years) were further studied.IIEF-5 score correlated negatively with NIH-CPSI(r = 0.251), PHQ (r = 0.355) and PCS (r = 0.322)scores (P<0.001).PHQ score correlated positively with NIH-CPSI (r = 0.586) and PCS(r = 0.662) scores (P<0.001).NIH-CPSI, PHQ, PCS and IIEF-5 scores did not differ significantly between class IIIA and IIIB CP/CPPS. Multivariate logistic regression showed that UPOINT psychological (P) domain and NIH-CPSI symptom severity were independent risk factors for ED in CP/CPPS. It is concluded that psychological factors and symptom severity are independent risk factors for ED in CP/CPPS.
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Affiliation(s)
- Yadong Zhang
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
- * E-mail: (YZ); (CD)
| | - Tao Zheng
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xiang'an Tu
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xin Chen
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Zhu Wang
- Department of Ultrasound Medicine, Endocrinology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Shengfu Chen
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Qiyun Yang
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Zi Wan
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Dayu Han
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Haipeng Xiao
- Department of Endocrinology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xiangzhou Sun
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Chunhua Deng
- Department of Urology, 1 Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
- * E-mail: (YZ); (CD)
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Chen X, Zhou Z, Qiu X, Wang B, Dai J. The Effect of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) on Erectile Function: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0141447. [PMID: 26509575 PMCID: PMC4625019 DOI: 10.1371/journal.pone.0141447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022] Open
Abstract
Background High prevalence of erectile dysfunction (ED) has been observed in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, whether or not CP/CPPS is a risk factor of ED remains unknown and controversial. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between CP/CPPS and ED. Methods PubMed, Embase, Web of Science, and The Cochrane Library were searched up to November 11, 2014 to identify studies reporting the association between CP/CPPS and ED. Case–control, cohort and cross-sectional studies were included. Quality of the included studies was assessed. The odds ratio of ED and the mean difference of five-item International Index of Erectile Function (IIEF-5) score were pooled using a random effects model. Subgroup analysis and sensitivity analyses were performed. Results Three cross-sectional studies, two case–control studies, and four retrospective studies with 31,956 participants were included to calculate the pooled odds ratio of ED, and two studies with 1499 participants were included to calculate the pooled mean difference of IIEF-5 scores. A strong correlation was found between CP/CPPS and ED (pooled odds ratio: 3.02, 95% CI: 2.18–4.17, P < 0.01), with heterogeneity across studies (I2 = 65%; P < 0.01). A significant decrease in the IIFE-5 score was observed in the CP/CPPS group (pooled mean difference: −4.54, 95% CI: −5.11–−3.98; P < 0.01). Conclusion Our study indicates that patients with CP/CPPS have an increased risk of suffering from ED. Assessment of erectile function is necessary for the therapy of patients with CP/CPPS. Further evidence is necessary to confirm the relationship between CP/CPPS and ED.
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Affiliation(s)
- Xiang Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - ZhiRui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - XiaoChun Qiu
- Library of Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- * E-mail: (BW); (JD)
| | - JiCan Dai
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail: (BW); (JD)
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Comparison of National Institutes of Health-Chronic Prostatitis Symptom Index with International Index of Erectile Function 5 in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Large Cross-Sectional Study in China. BIOMED RESEARCH INTERNATIONAL 2015; 2015:560239. [PMID: 26273630 PMCID: PMC4530206 DOI: 10.1155/2015/560239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022]
Abstract
The purpose of the study is to evaluate the relationship between NIH-CPSI and IIEF-5 in Chinese men with CP/CPPS. A large cross-sectional and multicenter survey was conducted from July 2012 to January 2014. Men were recruited from urology clinics which were located at the five cities in China. All men participated in the survey by completing a verbal questionnaire (consisted of sociodemographics, past medical history, sexual history, and self-estimated scales). The results showed that 1,280 men completed the survey. Based on the CP/CPPS definition, a total of 801 men were diagnosed as having CP/CPPS. Men with CP/CPPS reported higher scores of NIH-CPSI and lower scores of IIEF-5 than men without CP/CPPS. NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. The total scores of NIH-CPSI were significantly more strongly correlated with question 5 than other questions of IIEF-5. The total scores of IIEF-5 were significantly more strongly correlated with pain symptoms scores of NIH-CPSI. Strongest correlation was found between QoL impact and question 5 of IIEF-5. The findings suggested that NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. Strongest correlation was found between QoL impact and question 5 of IIEF-5.
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Wang XJ, Xia LL, Xu TY, Zhang XH, Zhu ZW, Zhang MG, Liu Y, Xu C, Zhong S, Shen ZJ. Changes in erectile organ structure and function in a rat model of chronic prostatitis/chronic pelvic pain syndrome. Andrologia 2015; 48:243-51. [PMID: 25990367 DOI: 10.1111/and.12437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 12/29/2022] Open
Abstract
There is a growing recognition of the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED); however, most of the reports are based on questionnaires which cannot distinguish between organic and functional ED. The purpose of this study was to determine the exact relationship between CP/CPPS and ED, and to investigate the changes in erectile organ structure and function in a rat model of CP/CPPS. We established a rat model of experimental autoimmune prostatitis (EAP), which is a valid model for CP/CPPS. Erectile function in EAP and normal rats was comparable after cavernous nerve electrostimulation. The serum testosterone and oestradiol levels, ultrastructure of the corpus cavernosum and expression of endothelial nitric oxide synthase and neuronal nitric oxide synthase in the two groups were similar; however, there was a decrease in smooth muscle-to-collagen ratio and alpha-smooth muscle actin expression and an increase in transforming growth factor-beta 1 expression was observed in EAP rats. Thus, organic ED may not exist in EAP rats. We speculate that ED complained by patients with CP/CPPS may be psychological, which could be caused by impairment in the quality of life; however, further studies are needed to fully understand the potential mechanisms underlying the penile fibrosis in EAP rats.
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Affiliation(s)
- X-J Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - L-L Xia
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - T-Y Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X-H Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z-W Zhu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - M-G Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Liu
- Department of Histology and Embryology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Reproductive Medicine, Shanghai, China
| | - C Xu
- Department of Histology and Embryology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Reproductive Medicine, Shanghai, China
| | - S Zhong
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z-J Shen
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men -- a systematic review. J Psychosom Res 2014; 77:333-50. [PMID: 25300538 DOI: 10.1016/j.jpsychores.2014.09.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved. METHODS In a systematic review conducted according to the PRISMA reporting guidelines we searched different databases (MEDLINE, EMBASE, PsychINFO) using the broad search terms "chronic pelvic pain syndrome AND men". Two raters independently screened the literature and assessed the risk of bias. RESULTS We included 69 original research articles which considered psychosocial variables. We found studies investigating different psychosocial factors (pain catastrophizing, stress, personality factors, social aspects), co-morbid psychiatric disorders (depression, anxiety and trauma-related disorders, somatization disorder, substance abuse) and Quality of Life (QoL). In addition, there is a high risk of bias in most studies e.g. concerning the study design or the measures. CONCLUSIONS There is evidence suggesting that psychological factors are important in understanding CP/CPPS. However, research concentrated on a few aspects while the others were not covered adequately. We found evidence of a higher number of psychosocial factors and psychiatric co-morbidities than is currently included in the UPOINT system. More high quality research is needed to understand the interplay of psychosocial factors in CP/CPPS. Furthermore, these factors should be incorporated into treatment approaches.
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Mo MQ, Long LL, Xie WL, Chen S, Zhang WH, Luo CQ, Deng LW. Sexual dysfunctions and psychological disorders associated with type IIIa chronic prostatitis: a clinical survey in China. Int Urol Nephrol 2014; 46:2255-61. [DOI: 10.1007/s11255-014-0810-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Effectiveness of diet, sexual habits and lifestyle modifications on treatment of chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis 2014; 17:238-45. [PMID: 24819236 DOI: 10.1038/pcan.2014.18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/16/2014] [Accepted: 03/24/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The potential benefits of a therapeutic regimen for chronic pelvic pain syndrome (CPPS) based on the adherence to some specific rules concerning diet, sexual habits and lifestyle have never been investigated. METHODS A review of literature was executed to prepare a vademecum of 13 rules relating to diet, sexual habits and lifestyle that patients had to adhere to in order to treat CPPS. Patients affected by CPPS were enrolled and assigned to two equal groups that were both treated with 100 mg of nimesulide for 1 week. Group two patients were instructed to adhere to the vademecum rules, whereas patients in Group one received instructions to make no changes in their lifestyles. The NIH-Chronic Prostatitis Symptom Index was administered at baseline and after 3 months. The main outcome measure was the change in the mean total NIH-Chronic Prostatitis Symptom Index scores between the two groups from baseline to after treatment. Statistical methods for two-group comparisons were used. RESULTS Overall,100 patients were recruited. Thirty-nine out of fifty patients (78%) belonging to Group two adhered to the vademecum rules. In Group one, the total NIH-Chronic Prostatitis Symptom Index score was 21.9 at baseline and 17.6 post-treatment, whereas in Group two these scores were 22.1 and 8.1, respectively (P<0.0001). CONCLUSIONS We detected 13 potentially eliminable risk factors for CPPS on the basis of which we prepared a vademecum of 13 rules to treat this disease that were well tolerated and highly effective in significantly reducing all types of symptoms caused by CPPS.
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Seyam R. A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men. Ther Adv Urol 2013; 5:254-97. [PMID: 24082920 DOI: 10.1177/1756287213497231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. OBJECTIVES The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. METHODS A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. RESULTS A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. CONCLUSION There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
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Affiliation(s)
- Raouf Seyam
- King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC 83, Riyadh 11211, Saudi Arabia
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Tran CN, Shoskes DA. Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. World J Urol 2013; 31:741-6. [PMID: 23579441 DOI: 10.1007/s00345-013-1076-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/12/2013] [Indexed: 12/22/2022] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), or NIH category III prostatitis, is a common clinical syndrome characterized by genital/pelvic pain and lower urinary tract symptoms in the absence of urinary tract infection. There is also growing recognition of the association of sexual dysfunction with CP/CPPS including erectile dysfunction, ejaculatory pain, and premature ejaculation. In this review, we discuss the association between CP/CPPS and sexual dysfunction, potential mechanisms for sexual dysfunction, and treatment strategies for erectile dysfunction in CP/CPPS.
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Affiliation(s)
- Christine N Tran
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk Q10-1, Cleveland, OH 44195, USA
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Mehta A, Stember DS, O'Brien K, Mulhall JP. Defining the aetiology of erectile dysfunction in men with chronic pelvic pain syndrome. Andrology 2013; 1:483-6. [PMID: 23427195 DOI: 10.1111/j.2047-2927.2013.00066.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/01/2013] [Accepted: 01/01/2013] [Indexed: 11/28/2022]
Abstract
Men presenting with chronic pelvic pain syndrome (CPPS) frequently report concomitant erectile dysfunction (ED), but the underlying cause of ED in this patient population has not been previously studied. This study prospectively investigated the aetiology of ED in men with CPPS. The study population comprised 46 men with penile pain or dysorgasmia, and concomitant ED. All participants completed the NIH-CPSI and international index of erectile function- erectile function domain (IIEF-EFD) questionnaires, and underwent penile duplex Doppler ultrasonography (DUS), following intracavernosal trimix injection, to evaluate erectile hemodynamic parameters. Pearson's correlation between NIH-CPSI and IIEF-EFD scores, and between NIH-CPSI score and the erectile response to trimix injections was investigated. The prevalence of mild, moderate and severe CPPS symptoms was 26, 48 and 26% respectively. The severity of ED was mild, moderate or severe in 15, 61 and 24% of men respectively. NIH-CPSI and IIEF-EFD scores were negatively correlated (r = -0.32, p = 0.002). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were normal in 96 and 100% of men respectively. The majority of men (78%) required ≥2 trimix injections to attain an adequate erection for DUS. NIH-CPSI scores and the number of trimix injections needed were positively correlated (r = 0.22, p = 0.035). The aetiology of erectile dysfunction in men who present with CPPS and concomitant ED is almost always psychogenic. Penile DUS in this population of men is fraught with the potential for error, and frequently necessitates more than one dose of a vasoactive agent.
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Affiliation(s)
- Akanksha Mehta
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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Benson JS, Abern MR, Larsen S, Levine LA. Does a positive response to spermatic cord block predict response to microdenervation of the spermatic cord for chronic scrotal content pain? J Sex Med 2012; 10:876-82. [PMID: 23016953 DOI: 10.1111/j.1743-6109.2012.02937.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Microdenervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with intractable scrotal content pain. AIM This study evaluates the correlation between a positive response to a spermatic cord block with local anesthetic and the subsequent surgical outcome following MDSC. MAIN OUTCOME MEASURES Pre- and post-cord block pain and pre- and post-MDSC pain. METHODS A retrospective review of 74 patients (77 testicular units) who underwent MDSC from 2006 to 2010 was performed. Pre- and post-spermatic cord block pain scores based on a 0-10 visual analog scale (VAS) were compared with pre- and post-MDSC pain scores. A positive response to the block was defined as greater than or equal to 50% temporary reduction of pain based on VAS. RESULTS The average patient age was 42 years with a mean follow-up of 10 months. The mean duration of symptoms before surgery was 69 months. Mean pre-cord block pain score was 8 with an 89% average decrease in pain following the block. Mean post-MDSC pain score was 2 with an average decrease of 73%. The level of temporary improvement from the cord block appeared to be a useful predictor of sustained improvement with MDSC (P = 0.05). Positive response to spermatic cord block was an independent predictor of MDSC response (P = 0.03). CONCLUSIONS Men with chronic orchialgia who have a positive response to a spermatic cord block are likely to have durable and complete resolution of symptoms after undergoing MDSC. The amount of pain relief obtained after the cord block correlates with pain relief after undergoing a MDSC. Men with chronic orchialgia who desire surgical correction should undergo a preoperative spermatic cord block as part of their complete evaluation. The result of the cord block can help guide the practitioner and the patient toward definitive surgical management via MDSC.
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Affiliation(s)
- Jonas S Benson
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
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Rubio-Aurioles E, Bivalacqua TJ. Standard operational procedures for low sexual desire in men. J Sex Med 2012; 10:94-107. [PMID: 22971157 DOI: 10.1111/j.1743-6109.2012.02778.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Low sexual desire in men is a condition that has received little attention; nevertheless it occurs with high frequency. Clinicians are in need of clear guidelines to address this problem. AIM To develop standardized operational procedures to be implemented with men presenting low sexual desire/interest (LSD/I). METHODS Review of relevant evidence-based literature and published guidelines, integrated with expert opinion. MAIN OUTCOME Operational procedures for LSD/I that are recommended for clinical practice with various degrees of support from published evidence. RESULTS A new classification scheme is proposed; LSD/I is proposed as an umbrella term for which hypoactive sexual desire disorder (HSDD) is only a subtype. The following standard operational procedures are described: (i) Detection of LSD/I: screening for LSD/I, screening for LSD/I in patients with other sexual dysfunctions; (ii) Diagnosis and assessment of etiology: diagnostic criteria for LSD/I, assessment of depression status, assessment of relationship status, assessment of endocrinologic status, diagnostic criteria for HSDD in men; (iii) TREATMENT treatment of LSD/I secondary to low testosterone, treatment of LSD/I secondary to elevated prolactin, treatment of LSD/I secondary to other endocrinologic disorders, treatment of LSD/I secondary to depressive illness and or anxiety disorders, treatment of LSD/I secondary to relationship conflict and treatment of HSDD. A diagnostic and treatment algorithm is presented. CONCLUSIONS LSD/I is a common condition that should be identified in patients; it is recommended that this condition be actively investigated by the clinician. Once the diagnosis of LSD/I in men is confirmed, a thorough search for possible causes needs to include both biological and psychological causes. TREATMENT should be etiologically oriented.
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Affiliation(s)
- Eusebio Rubio-Aurioles
- Clinical Research, Asociación Mexicana para la Salud Sexual, A.C. (AMSSAC), Mexico City, Mexico.
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Chung SD, Huang CC, Lin HC. Chronic prostatitis and depressive disorder: a three year population-based study. J Affect Disord 2011; 134:404-9. [PMID: 21665291 DOI: 10.1016/j.jad.2011.05.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/25/2011] [Accepted: 05/25/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is limited research on the relationship between chronic prostatitis (CP) and the subsequent risk of depressive disorders (DD). This population-based study aims to prospectively examine the relationship between a history of CP and the risk of developing DD in Taiwan. METHODS A total of 3051 adult patients, newly diagnosed with CP during 2001 to 2005, were recruited, together with 15,255 matched enrollees without a history of CP as a comparison cohort. All patients were tracked for a three year period from their index healthcare encounters to identify those who had subsequent DD. The Cox proportional hazards models were carried out to compute the risk of DD in the study and comparison cohorts, after adjustment for socio-demographic characteristics. RESULTS Of a total of 18,306 patients, 163 (5.34%) from the CP group and 494 (3.24%) from the comparison group had a subsequent diagnosis of DD during the follow-up period. Stratified Cox proportional analysis shows that, after adjusting for monthly income, geographic region, and urbanization level of the community in which the patient resided, hypertrophy (benign) of prostate, and urinary incontinence, the hazard ratio of DD during the three year follow-up period is 1.63 for patients with chronic prostatitis (95% CI = 1.36-1.96) than those without chronic prostatitis. The differences are most significant in the younger group, aged less than 30 years (hazard ratio, 2.50; 95% CI = 1.18-4.51). CONCLUSIONS These results suggest that CP patients experience an increased risk of DD compared to non-CP patients during a three year follow-up period.
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Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
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Ciftci H, Savas M, Gulum M, Yeni E, Verit A, Topal U. Evaluation of sexual function in men with orchialgia. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:631-634. [PMID: 21290257 DOI: 10.1007/s10508-011-9726-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 08/04/2010] [Accepted: 08/04/2010] [Indexed: 05/30/2023]
Abstract
This study examined the effect of chronic scrotal pain on sexual function using the International Index of Erectile Function (IIEF). We enrolled 50 patients with symptoms consistent with orchialgia and 50 control subjects without orchialgia, who were healthy, sexually active, married, and age-matched. Both groups were evaluated using the IIEF questions for sexual function, and quality of life was investigated using the abbreviated version of the World Health Organization Quality of Life Questionnaire. A significant difference was found in the values of orgasmic function, intercourse satisfaction, sexual desire, overall sexual satisfaction, and total IIEF scores between the patient and control groups; however, there were no significant group differences in the IIEF scores related to erectile function. In the patient group, 39 of 50 subjects reported decreased sexual desire and satisfaction due to a decrease in frequency of sexual activities. Thus, investigation of sexual function was essential for these patients in order to determine the adequate management and treatment of chronic orchialgia.
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Affiliation(s)
- Halil Ciftci
- Department of Urology, School of Medicine, Harran University, Sanliurfa, Turkey.
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Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ. Retentissement sur la sexualité et la fertilité des douleurs pelvipérinéales chroniques. Prog Urol 2010; 20:917-21. [DOI: 10.1016/j.purol.2010.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 11/29/2022]
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The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis. Int J Impot Res 2010; 22:349-54. [DOI: 10.1038/ijir.2010.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Calabrò RS, Marra A, Quattrini F, Gervasi G, Levita A, Bramanti P. Central neuropathic pain: an unusual case of painful ejaculation responding to topiramate. J Sex Med 2010; 9:3274-8. [PMID: 20524978 DOI: 10.1111/j.1743-6109.2010.01855.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Painful ejaculation (PE) is an uncommon condition and it is usually associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, ejaculatory duct obstruction, radical prostatectomy, and prostate radiation. Topiramate (TPM) is a new antiepileptic drug with recognized efficacy in neuropathic pain. AIM The study is aimed to evaluate TPM efficacy in ejaculation pain. METHODS Following a spinal cord injury, a 53-year-old man was referred to our institute for persistent PE. Neurological examination showed mild hypoesthesia of the genital area. Urogenital examination, neurophysiological tools, and computed tomography of the dorso-lumbar spine were normal. MAIN OUTCOME MEASURES The main outcome measure was the visual analogue scale. RESULTS Since pain was refractory to conventional neuropathic pharmacological therapies, TPM was introduced up to 150 mg daily with a dramatic improvement of PE. CONCLUSIONS TPM may be considered as a valid therapeutic option for the treatment of PE.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino-Pulejo, Messina, Italy.
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ter Kuile MM, Weijenborg PT, Spinhoven P. ORIGINAL RESEARCH—PAIN: Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression. J Sex Med 2010; 7:1901-10. [DOI: 10.1111/j.1743-6109.2009.01414.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yoon HS, Yoon H. Correlations of interstitial cystitis/painful bladder syndrome with female sexual activity. Korean J Urol 2010; 51:45-9. [PMID: 20414410 PMCID: PMC2855473 DOI: 10.4111/kju.2010.51.1.45] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 10/20/2009] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We investigated how the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) are correlated with the sexual activity of these patients. MATERIALS AND METHODS A total of 87 patients were included in this study; 18 patients were diagnosed with IC and the other 69 had PBS. The diagnosis was made on the basis of the concept of IC/PBS proposed by the ICS in 2002. Patients were asked to fill in a Bristol female lower urinary tract symptom questionnaire, and symptoms were rated on a scale of from 1 to 4 or 5. Pearson's correlation coefficient was used to analyze the correlation of pain and urinary symptoms with quality of life and sexual activity. RESULTS The average age of the patients was 51+/-14.7 years (range, 28-74 years). Age and vulvodynia were positively correlated with one another (r=0.232), and there was a negative correlation between age and dyspareunia (r=-0.302). Among the items regarding IC/PBS and sexual activity, frequency showed a positive correlation with vulvodynia (r=0.258) in addition to an inhibited sex life (r=0.403). Urgency showed a positive correlation with an inhibited sex life (r=0.346). Vulvodynia showed a positive correlation with an inhibited sex life (r=0.259) and dyspareunia (r=0.401). The main symptoms of IC/PBS (frequency, urgency, and pelvic pain) showed a positive correlation with almost all items related to quality of life (p<0.05). CONCLUSIONS Frequency, urgency, and various types of pain are negatively correlated with the sexual activity of patients. This suggests that physicians should consider sexual function in the management of patients with IC/PBS.
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Affiliation(s)
- Hyun Suk Yoon
- Department of Urology, School of Medicine, Ewha Womans University, Seoul, Korea
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Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol 2009; 56:418-24. [PMID: 19372000 DOI: 10.1016/j.eururo.2009.03.043] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 03/11/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is no sufficiently validated therapy for chronic pelvic pain syndrome (CPPS). OBJECTIVE To investigate the effects of extracorporeal shock wave therapy (ESWT) in 60 patients suffering from CPPS. DESIGN, SETTING, AND PARTICIPANTS Sixty patients suffering from CPPS for at least 3 mo were investigated in two groups. Both groups were treated four times (once per week), each by 3000 impulses; group 2 was performed as a sham procedure. The investigation was designed as a placebo-controlled, prospectively randomised, double-blind phase 2 study. Standardised follow-up was performed 1, 4, and 12 wk after ESWT. INTERVENTIONS Low-energy-density ESWT was performed using a perineal approach without anaesthesia. In the placebo group, the same setting was used without shock wave energy transmission. MEASUREMENTS ESWT effects on pain, quality of life (QoL), erectile function (EF), and micturition were evaluated. The parameters were investigated using validated questionnaires (National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function [IIEF]) and the Visual Analog Scale (VAS) for pain evaluation. RESULTS AND LIMITATIONS All patients completed outpatient treatments and follow-ups without any problems. All 30 patients in the verum group showed statistically (highly) significant improvement of pain, QoL, and voiding conditions following ESWT in comparison to the placebo group, which experienced a continuous deterioration of the same parameters during the follow-up period. Perineal ESWT was easy and safe to perform without anaesthesia or any side-effects. CONCLUSIONS This is the first prospectively randomised, double-blind study to reveal perineal ESWT as a therapy option for CPPS with statistically significant effects in comparison to placebo. ESWT may in particular be interesting because of its easy and inexpensive application, the lack of any side-effects, and the potential for repetition of the treatment at any time.
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Affiliation(s)
- Reinhold Zimmermann
- Department of Urology, Elisabethinen Hospital, University-affiliated Hospital, Linz, Austria.
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Arabkheradmand J, Foroutan SK, Ranjbar S, Abbasi T, Hessami S, Gorji A. Improvement of Chronic Pain by Treatment of Erectile Dysfunction. J Sex Med 2008; 5:2911-6. [DOI: 10.1111/j.1743-6109.2008.01006.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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