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Lee JK, Law TY, Shen L, Pek GX, Lim QY, Tan YQ, Chia JY, Li MK. Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study. Prostate Int 2024; 12:27-34. [PMID: 38523905 PMCID: PMC10960085 DOI: 10.1016/j.prnil.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 03/26/2024] Open
Abstract
Background Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS. Methods Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King's Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks. Results Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King's Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period. Conclusions ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.
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Affiliation(s)
- Joe K.C. Lee
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Terence Y.X. Law
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gregory X.W. Pek
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Qi Y. Lim
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Yi Q. Tan
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Jun Y. Chia
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Man K. Li
- Department of Urology, National University Hospital, Singapore, Singapore
- Li Man Kay Urology Associates Mount Elizabeth Novena Hospital, Singapore, Singapore
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Nettey OS, Gu C, Jackson NJ, Ackerman AL. Validation of Distinct Bladder Pain Phenotypes Utilizing the MAPP Research Network Cohort. Int Urogynecol J 2024; 35:637-648. [PMID: 38300276 PMCID: PMC11023803 DOI: 10.1007/s00192-024-05735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION AND HYPOTHESIS As interstitial cystitis/bladder pain syndrome (IC/BPS) likely represents multiple pathophysiologies, we sought to validate three clinical phenotypes of IC/BPS patients in a large, multi-center cohort using unsupervised machine learning (ML) analysis. METHODS Using the female Genitourinary Pain Index and O'Leary-Sant Indices, k-means unsupervised clustering was utilized to define symptomatic phenotypes in 130 premenopausal IC/BPS participants recruited through the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network. Patient-reported symptoms were directly compared between MAPP ML-derived phenotypic clusters to previously defined phenotypes from a single center (SC) cohort. RESULTS Unsupervised ML categorized IC/BPS participants into three phenotypes with distinct pain and urinary symptom patterns: myofascial pain, non-urologic pelvic pain, and bladder-specific pain. Defining characteristics included presence of myofascial pain or trigger points on examination for myofascial pain patients (p = 0.003) and bladder pain/burning for bladder-specific pain patients (p < 0.001). The three phenotypes were derived using only 11 features (fGUPI subscales and ICSI/ICPI items), in contrast to 49 items required previously. Despite substantial reduction in classification features, unsupervised ML independently generated similar symptomatic clusters in the MAPP cohort with equivalent symptomatic patterns and physical examination findings as the SC cohort. CONCLUSIONS The reproducible identification of IC/BPS phenotypes, distinguishing bladder-specific pain from myofascial and genital pain, using independent ML analysis of a multicenter database suggests these phenotypes reflect true pathophysiologic differences in IC/BPS patients.
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Affiliation(s)
| | - Cindy Gu
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Box 951738, Los Angeles, CA, 90095-1738, USA
| | - Nicholas James Jackson
- Department of Internal Medicine and Health Services Research, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - A Lenore Ackerman
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Box 951738, Los Angeles, CA, 90095-1738, USA.
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Wang Y, Dang Z, Wang X, Chen Y, Dong P, Liu G, Tan W, Gui Z, Bu F, Lin F, Liang C. Obacunone alleviates chronic pelvic pain and pro-inflammatory depolarization of macrophage induced by experimental autoimmune prostatitis in mice. Biochem Biophys Rep 2023; 36:101565. [PMID: 37965064 PMCID: PMC10641089 DOI: 10.1016/j.bbrep.2023.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
Chronic pelvic pain syndrome (CPPS) is a common complication of prostatitis, which was associated with the pathological depolarization of macrophage and the neuroinflammation. However, its underlying reason is far from clear and few effective treatments is applicable. In this study, we tested the effect of obacunone (Oba), a highly oxygenated triterpenoid, on CPPS. The experimental autoimmune prostatitis (EAP) was induced by subcutaneous injection of heterologous prostate homogenate in mice. We found that EAP led to prostatodynia, neuronal activation of spinal dorsal horn, and the pro-inflammatory depolarization of macrophage within prostate, which was significantly alleviated by oral administration of Oba in a dose-dependent manner. Mechanistically, EAP-induced production of IL-6 on prostatic macrophage was suppressed by Oba. Moreover, co-administration of Oba and MIF inhibitor ISO-1 did not lead to additive effect when compared with either alone. In summary, we conclude that Oba prevents the production of macrophage-derived pro-inflammatory factors by inhibiting MIF, which eventually alleviates CPPS after prostatitis.
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Affiliation(s)
- Yadong Wang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
- Department of Urology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Zhaohui Dang
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Xu Wang
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Yuanyuan Chen
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Peng Dong
- Department of Neurosurgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Gang Liu
- Department of Neurosurgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Weibin Tan
- Department of Neurosurgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Zhong Gui
- Department of Neurosurgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Fan Bu
- Department of Neurology & Psychology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Feng Lin
- Department of Urology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, 518033, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
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Suarez Arbelaez MC, Monshine J, Porto JG, Shah K, Singh PK, Roy S, Amin K, Marcovich R, Herrmann TRW, Shah HN. The emerging role of the urinary microbiome in benign noninfectious urological conditions: an up-to-date systematic review. World J Urol 2023; 41:2933-2948. [PMID: 37737900 DOI: 10.1007/s00345-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The goal of this systematic review was to examine the current literature on the urinary microbiome and its associations with noninfectious, nonmalignant, urologic diseases. Secondarily, we aimed to describe the most common bioinformatics used to analyze the urinary microbiome. METHODS A comprehensive literature search of Ovid MEDLINE using the keywords "microbiota" AND "prostatic hyperplasia," "microbiota" AND "urinary bladder, overactive," "microbiota" AND "pelvic pain," and "microbiota" AND "urolithiasis" OR "nephrolithiasis" OR "urinary calculi" AND "calcium oxalate" was performed to identify relevant clinical microbiome studies associated with noninfectious benign urological conditions published from 2010 to 2022. We included human studies that evaluated the urinary, stone, or semen microbiota, or any combination of the above-mentioned locations. RESULTS A total of 25 human studies met the inclusion criteria: 4 on benign prostatic hyperplasia (BPH), 9 on overactive bladder (OAB), 8 on calcium oxalate stones, and 4 on chronic pelvic pain syndrome (CPPS). Specific taxonomic profiles in the urine microbiome were associated with each pathology, and evaluation of alpha- and beta-diversity and relative abundance was accounted for most of the studies. Symptom prevalence and severity were also analyzed and showed associations with specific microbes. CONCLUSION The study of the urogenital microbiome is rapidly expanding in urology. Noninfectious benign urogenital diseases, such as BPH, calcium oxalate stones, CPPS, and OAB were found to be associated with specific microbial taxonomies. Further research with larger study populations is necessary to solidify the knowledge of the urine microbiome in these conditions and to facilitate the creation of microbiome-based diagnostic and therapeutic approaches.
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Affiliation(s)
| | - Joshua Monshine
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Praveen K Singh
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sabita Roy
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katherine Amin
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Huang N, Qin Z, Sun W, Bao K, Zha J, Zhang P, Feng P, Zhao X, Liu M, Shi J, Ma M. Comparing the effectiveness of extracorporeal shockwave therapy and myofascial release therapy in chronic pelvic pain syndrome: study protocol for a randomized controlled trial. Trials 2023; 24:675. [PMID: 37853420 PMCID: PMC10583345 DOI: 10.1186/s13063-023-07633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome is a highly prevalent syndrome. Previous studies showed that extracorporeal shockwave therapy and myofascial release therapy could improve the quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Theoretically, combined therapy with extracorporeal shockwave therapy and myofascial release therapy will likely have significant advantages in treating CP/CPPS. We, therefore, present a protocol for conducting a well-designed randomized controlled trial to compare the efficacy and safety of each therapy. METHODS The proposed study will be a three-group randomized control trial (RCT) design that includes 150 participants from Zhongda Hospital Affiliated to Southeast University, with equal allocation of participants to the three intervention groups. The study duration will be 8 weeks, which includes a 4-week treatment period and a 4-week follow-up period. The primary outcome will be the changes in surface electromyography (sEMG) assessment and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). The secondary outcomes will include the changes in three-dimensional quantification, shear wave elastography (SWE), and sympathetic skin response (SSR) testing. Assessments will be conducted before the intervention (T0), before the 5th intervention (T1), immediately after the 8th intervention (T2), and the 4th week after the end of the 8th intervention (T3). DISCUSSION This trial will compare the differences in efficacy between single extracorporeal shockwave therapy, single myofascial release therapy, and combined therapy to select the most appropriate treatment option for patients with CP/CPPS. The possible pathogenesis of CP/CPPS would also be analyzed by comparing the intercorrelation between each objective and subjective measurement (NIH-CPSI score, sEMG, SWE, SSR). TRIAL REGISTRATION The name of the registry: Extracorporeal Shockwave and Myofascial Release Therapy in Chronic Pelvic Pain Syndrome. REGISTRATION NUMBER NCT05659199. Date of registration: December 2022.
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Affiliation(s)
- Ningqing Huang
- Department of Physical Medicine and Rehabilitation, Southeast University, Nanjing, Jiangsu Province, People's Republic of China
| | - Zhi Qin
- Department of Radiology, Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Wudong Sun
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China
| | - Kaiming Bao
- Division of Biokinesiology and Physical Therapy, University of Southern California, Nanjing, Jiangsu Province, People's Republic of China
| | - Jingxian Zha
- Department of Obstetrics, Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Peng Zhang
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China
| | - Panpan Feng
- Nanjing Institute of Physical Education, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiaojun Zhao
- Nanjing Institute of Physical Education, Nanjing, Jiangsu Province, People's Republic of China
| | - Mengqian Liu
- Department of Physical Medicine and Rehabilitation, Southeast University, Nanjing, Jiangsu Province, People's Republic of China
| | - Jinjun Shi
- Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Ming Ma
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China.
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Sokmen D, Comez YI. Efficacy and Safety of Extracorporeal Shock Wave Therapy in the Treatment of Chronic Prostatitis/ Chronic Pelvic Pain Syndrome and Acquired Premature Ejaculation Patients. Urol Int 2023; 107:872-876. [PMID: 37611558 DOI: 10.1159/000531623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/14/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy and safety of extracorporeal shock wave therapy (ESWT) in patients with acquired premature ejaculation (APE) due to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHOD Patients with APE due to CP/CPPS between January 2020 and June 2022 were included in the study. Demographic data of the patients were recorded, and the degree of their symptoms was evaluated with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), premature ejaculation diagnostic tool (PEDT), and Premature Ejaculation Profile (PEP). The international prostate symptom index (IPSS) was also used for lower urinary tract symptoms (LUTS), and the international erectile function index-erectile function (IIEF-EF) was used to evaluate erectile functions. All patients received treatment with the Medispec Bold Li-ESWT device without using any anesthesia method (12 sessions). The changes in the symptom scores of the patients were evaluated before the treatment and at the 3rd month after the treatment. RESULTS A total of 42 patients were included in the study. The mean age of the patients was 43.75 ± 12.03 (20-55), and the mean BMI was 23.58 ± 7.61 (18.03-35.98) kg/m2. The patients' estimated mean intravaginal ejaculation latency time (IELT) before ESWT was 37.98 ± 21.87 s. After a total of 12 sessions of ESWT, the IIEF-EF, IPSS, NIH-CPSI, and PEP index scores of the patients showed significant improvements (p < 0.001 for each). The IELT mean increased to 74.81 ± 46.79 s (p < 0.001). Posttreatment IELT fold increase was determined as 3.25 ± 1.72 fold. A highly significant positive correlation (p = 0.032; r = 0.839) was found between the CPSI score difference and the posttreatment PEP index score. CONCLUSION Li-ESWT treatment is an effective and safe treatment with positive effects on both LUTS and premature ejaculation in patients with APE symptoms due to CP/CPPS. Patients who benefit from CP treatment also have longer IELT times.
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Affiliation(s)
| | - Yusuf Ilker Comez
- Department of Urology, Memorial Bahcelievler Hospital, Istanbul, Turkey
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Yang Y, Hu R, Zheng J, Wang Q, Xu S, Zhou Z, Zhang D, Shen W. Glucocorticoid nanoformulations relieve chronic pelvic pain syndrome and may alleviate depression in mice. J Nanobiotechnology 2023; 21:198. [PMID: 37340409 DOI: 10.1186/s12951-023-01893-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/11/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is a typical symptom of chronic prostatitis (CP) in males that may cause abnormal urination, sexual dysfunction, or depression and significantly affect the quality of life of the patient. Currently, there is no effective treatment for CPPS due to its recurrence and intractability. For synergistic CPPS therapy, we developed pH/reactive oxygen species (ROS) dual-responsive dexamethasone (Dex) nanoformulations using a ROS-responsive moiety and phytochemical modified α-cyclodextrin (α-CD) as the carrier. RESULTS Dex release from the nanoformulations can be controlled in acidic and/or ROS-rich microenvironments. The fabricated Dex nanoformulations can also be efficiently internalized by lipopolysaccharide (LPS)-stimulated macrophages, prostatic epithelial cells, and stromal cells. Moreover, the levels of proinflammatory factors (e.g., TNF-α, IL-1β, and IL-17 A) in these cells were significantly decreased by Dex nanoformulations treatment through the release of Dex, phytochemical and elimination of ROS. In vivo experiments demonstrated notable accumulation of the Dex nanoformulations in prostate tissue to alleviate the symptoms of CPPS through the downregulation of proinflammatory factors. Interestingly, depression in mice may be relieved due to alleviation of their pelvic pain. CONCLUSION We fabricated Dex nanoformulations for the effective management of CPPS and alleviation of depression in mice.
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Affiliation(s)
- Yang Yang
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China
- Department of Chemistry, College of Basic Medicine, Army Medical University, Third Military Medical University, Chongqing, 400038, China
| | - Ruimin Hu
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China
| | - Jun Zheng
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China
| | - Qianmei Wang
- Department of Pharmacy, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China
| | - Senlin Xu
- Department of Pathology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China
| | - Zhansong Zhou
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China.
| | - Dinglin Zhang
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China.
- Department of Chemistry, College of Basic Medicine, Army Medical University, Third Military Medical University, Chongqing, 400038, China.
| | - Wenhao Shen
- Department of Urology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, 400038, China.
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Khalafalla K, Albakr A, El Ansari W, Majzoub A, Elbardisi H, AlRumaihi K, Arafa M. Short and long-term effectiveness of external shock wave therapy for chronic pelvic pain syndrome in men. Arab J Urol 2023; 21:162-169. [PMID: 37521448 PMCID: PMC10373607 DOI: 10.1080/2090598x.2023.2207415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/21/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Chronic pelvic pain syndrome (CPPS) is a frequent urological diagnosis that affects men's quality of life. Extracorporeal shockwave therapy (ESWT) is a recent treatment option for patients with CPPS. We evaluated ESWT's short and long - term efficacy in managing CPPS. Methods This prospective self-controlled study included 75 patients diagnosed with CPPS at our tertiary pelvic pain clinic between January 2017-June 2019. Patients were referred for ESWT and received four sessions one week apart. The National Institute for Health - Chronic Prostatitis Symptom Index (NIH - CPSI) questionnaire was used to assess patients' symptom severity before starting therapy and at 0, 12 and 26 weeks after completing ESWT. Demographics, clinical data and complications were also recorded. Results Patients' mean age was 37.9 ± 8.6 years, and mean duration of symptoms was 5 ± 4.5 years. Compared to pre-treatment scores, all patients exhibited improvements across all NIH - CPSI domains directly after completing ESWT (week 0 post-treatment), with a mean difference improvement of 9.26 ± 5.7, 5.2 ± 3.4, 1.19 ± 2.18 and 2.88 ± 2.46 points in the total, pain, urinary symptoms, and quality-of-life scores respectively. At 12 weeks after completing ESWT, 80.9% of patients reported improvements, with mean difference improvement of 8.07 ± 7.56, 4.55 ± 4.6, 0.76 ± 2.48, 2.85 ± 2.78 in the total, pain, urinary symptoms, and quality-of-life scores respectively. Again, none of the patients developed any treatment-related complications. At 26 weeks after completing ESWT, 82.4% of patients reported improvements, with mean difference improvement of 8.29 ± 7.7%, 4.92 ± 4.69, 0.75 ± 2.96, 2.5 ± 3.0 in total, pain, urinary symptoms, and quality-of-life scores respectively. None of the patients developed treatment-related complications. Conclusions ESWT is a safe and effective treatment modality for patients with CPPS, with short-term improvement in total, pain, urinary symptom, and quality-of-life scores; and long-term improvement in total, pain, and quality-of-life scores.
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Affiliation(s)
- Kareim Khalafalla
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Division of Urology, Department of Surgery, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Albakr
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Population Health, College of Medicine, Qatar University, Doha, Qatar
- Institute for Population Health, Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Urology, Qatar University, Doha, Qatar
| | - Khalid AlRumaihi
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Urology, Qatar University, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Andrology, Cairo University, Cairo, Egypt
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9
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Origo D, Dal Farra F, Bruni MF, Catalano A, Marzagalli L, Bruini I. Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case-control study. Int Urol Nephrol 2023; 55:511-518. [PMID: 36522568 DOI: 10.1007/s11255-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized. METHODS The aim of this exploratory matched case-control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI), "Hospital Anxiety and Depression Scale" (HADS), "Fear Avoidance Belief Questionnaire" (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area. RESULTS The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms' impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings. CONCLUSION This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.
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Affiliation(s)
- Daniele Origo
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Fulvio Dal Farra
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy. .,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Maria Federica Bruni
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Andrea Catalano
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Lorenzo Marzagalli
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Irene Bruini
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
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Higazy A, Shorbagy AA, Shabayek M, Radwan A, Halim GN, Osman D, Osman T. Short course of dutasteride in treatment of a refractory category IIIB chronic prostatitis (A placebo-controlled study). Prostate Int 2022; 10:213-7. [PMID: 36570649 DOI: 10.1016/j.prnil.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate the short-term efficacy of Dutasteride in the management of chronic prostatitis (CP)/chronic pelvic pain syndrome. Materials and methods A randomized placebo-controlled double-blind study was conducted that including 50 patients diagnosed with CP based on the presence of pelvic pain for ≥3 months of the preceding 6 months. Patients were randomized into 2 equal groups to evaluate Dutasteride of 0.5 mg once daily that was given for 3 months compared to a placebo. Results Forty-nine patients were evaluated after the follow-up period with no statistically significant difference in the perioperative demographic data. The mean age of the Dutasteride group was 48.3 (range 41-62) compared to a mean age of 46.5 (range 44-60) in the placebo group. There was a highly statistically significant improvement in the Dutasteride group compared to its preoperative parameters and the placebo compared group in the terms of pain, urinary scores, and total National Institutes of Health CP symptom score. Moderate and marked improvement in patients' symptomatology was seen in 56% of the dutasteride group, while only 8% in the dutasteride group failed to show an improvement with no significant side effects noted in our study. Conclusion The short-term outcome of dutasteride therapy showed an improvement in the National Institutes of Health-CP symptom score compared to a placebo in the treatment of category IIIB CP. The trial was registered in the clinical trialgov registry with a registration number NCT04756206.
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Wu XL, Li N, Xu C, Yang ZW, Sun QH, Dai XY, Shi TY, Yang SQ, Gu CL, Cheng K. [Effect of electroacupuncture on pain threshold and expression of pain-related factors cyclooxygenase-2, prostaglandin E2 and β-endorphin in rats with chronic pelvic pain syndrome]. Zhen Ci Yan Jiu 2022; 47:531-536. [PMID: 35764521 DOI: 10.13702/j.1000-0607.20210613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the possible mechanism of electroacupuncture (EA) underlying improvement of chronic pelvic pain syndrome (CPPS). METHODS Fifty SD rats were randomly divided into control, model, sham operation, EA and sham EA groups (n=10 rats in each group). The CPPS model was established by injecting complete Freund's adjuvant (CFA, 50 μL) into the ventral lobes of the prostate. EA (2 Hz/100 Hz) was applied to "Guanyuan"(CV4), "Zhongji"(CV3), "Sanyinjiao" (SP6) and "Huiyang"(BL35) once daily for 40 min, 5 days a week for 4 weeks, while rats in the sham EA group were treated with the same acupoints but without electrical stimulation. Mechanical pain threshold (MPT) and heat pain threshold (HPT) were measured before and after intervention. The body weight and prostate weight were measured and prostate index was calculated. Histopathological changes of prostate tissue were observed by HE staining. The levels of cycloxygenase-2 (COX-2), prostaglandin E2 (PGE2) and β-endorphin (β-EP) in prostate tissue were detected by ELISA. RESULTS Compared with the control and sham operation groups, the MPT and HPT were significantly lower (P<0.01), and the prostate weight, prostate index, the contents of PGE2 and COX-2 were significantly increased (P<0.01), while the content of β-EP was significantly decreased (P<0.01) in the model group. Compared with the model group, the MPT and HPT were significantly increased (P<0.01) after 3 and 4 courses of treatment, and the prostate weight, prostate index, the contents of PGE2 and COX-2 were significantly decreased (P<0.01), while the content of β-EP was significantly increased (P<0.01) in the EA group, rather than in the sham EA group (P>0.05). CONCLUSION EA can effectively relieve pain in CPPS rats, which may be related to its functions in down-regulating COX-2 and PGE2, and up-regulating β-EP.
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Affiliation(s)
- Xiao-Ling Wu
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Na Li
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Chang Xu
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhi-Wen Yang
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qian-Hui Sun
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xing-Ye Dai
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tian-Yu Shi
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shou-Qin Yang
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Chun-Ling Gu
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Kai Cheng
- College of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
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Diallo MT, Ali M, Zhang Q, Wang Y, Long Z, Ding J, Zhang C, Zhu X, Jiang M, Sun Q, Zhou X, Wang D. Morphological study of chronic prostatitis- chronic pelvic pain syndrome (CP/CPPS) normal modeling dose of T2 peptide in mice. Int Urol Nephrol 2022; 54:1199-1206. [PMID: 35438412 DOI: 10.1007/s11255-022-03185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES However, the pathogenesis and etiology of CP/CPPS are still poorly understood. Therefore, there is a need for further research through the Image J software to develop models capable of imitating the pathogenesis and etiology of CP/CPPS with different doses of the pathogenesis and the etiology of CP/CPPS is still poorly understood. The aim was to determine the area of the prostatic interstitium, the localization of the inflammation, and the impact of different doses on the group model. MATERIALS AND METHODS A total of 30 male ICR mice were randomly grouped into 5 (n = 6): 45 μg group = 6, 60 μg group = 6, 90 μg group = 6, 120 μg group = 6, 120 μg group = 6, control group = 6. With the exception of the control group, all the groups were immunized by injecting 0.2 mL of T2 peptide emulsion and immune adjuvant CFA to induce non-bacterial chronic prostatitis on days 0 and 14 of the mice and finally executed on day 28. All injections were administered subcutaneously. HE staining was used to evaluate changes in prostate pathology. Image J was used to calculate the area of the prostate interstitium, which represents the degree of prostate edema. To compare statistical differences between groups, the ANOVA test was used. RESULTS From the perspective of pathological scoring, the 60 μg, 90 μg, and 120 μg groups had the highest scores using Image J to treat inflammatory cells. In addition, in the prostate interstitium area treated, it was found that the 90 μg group attained the largest prostate interstitial area as well as the highest degree of swelling. CONCLUSIONS From the results, Image J software is an effective tool in the calculating the surface of the prostatic interstitium and the specific localization of the inflammation.
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Affiliation(s)
- Maladho Tanta Diallo
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, School of Pharmacy, China Pharmaceutical University, 639# Longmian Avenue, Nanjing, Jiangsu Province, 211198, People's Republic of China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Yang Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Ziyang Long
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Jianyue Ding
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Cangyuan Zhang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Xiaodong Zhu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Mingrui Jiang
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Qiannan Sun
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
| | - Xiaohui Zhou
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, School of Pharmacy, China Pharmaceutical University, 639# Longmian Avenue, Nanjing, Jiangsu Province, 211198, People's Republic of China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
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Dal Farra F, Aquino A, Tarantino AG, Origo D. Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis. Int Urogynecol J 2022. [PMID: 35389057 DOI: 10.1007/s00192-022-05173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact. METHODS A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria. RESULTS Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was "very low". Other results were presented in a qualitative synthesis. CONCLUSIONS In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.
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Piontek K, Ketels G, Klotz SGR, Dybowski C, Brünahl C, Löwe B. The longitudinal association of symptom-related and psychological factors with health-related quality of life in patients with chronic pelvic pain syndrome. J Psychosom Res 2022; 153:110707. [PMID: 34954604 DOI: 10.1016/j.jpsychores.2021.110707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyze the course of symptom-related measures, psychological variables and health-related quality of life (HRQoL) over a 12-month period, and to longitudinally examine symptom-related and psychological factors as predictors for HRQoL in male and female patients with chronic pelvic pain syndrome (CPPS). METHODS Data from 125 patients aged 19-83 years at baseline attending an interdisciplinary outpatient clinic for CPPS were analyzed. Participants completed a self-administered questionnaire on subjective health issues, and a postal follow-up survey was conducted 12 months later. We assessed physical and mental HRQoL, CPPS symptom severity, pain intensity, severity of somatic, depressive and anxiety symptoms, pain catastrophizing, and data on treatments during the follow-up period. Data were analyzed using multilevel linear modelling. RESULTS CPPS symptom severity, pain intensity, and pain catastrophizing significantly decreased over time. HRQoL and levels of somatic symptoms, depressive symptoms and anxiety remained stable. Lower baseline levels of somatic symptoms were associated with an increase in physical HRQoL, and lower baseline levels of depressive symptoms, anxiety and pain catastrophizing were associated with an increase in mental HRQoL after 12 months. Treatment utilization was neither related to decrease in CPPS symptom severity, pain intensity and pain catastrophizing, nor to HRQoL after 12 months. CONCLUSIONS Our data suggest that CPPS is related to persistently diminished HRQoL. Somatic symptoms and psychological factors are important determinants of HRQoL and potential therapeutic targets. To evaluate the efficacy and impact of treatment on CPPS-related outcomes, future large-scaled studies should systematically assess detailed data about therapies patients receive in routine care.
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AlKhayal A, Alasmari FA, Alomeyr BK, Abumelha S, Alrabeeah K. Chronic pelvic pain syndrome symptoms significantly affect medical students' well-being. Urol Ann 2022; 14:259-264. [PMID: 36117802 PMCID: PMC9472309 DOI: 10.4103/ua.ua_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Aims This study aims to determine the prevalence of chronic pelvic pain syndrome (CPPS) symptoms among male-medical students in Riyadh, Saudi Arabia. Settings and Design It is a cross-sectional study at King Saudi Bin Abdulaziz University for Health Sciences, College of Medicine at Riyadh, Saudi Arabia. Subjects and Methods A total of 300 male medical students were given a hardcopy questionnaire to be filled anonymously that includes demographic characteristics, several questions regarding the health status, habits of the participants, and the National Institutes of Health Chronic Prostatitis Symptom Index for evaluating CPPS symptoms. Statistical Analysis Used SPSS (v21) was used for the analysis. Qualitative data presented by frequencies and percentages and quantitative data presented by median and interquartile range (Q1 to Q3). The Chi-square test and binary logistic regression were used to assess the relationship between the outcome variables with demographical data. Results In total 300 male medical students were surveyed, 245 medical students returned the questionnaire giving a response rate of 81.6%. The prevalence of CPPS symptoms among all participants was 57.9%. Majority of the participants does not have any associated medical/psychological conditions 152 (62%). Students with irritable bowel syndrome (IBS) or/and anxiety have statistically significant association with CPPS symptoms (P < 0.05). A total of 23% of students with CPPS reported being impaired with their quality of life (QOL), while 77% are satisfied. Conclusions The prevalence of CPPS symptoms among male medical students is high. Anxiety, IBS, and lack of activity might be associated with CPPS symptoms, which have a significant negative impact on the QOL. For the future direction, a large-scale global study should be conducted to link the effects of CPPS symptoms on male medical students well-being.
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Affiliation(s)
- Abdullah AlKhayal
- King Abdulaziz Medical City, Division of Urology, Riyadh, Saudi Arabia,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Faisal Ali Alasmari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Bander Khaled Alomeyr
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia,Address for correspondence: Dr. Bander Khaled Alomeyr, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. E-mail:
| | - Saad Abumelha
- King Abdulaziz Medical City, Division of Urology, Riyadh, Saudi Arabia,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Khalid Alrabeeah
- King Abdulaziz Medical City, Division of Urology, Riyadh, Saudi Arabia,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol 2021; 265:143-149. [PMID: 34492609 DOI: 10.1016/j.ejogrb.2021.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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Abstract
OBJECTIVE : To outline our approach for the evaluation and management of patients with chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) based on our interpretation and application of currently available evidence. METHODS : CP/CPPS in men is a medical condition that plagues both the patient and the practitioner, as it is widely believed to be poorly understood and difficult to treat. While pelvic pain is typically the predominant symptom, many men may exhibit voiding symptoms, sexual dysfunction and psychiatric complaints. Still, most studies of CP/CPPS management have evaluated singular treatments, without focussing on individual patients' clinical phenotypes. This is a clinically practical mini-review based on the authors' interpretation and application of currently available evidence related to management of CP/CPPS. RESULTS : Patient evaluation should consist of history and physical examination (with focus on the genitourinary and digital rectal examination), laboratory tests (including urine analysis and urine culture with consideration of pre- and post-prostate massage urine cultures), post-void residual, and questionnaires including the National Institutes of Health Chronic Prostatitis Symptoms Index, which helps assess symptom severity and treatment response. Once CP/CPPS is diagnosed, the UPOINT phenotype system, which classifies patients into six domains: Urinary, Psychosocial, Organ Specific, Infectious, Neurological/systemic and Tenderness of skeletal muscles, is used to guide treatment. Each domain is characterised by specific complaints and thus is responsive to distinct treatments. As patients may be grouped into multiple domains, each patient's overall multimodal treatment can vary. CONCLUSION : Using the UPOINT phenotype system is a holistic approach that can yield significant benefits for patients with CP/CPPS.
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Affiliation(s)
- Darren J. Bryk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel A. Shoskes
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kim KS, Choi YS, Bae WJ, Cho HJ, Ha US, Hong SH, Lee JY, Han CH, Kim SW. Clinical Efficacy of Multi-Focal Low-Intensity Extracorporeal Shockwave Therapy in the Treatment of Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: Prospective-Randomized, Double Blind, Placebo-Controlled Study. World J Mens Health 2021; 40:678-685. [PMID: 34448376 PMCID: PMC9482853 DOI: 10.5534/wjmh.210078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/27/2021] [Accepted: 07/03/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess the safety and effect of the multifocal low-intensity extracorporeal shockwave therapy (MESWT) in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Materials and Methods We randomly separated 30 patients with CP/CPPS into a MESWT and placebo group of same number using prospective-randomized, double-blind design. The participants' National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total and subdomain scores, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and visual analogue scale (VAS) were assessed and compared at baseline and at finishing immediately and 4 weeks after procedure and also were compared between MESWT and placebo group. Results A total of 30 participants were randomized a MESWT or placebo group. Twenty of thirty participants completed this trial. NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS had significantly ameliorated compared with baseline in the MESWT group at 4 weeks assessment. Furthermore, comparison of the results from MESWT and placebo groups represented statistically significant differences in NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS. No side effects or events were occurred in both groups of the participants during study periods. Conclusions MESWT can be an effective treatment modality in patients with CP/CPPS as it improves pain and QoL.
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Affiliation(s)
- Kang Sup Kim
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Yong Sun Choi
- Department of Urology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Chang Hee Han
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Kim KS, Choi YS, Bae WJ, Cho HJ, Ha US, Hong SH, Lee JY, Ahn ST, Moon DG, Kim SW. Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome IIIb: A Prospective-Randomized, Double-Blind, Placebo-Controlled Study. World J Mens Health 2021; 40:473-480. [PMID: 34448374 PMCID: PMC9253802 DOI: 10.5534/wjmh.210010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose There is no definite treatment method for chronic pelvic pain syndrome (CPPS). The purpose of this study was to compare and assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) versus placebo treatment in CPPS IIIb patients. Materials and Methods Thirty participants with CPPS IIIb were included and randomized in this prospective, double-blind, placebo-controlled study. Li-ESWT was performed at the perineum without anesthesia once per week for 8 weeks. CPPS-related symptoms were evaluated using the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI). Pain and erectile function were appraised using the Visual Analogue Scale (VAS) and International Index of Erectile Function-Erectile Function (IIEF-EF), respectively. The Global Efficacy Assessment Question (GEAQ) was also assessed. The parameters were evaluated immediately after the last Li-ESWT treatment and 4 weeks after Li-EWST treatment. Results Fifteen subjects each in the Li-ESWT and placebo groups completed this study. Amelioration of NIH-CPSI total, pain, and quality of life score in the Li-ESWT group was found compared to the placebo group (p=0.002, 0.02, 0.001, respectively). Improvement of the VAS score was observed in the Li-ESWT group (p=0.002). The differences in the GEAQ “Yes” responses were also significant in the Li-ESWT group. No patients experienced side effects related to ESWT during therapeutic period or follow-up duration. Conclusions Results indicated that Li-ESWT improved the NIH-CPSI score, pain, and the quality of life in CPPS IIIb patients. Li-ESWT could be an effective alternative treatment modality for CPPS IIIb.
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Affiliation(s)
- Kang Sup Kim
- Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong Sun Choi
- Department of Urology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea.
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Korea.
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21
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Carralero-Martínez A, Muñoz Pérez MA, Pané-Alemany R, Blanco-Ratto L, Kauffmann S, Ramírez-García I. Efficacy of capacitive resistive monopolar radiofrequency in the physiotherapeutic treatment of chronic pelvic pain syndrome: study protocol for a randomized controlled trial. Trials 2021; 22:356. [PMID: 34016168 PMCID: PMC8136758 DOI: 10.1186/s13063-021-05321-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder that affects 5.7% to 26.6% of women and 2.2% to 9.7% of men, characterized by hypersensitivity of the central and peripheral nervous system affecting bladder and genital function. People with CPPS have much higher rates of psychological disorders (anxiety, depression, and catastrophizing) that increase the severity of chronic pain and worsen quality of life. Myofascial therapy, manual therapy, and treatment of trigger points are proven therapeutic options for this syndrome. This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to other physiotherapeutic techniques for reducing pain and improving the quality of life of patients with CPPS. METHODS This triple-blind (1:1) randomized controlled trial will include 80 women and men with CPPS. Participants will be randomized into a CRMRF activated group or a CRMRF deactivated group and receive physiotherapeutic techniques and pain education. The groups will undergo treatment for 10 consecutive weeks. At the beginning of the trial there will be an evaluation of pain intensity (using VAS), quality of life (using the SF-12), kinesiophobia (using the TSK-11), and catastrophism (using the PCS), as well as at the sixth and tenth sessions. DISCUSSION The results of this study will show that CRMRF benefits the treatment of patients with CPPS, together with physiotherapeutic techniques and pain education. These results could offer an alternative conservative treatment option for these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03797911 . Registered on 8 January 2019.
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Affiliation(s)
- A Carralero-Martínez
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Servicio de Ginecología, Instituto Clínic de Ginecología, Obstetricia y Neonatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M A Muñoz Pérez
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP-Jordi Gol), Barcelona, Spain
- Institut Català de la Salut (ICS), Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - R Pané-Alemany
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
| | - L Blanco-Ratto
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Fundació Universitària del Bages (FUB), Barcelona, Spain
| | - S Kauffmann
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain
- Fundació Universitària del Bages (FUB), Barcelona, Spain
- Servicio de Fisioterapia, Womens Salud y Bienestar de la Mujer SL, Barcelona, Spain
| | - I Ramírez-García
- Rehabilitación Abdomino-Pelviana (RAPbarcelona SL), Barcelona, Spain.
- Servicio de Fisioterapia, Instituto Médico Tecnológico SL, Barcelona, Spain.
- Blanquerna School of Health Science-Universitat Ramon Llull, Barcelona, Spain.
- Universidad Internacional de Catalunya (UIC), Barcelona, Spain.
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22
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Parsons BA, Goonewardene S, Dabestani S, Pacheco-Figueiredo L, Yuan Y, Zumstein V, Cottrell AM, Borovicka J, Dinis-Oliveira P, Berghmans B, Elneil S, Hughes J, Messelink BEJ, de C Williams AC, Baranowski AP, Engeler DS. The Benefits and Harms of Botulinum Toxin-A in the Treatment of Chronic Pelvic Pain Syndromes: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel. Eur Urol Focus 2021; 8:320-338. [PMID: 33526405 DOI: 10.1016/j.euf.2021.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/10/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option. OBJECTIVE To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS. EVIDENCE ACQUISITION A systematic review of the use of BTX-A in the treatment of CPPS was conducted (PROSPERO-ID: 162416). Comprehensive searches of EMBASE, PUBMED, Medline, and SCOPUS were performed for publications between January 1996 and May 2020. Identified studies were screened and selected studies assessed for quality prior to data extraction. The primary outcomes were improvement in pain and adverse events following treatment. Secondary outcomes included quality of life, global response assessment, sexual function, bowel function, and bladder function. EVIDENCE SYNTHESIS After screening 1001 abstracts, 16 studies including 11 randomised controlled trials were identified, enrolling 858 patients and covering a range of CPPS subtypes. Most studies showed high risks of bias and confounding across all domains. A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis and calculation of pooled effect estimates of measured outcomes. BTX-A reduced pain significantly in patients with bladder pain syndrome in two studies and in patients with prostate pain syndrome in one study, but no included studies showed benefit for patients with gynaecological pelvic pain. Adverse event reporting was variable and generally poor, but no serious adverse events were described. CONCLUSIONS Beneficial effects of BTX-A on pain, quality of life, and functional symptoms were seen in patients with certain CPPS subtypes, but the current evidence level is too weak to allow recommendations about BTX-A use for treating CPPS. PATIENT SUMMARY Botulinum toxin A is used to treat different pain disorders, but current studies are of insufficient quality to determine whether it reduces pain and improves quality of life in patients with chronic pelvic pain. Further research is needed.
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Affiliation(s)
| | | | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Luis Pacheco-Figueiredo
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | | | | | - Paulo Dinis-Oliveira
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Bary Berghmans
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sohier Elneil
- University College Hospital and the Hospital for Neurology and Neurosurgery, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert E J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Andrew P Baranowski
- University College London and the National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London, UK
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23
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Song Z, Jin C, Bian Z, Liang C. Extracorporeal shock wave therapy decreases the number of total and degranulated mast cells and alleviates pelvic pain in a rat model of prostatitis. Mol Cell Biochem 2021; 476:1905-1913. [PMID: 33492609 DOI: 10.1007/s11010-020-04009-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common male urological disease characterized by chronic pelvic pain. Extracorporeal shock wave therapy (ESWT) has been used to treat patients with CP/CPPS, but the parameters used by ESWT are not uniformly determined. Herein, this study aims to assess the effects of ESWT with different energy flux densities on pelvic pain in CP/CPPS rats and to explore the mechanisms. A rat model of CP/CPPS was induced by intraprostatic injection of 1% carrageenan. ESWT with different energy flux densities (0.09, 0.20, 0.30, 0.40 mJ/mm2) was applied in the pelvic region of CP/CPPS rats once a week for 4 weeks. The results showed that compared with the other energy flux densities (0.09, 0.30, and 0.40 mJ/mm2), ESWT with 0.20 mJ/mm2 exhibited a more powerful effect in alleviating pelvic pain and prostate damage. The therapeutic effect is associated with the reduction of the number of total and degranulated mast cells. Collectively, ESWT with 0.20 mJ/mm2 achieved the optimal therapeutic effect in alleviating pelvic pain in CP/CPPS rats.
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Affiliation(s)
- Zhengyao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
| | - Chen Jin
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.,Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, China
| | - Zichen Bian
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.,Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.
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24
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Zhang K, Guo RQ, Chen SW, Chen B, Xue XB, Chen S, Huang J, Liu M, Tian Y, Zuo L, Chen M, Zhou LQ. The efficacy and safety of Serenoa repens extract for the treatment of patients with chronic prostatitis/ chronic pelvic pain syndrome: a multicenter, randomized, double-blind, placebo-controlled trial. World J Urol 2021; 39:3489-3495. [PMID: 33452912 PMCID: PMC8510895 DOI: 10.1007/s00345-020-03577-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To perform a placebo-controlled trial to evaluate the efficacy and safety of Serenoa repens extract (SRE) for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Methods We conducted a double-blind, randomized, placebo-controlled, multicenter, clinical phase 4 study of 221 patients with CP/CPPS across 11 centers. Participants were randomly assigned in a 2:1 ratio to receive SRE or placebo for 12 weeks. The primary efficacy endpoint was the change in total score on the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). Secondary efficacy endpoints included improvements within each domain of NIH-CPSI, clinical response rate, and International Index of Erectile Function 5 items (IIEF-5). Results In total, 226 patients were enrolled and randomized between January 2017 and June 2018. Of these 221 patients were included in the intent-to-treat analysis: 148 in the SRE group and 73 patients in the placebo group. Compared to the placebo, SRE led to statistically significant improvements in the NIH-CPSI total score and sub-scores. The significant improvements of NIH-CPSI scores were established after 2 weeks from the first dose, and continued to the end of the treatment. Furthermore, a significantly higher rate of patients achieved a clinical response in the SRE group compared with that in the placebo group (73.0% vs 32.9%, P < 0.0001). Only minor adverse events were observed across the entire study population. Conclusions SRE was effective, safe, and clinically superior to placebo for the treatment of CP/CPPS. ChiCTR-IPR-16010196, December 21, 2016 retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1007/s00345-020-03577-2.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Peking University First Hospital, The Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China.,Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
| | - Run-Qi Guo
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan-Wen Chen
- Department of Urology, Huashan Hospital of Fudan University, Shanghai, China
| | - Bin Chen
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin-Bo Xue
- Department of Urology, The Second Affiliated Hospital, Soochow University, Suzhou, China
| | - Shan Chen
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Zuo
- Department of Urology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, 210000, Jiangsu, China.
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, The Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China. .,Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China.
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25
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Sahin A, Kutluhan MA, Yildirim C, Urkmez A, Akan S, Verit A. Results of purified micronized flavonoid fraction in the treatment of categorized type III chronic pelvic pain syndrome: a randomized controlled trial. Aging Male 2020; 23:1103-1108. [PMID: 31615318 DOI: 10.1080/13685538.2019.1678581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The management of chronic pelvic pain syndrome (CPPS) is controversial because of the unclear pathogenesis of this disease. In one theory, prostatitis has been proposed to be associated with pelvic venous diseases such as varicocele and hemorrhoids, dilatation of the Santorini plexus. In this study, we investigated the effect of micronized flavonoid fraction (an agent used in venous insufficiency) in the treatment of type III CPPS. METHODS Patients diagnosed with type III chronic prostatitis were randomized and divided into 3 groups. Group 1 consisted of patients using antibiotics + anti-inflammatory + alpha-blocker (n = 47), Group 2 consisted of patients using antibiotics + anti-inflammatory + purified micronized flavonoid fraction (n = 45), and Group 3 consisted of patients using only purified micronized flavonoid fraction (n = 35). RESULTS The mean age of the patients was 32.93 ± 4.70 (range; 23-44) years. There was a statistically significant difference between the groups in terms of the 6th month NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) total scores (p = .000). Also, it was found that NIH-CPSI total scores at month 12 in Group 3 were significantly higher than those in Group 1 and 2 (p1 = .000, p2 = .002). NIH-CPSI total scores at month 12 in Group 2 were significantly higher than those in Group 1 (p = .000). CONCLUSION The use of purified micronized flavonoid will decrease prostatic inflammation occurring due to increased perineal venous return.it can also be preferred as part of multimodal therapy because of its profile with relatively less side effects and being more affordable compared with alpha-blockers.
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Affiliation(s)
- Aytac Sahin
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Musab Ali Kutluhan
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Caglar Yildirim
- Department of Urology, Mardin State Hospital, Mardin, Turkey
| | - Ahmet Urkmez
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Serkan Akan
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Ayhan Verit
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
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26
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Guu SJ, Liu CC, Juan YS, Li CC, Tsai CC. The 12-month follow-up of the low-intensity extracorporeal shockwave therapy in the treatment of patients with chronic pelvic pain syndrome refractory to 3-As medications. Aging Male 2020; 23:793-800. [PMID: 30945953 DOI: 10.1080/13685538.2019.1597341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Applying low-intensity extracorporeal shockwave therapy (LI-ESWT) has been reported to improve symptoms of refractory chronic pelvic pain syndrome (CPPS) in short-term follow-up. This study aims to demonstrate the effect of LI-ESWT on refractory CPPS over the span of a 12-month follow-up. MATERIALS AND METHODS This was an open-label, single-arm prospective study. LI-ESWT consisted of 3000 shock waves once weekly for 4 weeks (Duolith SD1 T-Top) were applied. Clinical symptoms were re-assessed at 1, 3, 6, and 12 months using NIH-CPSI score, visual analog scale, 5-item version of the International Index of Erectile Function and International Prostate Symptom Score. RESULTS Thirty-one of the 43 patients enrolled had a successful response at the 1-month follow up after the treatment. Twenty-six of the 31 patients who responded successfully to LI-ESWT at the 1-month follow-up, maintained their response at the 6- and 12-month follow-up. The existence of psychosocial disorder at the baseline characteristics analysis was the only potential factor that may hinder the effectiveness of LI-ESWT. CONCLUSIONS LI-ESWT has shown to be a safe and effective therapy for CPPS patients at the long-term follow-up. History of psychological disorders might be a significant predictor of a successful response.
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Affiliation(s)
- Shiao-Jin Guu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chu Liu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chun Tsai
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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27
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Nikkola J, Holm A, Seppänen M, Joutsi T, Rauhala E, Kaipia A. Repetitive Transcranial Magnetic Stimulation for Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: A Prospective Pilot Study. Int Neurourol J 2020; 24:144-9. [PMID: 32615676 DOI: 10.5213/inj.1938258.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/16/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the feasibility, efficacy, and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with treatment-resistant chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Methods Eleven patients with CP/CPPS were enrolled in this prospective clinical study. rTMS was performed for 5 consecutive days in 20-minute sessions. Patients were evaluated at baseline, after treatment, and at 1, 4, 8, and 12 weeks after the last session with questionnaires concerning pain (numerical rating scale [NRS], the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI], and the Short Form-36 [SF-36]), urinary symptoms (NIH-CPSI, Danish Prostatic Symptom Score [DAN-PSS-1]), quality of life (NIH-CPSI, SF-36), and psychometrics (Beck Depression Index [BDI]). Telephone-based interviews were used to evaluate side effects, subjective response, and changes in drug consumption. Results All patients completed the planned treatment and follow-up according to protocol. No patients experienced serious side effects or significant pain increase during or after treatment. Mild transient tension headache responsive to oral pain medication was reported by 2 patients. Decreased pain was observed on the NRS after treatment and at 1 and 8 weeks (P=0.019, P=0.006, P=0.042, respectively) and on the NIH-CPSI pain domain at 1 week (P=0.04). Improvement in lower urinary tract symptoms was observed after treatment in the NIH-CPSI urinary domain (P=0.02) but not with the DANPSS-1. No significant changes in the BDI were observed. Nine patients reported a positive overall subjective response (82%) and 6 patients (55%) were able to reduce pain medication. Higher age was associated with lower NRS scores after treatment (R=0.605, P=0.048) and at 8 weeks (R=0.659, P=0.028). Conclusions rTMS for patients with CP/CPPS seemed to be well tolerated, at least moderately effective in pain reduction, and might be of interest in patients with chronic pelvic pain resistant to conventional treatment. These findings remain to be confirmed by a randomized trial.
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28
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Klotz SGR, Ketels G, Richardsen B, Löwe B, Brünahl CA. [Physiotherapeutic assessment of chronic pelvic pain syndrome : Development of a standardized physiotherapeutic assessment instrument for interprofessional cooperation in patients with chronic pelvic pain syndrome]. Schmerz 2018; 32:188-94. [PMID: 29693198 DOI: 10.1007/s00482-018-0293-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The chronic pelvic pain syndrome (CPPS) can be associated with physiotherapeutic findings. An interprofessional approach is recommended for patients with CPPS; however, no standardized physiotherapeutic assessment and documentation instrument for specific physiotherapeutic assessments exist, which is not only the foundation for physiotherapy but also for interprofessional communication. OBJECTIVE The aim was the development of a physiotherapeutic assessment instrument for patients with CPPS and therefore, to create a tool for clinical use, research and interprofessional communication. MATERIAL AND METHODS Based on an explorative literature search and an expert consensus, the first version of the instrument was developed as part of a specialized outpatient clinic. This version was applied clinically for 13 months, edited and finalized after another expert consensus. RESULTS The developed instrument Physical Therapy Assessment for Chronic Pelvic Pain Syndrome (PTA-CPPS) lists external and internal groups of muscles for a systematic assessment of myofascial findings. Functional capacity, breathing movements as well as scars and regions of pain are recorded. A manual for the assessment protocol was developed as accompanying material. CONCLUSION The developed instrument provides for the first time a physiotherapeutic assessment tool for patients with CPPS for interprofessional clinical and scientific use.
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29
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Sánchez Llopis A, Di Capua Sacoto C, O'Connor JE, Martínez Romero A, Ruiz Cerdá JL. Study of the Apoptotic Effect in Patients with Urological versus Gynaecological Chronic Pelvic Pain. Urol Int 2019; 103:211-217. [PMID: 31129663 DOI: 10.1159/000500211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/07/2019] [Indexed: 11/19/2022]
Abstract
The objective is to observe if it could be possible to use the apoptosis test to distinguish different aetiologies in chronic pelvic pain syndrome (CPPS). A prospective study was done, 106 patients, 57 had previously been diagnosed with urological chronic pelvic pain (UCPP)/interstitial cystitis (IC) and 49 patients with gynaecological chronic pelvic pain (GCPP). Neoplastic cells cultures were exposed to the urine of patients with UCPP/IC and patients with GCPP. The urine ability to provoque apoptosis on them was analysed. The apoptosis degree was measured by quantifying the percentage of cells in phase subG0, determined by a flow cytometry analysis. It is observed that the cell cultures exposed to urine of patients with UCPP had a significantly higher sub-G1 peak and G2 phase than those of the cells exposed to urine from patient's GCPP. The average values of apoptosis in patients with UCPP were significantly higher to that obtained in -patients having GCPP. With the apoptosis tests having a value >10%, it is considered as positive as well. This means that when we are faced with a patient who has UCPP or non-bladder chronic pelvic pain, the probability of having an UCPP increases by 45% when the apoptosis test is positive for a value >10%. Urine from patients with UCPP has significantly higher apoptotic effect over than the effect produced by urine from patients with GCPP. The apoptosis test could be useful as an illness biomarker.
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Affiliation(s)
- Anna Sánchez Llopis
- Department of Urology, Hospital General de Castellón, Castellón de la Plana, Spain,
| | | | - Jose Enrique O'Connor
- Department of Biochemistry and Molecular Biology, Universitat Politecnica de Valencia, Valencia, Spain
| | - Alicia Martínez Romero
- Centro de Investigación Principe Felipe, Cytomics Technological Service, Valencia, Spain
| | - José Luís Ruiz Cerdá
- Department of Urology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Piontek K, Ketels G, Albrecht R, Schnurr U, Dybowski C, Brünahl CA, Riegel B, Löwe B. Somatic and psychosocial determinants of symptom severity and quality of life in male and female patients with chronic pelvic pain syndrome. J Psychosom Res 2019; 120:1-7. [PMID: 30929698 DOI: 10.1016/j.jpsychores.2019.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 02/08/2023]
Abstract
AIMS To investigate the combined impact of somatic and psychosocial factors on symptom severity and physical and mental quality of life (QoL) in male and female patients with chronic pelvic pain syndrome (CPPS). METHODS We examined 234 patients aged 18 to 84 years attending an interdisciplinary outpatient clinic for patients with CPPS in Hamburg, Germany. Using self-reports, we assessed CPPS symptom severity (NIH-CPSI), with the female counterpart of each male anatomical site used in the questionnaire for women; physical and mental QoL (SF-12) as well as symptoms of depression (PHQ-9) and anxiety (GAD-7); pain catastrophizing cognitions (PCS); social support (F-SozU) and medication intake. The presence of trigger and tender points was assessed in a physiotherapy examination. Hierarchical multiple regression analysis was calculated to analyze the contribution of somatic and psychosocial variables on CPPS symptom severity. Analyses were repeated with physical and mental QoL as outcomes. RESULTS In the overall model, the intake of pain medication (B = 3.78, SE = 1.25, p = .006), the presence of depressive symptoms (B = 0.40, SE = 0.15, p = .01) and pain catastrophizing (B = 0.18, SE = 0.05, p = .001) significantly predicted CPPS symptom severity. Corresponding analyses revealed a differential pattern of factors predicting physical and mental QoL, whereas higher levels of depressive symptoms were consistently associated with diminished mental (B = -0.63; p < .001) and physical QoL (B = -0.85; p < .001). CONCLUSION Present results emphasize the importance of psychosocial factors, in particular of depression, in CPPS symptom severity and both physical and mental QoL and give support to an integrated treatment concept encompassing both psychological support and somatic aspects of the disease.
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Affiliation(s)
- Katharina Piontek
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gesche Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Albrecht
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Schnurr
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Dybowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian A Brünahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Riegel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), commonly encountered in urologic practice, carries with it a stigma of poor understanding, ineffective treatment, and significant financial and quality of life burden. MATERIALS AND METHODS This clinically practical review is based on the authors' personal clinical experience in interpretation and application of currently available evidence. RESULTS Significant progress has been made in terms of classification and evaluation of the disease, leading to encouraging improvements in treatment outcomes. The Chronic Prostatitis Symptom Index (CPSI) is a helpful tool in clinical evaluation and has proven invaluable for research purposes, while UPOINT has demonstrated the heterogeneity of the disease and provides physicians with a uniquely patient-centered approach to treatment. The importance of the microbiome in the evaluation of CP/CPPS patients has yet to be fully appreciated. While personalized, multi-modal therapy appears to be the key to treatment, the addition of pelvic floor physiotherapy (PFPT) with injection of trigger points, and psychosocial therapies to the multi-modal approach armamentarium are promising advances. Innovative interventional approaches are encouraging but require study. CONCLUSIONS While encouraging therapies have been added to personalized, multi-modal treatment strategies, newer innovative therapies appear promising for improved treatment of CP/CPPS patients.
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Affiliation(s)
- R Christopher Doiron
- Department of Urology, Queen's University, Empire 4, Kingston General Hospital, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
| | - Daniel A Shoskes
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Curtis Nickel
- Department of Urology, Queen's University, Empire 4, Kingston General Hospital, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
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Salama AB, Abouelnaga WA. Effect of radial shock wave on chronic pelvic pain syndrome/chronic prostatitis. J Phys Ther Sci 2018; 30:1145-1149. [PMID: 30214114 PMCID: PMC6127492 DOI: 10.1589/jpts.30.1145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
[Purpose] This study aimed to evaluate the effect of radial extracorporeal shock wave
therapy (rESWT) on patients with chronic pelvic pain syndrome (CPPS). [Participants and
Methods] Forty male CPPS patients were randomly assigned into either an rESWT group or a
control group. The first group was treated with rESWT two times per week for four weeks
with a protocol 3,000 pulse, 12 Hz at 3 to 5 bar. The control group was treated with the
same protocol, but the device’s probe had been turned off. The follow-up assessment was
done using the National Institutes of Health-developed Chronic Prostatitis Symptom Index
(NIH-CPSI) before treatment, as well as one week, four weeks, and 8 weeks after treatment.
[Results] No significant difference was found in terms of age, sub-domain, or the total
score of the NIH-CPSI between the rESWT group and the control group at the baseline. A
statistically significant decrease was determined in the pain domain, urine score, quality
of life, and the total NIH-CPSI score of the rESWT group at all post-treatment time
points. All domains and the total score of the NIH-CPSI at all three follow-up time points
decreased more significantly in the rESWT group as compared to the control group.
[Conclusion] The findings of this study confirmed that rESWT is an effective method for
treating CPPS.
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Affiliation(s)
- Amr B Salama
- Department of Physical Therapy, College of Applied Medical Sciences, Najran University, Saudi Arabia.,Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University: Giza, Egypt
| | - Walid A Abouelnaga
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University: Giza, Egypt
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Dybowski C, Löwe B, Brünahl C. Predictors of pain, urinary symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS): A prospective 12-month follow-up study. J Psychosom Res 2018; 112:99-106. [PMID: 30097143 DOI: 10.1016/j.jpsychores.2018.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/18/2018] [Accepted: 06/29/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Chronic pelvic pain syndrome (CPPS) can affect both men and women and often causes substantial impairment to quality of life. Although cross-sectional studies have suggested that psychosocial aspects may constitute important factors in the etiology and maintenance of CPPS, longitudinal studies are rare. Therefore, the present study examines psychosocial factors as prospective predictors of pain intensity, urinary symptoms and impediments to quality of life in men and women with CPPS. METHODS Data were collected from patients during visits to a specialized, interdisciplinary outpatient clinic and after 12 months. Outcomes included pain intensity, urinary symptoms and impediments to quality of life, all of which were measured with the NIH-CPSI. Age, sex, depressive-anxious symptomatology (PHQ-ADS), pain catastrophizing (PCS), health anxiety (WI-7) and social support (FSozU) were examined as predictors in multivariate linear regressions. RESULTS Data from 109 patients (59.6% female; age M = 49.3, SD = 16.7) were analyzed. Pain severity (β = .30, p = .004), age (β = .22, p = .02), urinary symptoms (β = .24, p = .01) and depressive-anxious symptomatology (β = .29, p = .009) at baseline emerged as predictors of pain at follow-up. Urinary symptoms were predicted by urinary symptoms (β = .53, p < .001) and depressive-anxious symptomatology (β = .25, p = .01) at baseline; impediments to quality of life were predicted by depressive-anxious symptomatology (β = .27, p = .01). CONCLUSION Psychological factors, especially depressive-anxious symptomatology, predict CPPS-specific symptom severity and impediments to quality of life after 12 months and thus substantially contribute to the chronification of CPPS. It is recommended to address anxiety and depression in patients with CPPS as early as possible in biopsychosocially oriented treatment approaches.
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Affiliation(s)
- Christoph Dybowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Christian Brünahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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Briganti G, Falla JP, Roumeguère T. [ Chronic pelvic pain syndrome and Crohn's disease : a dangerous association]. Rev Med Brux 2018; 39:175-177. [PMID: 29869475 DOI: 10.30637/2018.16-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present the case of a 54 year old male complaining of abdominal pain localised in the right flank and irradiating in other abdominal regions. The pain was previously associated with kidney stones, but persisted months after their total evacuation. Suffering from Crohn's disease, low dose corticosteroids likely caused a particularly invalidating chronic prostatitis, which antibiotic treatment aggravated the symptoms of Crohn's disease, therefore complicating the therapeutic care by causing a vicious circle. Further epidemiological and microbiological studies are needed in order to establish an association between low dose steroid for Crohn's disease and chronic pelvic pain syndrome.
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Affiliation(s)
- G Briganti
- Etudiant en Master 2, Faculté de Médecine, ULB
| | - J-P Falla
- Médecin généraliste, Maître de stage, ULB
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Boltri M, Magri V, Montanari E, Perletti G, Trinchieri A. Computer-Assisted Quantitative Assessment of Prostatic Calcifications in Patients with Chronic Prostatitis. Urol Int 2018; 100:450-455. [PMID: 29698941 DOI: 10.1159/000486346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was the development of quantitative assessment of prostatic calcifications at prostatic ultrasound examination by the use of an image analyzer. MATERIALS AND METHODS A group of 82 patients was evaluated by medical history, physical, and transrectal ultrasound examination. Patients had a urethral swab, a 4-specimen study and culture of the seminal fluid. Patients were classified according to National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health. Subjective symptoms were scored by Chronic Prostatitis Symptom Index (CPSI) questionnaire. Ultrasound images were analyzed by the digital processing software Image J to quantitatively assess the presence of calcifications. RESULTS Computer-assessed calcified areas were significantly higher in chronic bacterial prostatitis (n = 18; group II; 6.76 ± 8.09%) than in the chronic pelvic pain syndrome group IIIa (n = 26; 2.07 ± 1.01%) and IIIb (n = 38; 2.31 ± 2.18%). The area of calcification of the prostate was significantly related to the CPSI score for domains of micturition (r = 0.278, p = 0.023), Prostatic Specific Antigen values (r = 0341, p = 0.005), postvoiding residual urine (r = 0.262, p = 0.032), total prostate volume (r = 0.592, p = 0.000), and adenoma volume (r = 0.593; p = 0.000). CONCLUSIONS The presence of calcifications is more frequently observed in patients with chronic bacterial prostatitis and is related to urinary symptoms.
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Affiliation(s)
- Matteo Boltri
- Urology Medical School, University of Trieste, Trieste, Italy
| | | | - Emanuele Montanari
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Gianpaolo Perletti
- Department of Basic Medical Sciences, Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium.,Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, Università degli Studi dell'Insubria, Busto Arsizio, Italy
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36
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Brünahl CA, Klotz SGR, Dybowski C, Riegel B, Gregorzik S, Tripp DA, Ketels G, Löwe B. Combined Cognitive-Behavioural and Physiotherapeutic Therapy for Patients with Chronic Pelvic Pain Syndrome (COMBI-CPPS): study protocol for a controlled feasibility trial. Trials 2018; 19:20. [PMID: 29316946 PMCID: PMC5759202 DOI: 10.1186/s13063-017-2387-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/29/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is a pain condition perceived in the pelvic area for at least 6 months. While evidence of the aetiology and maintenance of CPPS is still unclear and therapy options are rare, there is preliminary evidence for the efficacy of cognitive behavioural therapy and physiotherapy. However, an integrated treatment has not yet been studied. The primary aim of this study is therefore to test the feasibility of combined psychotherapy and physiotherapy for female and male patients with CPPS. The secondary aim is to explore changes in patient-relevant and economic outcomes compared to a control group. METHODS A feasibility study with a crossover design based on the principles of a 'cohort multiple randomized controlled trial' will be conducted to test a combined therapy for patients with CPPS. The study will consist of two consecutive treatment modules (cognitive behavioural group psychotherapy and physiotherapy as individual and group sessions), which will be applied in varying order. The modules will consist of nine weekly sessions with a 4-week break between the modules. The control group will undergo treatment as usual. Study subjects will be recruited from the interdisciplinary outpatient clinic for CPPS at the University Medical Center Hamburg-Eppendorf. Thirty-six patients will be assigned to the intervention, and 18 patients will be assigned to the control group. The treatment groups will be gender homogeneous. Feasibility as the primary outcome will be analysed in terms of the demand, acceptability, and practicality. Secondary study outcomes will be measured using validated self-rating-scales and physical examinations. DISCUSSION To the best of our knowledge, this study is the first to investigate the feasibility of combined psychotherapy and physiotherapy for patients with CPPS. In addition to testing feasibility, the results can be used for the preliminary estimation of therapeutic effects. The results from this study will be used to generate an enhanced therapeutic approach, which might be subject to further testing in a larger study. TRIAL REGISTRATION German Clinical Trials Register, DRKS00009976 . Registered on 15 March 2016. ISRCTN, ISRCTN43221600 . Registered on 10 May 2016.
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Affiliation(s)
- Christian A. Brünahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Susanne G. R. Klotz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christoph Dybowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Björn Riegel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Sonja Gregorzik
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Dean A. Tripp
- Department of Psychology, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
- Department of Anaesthesia, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
- Department of Urology, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
| | - Gesche Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
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Perletti G, Monti E, Magri V, Cai T, Cleves A, Trinchieri A, Montanari E. The association between prostatitis and prostate cancer. Systematic review and meta-analysis. ACTA ACUST UNITED AC 2017; 89:259-265. [PMID: 29473374 DOI: 10.4081/aiua.2017.4.259] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/20/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The main outcome of this review was the association between a history of clinical chronic prostatitis (NIH category II or III) and a histologically confirmed diagnosis of prostate cancer. MATERIALS AND METHODS Crude odds ratios and 95% confidence intervals (CI) were calculated to analyze dichotomous data. For analysis of pooled data we adopted a random-effects model and the inverse variance weighing method. Heterogeneity was assessed by calculating the I2 value. RESULTS Out of 2794 screened records, we retrieved 16 full-text articles written in English, reporting the data of 15 case-control studies, involving 422.943 patients. Pooled analysis resulted in a significant crude odds ratio of 1.83 (95% CI: 1.43 to 2.35; P < 0.00001). The total set of data showed considerable heterogeneity (I2 = 91%). Both the Egger's test and the Begg's test for funnel plot asymmetry did not reach statistical significance. The 'trim and fill' method applied to the funnel plot imputed 3 missing studies and the resulting adjusted estimate of the odds ratio was 2.12 (95% CI: 1.38 to 3.22). According to GRADE criteria, the overall quality of the meta-analysis data is low, mainly due to the presence of bias, confounders and extreme effect size outliers. Five among the included studies reported data assessed in 8015 African-American subjects. Pooled analysis resulted in a non-significant crude odds ratio of 1.59 (95% CI: 0.71 to 3.57; P = 0.26), and considerable heterogeneity (I2 = 90%). CONCLUSIONS Meta-analysis of 15 case-control studies shows that a history of clinical chronic prostatitis can significantly increase the odds for prostate cancer in the general population, whereas such association in African-American individuals remains uncertain.
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Affiliation(s)
- Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Busto A., Italy Department of Human Structure and Repair, Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium.
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38
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Qin Z, Liu Y, Zhou K, Wu J, Pang R, Li N, Xu C, Kwong JSW, Liu Z. Acupuncture for chronic prostatitis/ chronic pelvic pain syndrome: study protocol for a randomized controlled trial. Trials 2017; 18:616. [PMID: 29273095 PMCID: PMC5741861 DOI: 10.1186/s13063-017-2383-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/05/2017] [Indexed: 02/05/2023] Open
Abstract
Background Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition affecting men of all ages. Acupuncture may be an effective treatment option for CP/CPPS, but evidence is limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial. Methods Ten hospitals will recruit 440 participants with CP/CPPS in China from October 2017 to December 2019. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The whole study consists of 2-week baseline, 8-week treatment, and 24-week follow up. Twenty 30-mintute sessions of acupuncture or sham acupuncture treatment will be provided between week 1 and 8. The two co-primary outcomes are the proportion of responders at week 8 and week 32. Secondary outcomes include proportion of responders in the two groups at different time points; change in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score; change in the NIH-CPSI subscales; change in the International Prostate Symptom Score; change in the Hospital Anxiety and Depression Scale; expectation assessments; proportions of participants in each response category of the Global Response Assessment; change in the International Index of Erectile Function 5; change in the five-level EuroQol five-dimensional questionnaire and a visual analogue scale; and changes in peak and average urinary flow rate. Discussion This study will provide robust evidence on whether acupuncture is effective for relieving symptoms of CP/CPPS. Trials registration ClinicalTrials.gov, NCT03213938. Registered on 5 July 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2383-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zongshi Qin
- Department of Acupuncture and Neurology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Liu
- Data Centre of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kehua Zhou
- Catholic Health System Internal Medicine Training Program, Sisters of Charity Hospital, University at Buffalo, Buffalo, NY, USA
| | - Jiani Wu
- Department of Acupuncture and Neurology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ran Pang
- Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Li
- West China Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Chinese Evidence-Based Medicine Center and Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
| | - Joey S W Kwong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zhishun Liu
- Department of Acupuncture and Neurology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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39
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Ye C, Xiao G, Xu J, Qin S, Luo Y, Chen G, Lai HH, Zhou T. Differential expression of immune factor between patients with chronic prostatitis/ chronic pelvic pain syndrome and the healthy volunteers. Int Urol Nephrol 2017; 50:395-399. [PMID: 29235061 DOI: 10.1007/s11255-017-1763-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Immune mechanisms have been hypothesized to contribute to the development of CP/CPPS. In this study, we investigated the differential expression of immune factors between patients with CP/CPPS and healthy volunteers. METHODS This study was registered in Australian New Zealand Clinical Trials Registry. Healthy volunteers and patients with CP/CPPS were enrolled in this study. The inclusion criteria for patients were below: (1) aged 18-45 years old; (2) prostatitis-related syndrome longer than 3 months; (3) normal routine urine culture and negative bacterial culture in prostatic fluid. Patients were further classified into two groups: types IIIA and IIIB CP/CPPS according to the results of EPS routine test. Serum immune markers include IgA, IgM, IgG, CD4+ and CD8+. RESULTS There are total 23 CP/CPPS patients, including 12 type IIIB and 11 type IIIA. Relatively, there are 26 healthy volunteers. The serum levels of IgG were higher in CP/CPPS patients compared to healthy volunteers (1141.2 ± 204.3 vs 1031.9 ± 173.7 mg/L, p = 0.045), while the serum levels of CD8+ were lower in CP/CPPS patients compared to healthy volunteers (492.8 ± 185.6 vs 640.0 ± 246.8 cells/μL, p = 0.021). Furthermore, serum levels of IgG were higher in patients with IIIA CP/CPPS compared to those with IIIB (1244.3 ± 151.6 vs 1054.3 ± 209.3 mg/L, p = 0.023). CONCLUSIONS Differential levels of IgG and CD8+ between CPPS patients and healthy volunteers suggest a contributing role of immune mechanisms to the development of CP/CPPS; and IgG may play an important role in inflammatory CPPS. Clinical Study registration number ACTRN12613000792729.
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Affiliation(s)
- Chen Ye
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Guang'an Xiao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jian Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Shengfei Qin
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yuhua Luo
- Department of Urology, Haining People's Hospital, QianJiang West Road, Haining City, ZheJiang Province, People's Republic of China.
| | - Guanghua Chen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - H Henry Lai
- Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Tie Zhou
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Gasperi M, Krieger JN, Forsberg C, Goldberg J, Buchwald D, Afari N. Chronic prostatitis and comorbid non-urological overlapping pain conditions: A co-twin control study. J Psychosom Res 2017; 102:29-33. [PMID: 28992894 PMCID: PMC5683425 DOI: 10.1016/j.jpsychores.2017.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pain and voiding symptoms in the absence of an obvious infection or other cause. CP/CPPS frequently occurs with non-urological chronic overlapping pain conditions (COPCs) of unknown etiology. We conducted a co-twin control study in men discordant for chronic prostatitis (CP), an overarching diagnosis of which approximately 90% is CP/CPPS. The primary aim was to investigate the contribution of familial factors, including shared genetic and common environmental factors, to the comorbidity of CP and COPCs. METHODS Data from 6824 male twins in the Vietnam Era Twin Registry were examined to evaluate the association between self-reported lifetime physician diagnosis of CP with COPCs including fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, tension headaches, and migraine headaches. Random effects logistic regression models were used and within-pair analyses evaluated confounding effects of familial factors on the associations. RESULTS There were significant associations between CP and all 6 examined COPCs. After adjusting for shared familial influences in within twin pair analyses, the associations for all COPCs diminished but remained significant. Familial confounding was strongest for the association of CP with fibromyalgia and temporomandibular disorder and smallest for irritable bowel syndrome. CONCLUSIONS CP and COPCs are highly comorbid. These associations can be partially explained by familial factors. The mechanisms underlying these relationships are likely diverse and multifactorial. Future longitudinal research can help to further elucidate specific genetic and environmental mechanisms and determine potentially causal relationships between CP and its comorbidities.
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Affiliation(s)
- Marianna Gasperi
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | | | | | - Jack Goldberg
- University of Washington, Seattle, WA, USA,Vietnam Era Twin Registry, Seattle, WA, USA
| | - Dedra Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Niloofar Afari
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
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Brünahl C, Dybowski C, Albrecht R, Riegel B, Höink J, Fisch M, Löwe B. Mental disorders in patients with chronic pelvic pain syndrome (CPPS). J Psychosom Res 2017; 98:19-26. [PMID: 28554368 DOI: 10.1016/j.jpsychores.2017.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Chronic pelvic pain syndrome (CPPS) is a debilitating pain condition with prevalence rates between 2.0% and 26.6%. Studies indicate that CPPS is often associated with psychosocial factors, but little is known about the presence of full-blown mental disorders in female and male patients with CPPS. Therefore, the aim of this study was to investigate the frequencies of mental disorders in patients with CPPS. METHODS Cross-sectional data were collected from patients visiting a specialized outpatient clinic. Frequencies of mental disorders were investigated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and compared to the general population. Furthermore, self-rating questionnaires were used to assess somatic symptom severity (PHQ-15), depression severity (PHQ-9) and anxiety severity (GAD-7). RESULTS Data from 178 CPPS patients (60.1% female; age M=49.1, SD=18.0) were analyzed. Of the total sample, 95.2% (95% CI 90.8-97.9) suffered from at least one mental disorder. The most prevalent mental disorders were somatoform disorders (91.7%; 95% CI 86.4-95.4), followed by mood disorders (50.6%; 95% CI 42.8-58.4) and anxiety disorders (32.1%; 95% CI 25.2-39.8). The self-reported symptom burden was also significantly higher than in the general population. Compared to men, women met the diagnoses of somatoform (p=0.012) and anxiety disorders (p=0.027) significantly more often and reported a significantly higher total somatic symptom severity (p=0.001). CONCLUSION Our results provide evidence for a clinically relevant psychosocial symptom burden in patients with CPPS, indicating the need for the examination of psychopathologies and multi-professional treatment for this patient group.
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Lin L, Zhu BP, Cai L. Therapeutic effect of melittin on a rat model of chronic prostatitis induced by Complete Freund's Adjuvant. Biomed Pharmacother 2017; 90:921-7. [PMID: 28441718 DOI: 10.1016/j.biopha.2017.04.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The present study was aimed to establish a model of chronic prostatitis in rat with the use of intraprostatic injection of Complete Freund's Adjuvant, and to examine the anti-inflammatory and analgesic effects of melittin on the newly-developed chronic prostatic pain model. METHODS Adult male Sprague-Dawley rats were injected with Complete Freund's Adjuvant (CFA) into the prostate. Twelve days after model rats of the treatment group were injected melittin into the prostate, while those of the control group received sterile saline injection. The nociceptive effects of CFA were evaluated by using a behavior approach (i.e. mechanical pain threshold measurement) on the day of CFA injection and 6, 12, and 18days after CFA injection. After the in-live study was done, the prostate was collected for histological examination of inflammatory cell infiltration. Levels of cyclooxygenase (COX)-2 in prostate and glial fibrillary acidic protein (GFAP) in spinal cord were determined using immunohistochemistry. Rats of the sham control group received intraprostatic injection of sterile saline and were studied using the same methods RESULTS: Intraprostatic CFA injection induced local allodynia that lasted over at least 2 weeks. The pain behavior of rat was associated with increases in inflammatory cell infiltration into the prostate. Levels of COX-2 in prostate and GFAP in spinal cord were also elevated. Treatment with melittin significantly raised pain threshold, decreased inflammatory infiltrates, and suppressed COX-2 and GFAP expression. CONCLUSION Intraprostatic injection of CFA induced neurogenic prostatitis and prostatic pain. The established model will be useful to the study of CP/CPPS pathogenesis. Melittin demonstrated profound anti-inflammatory and analgesic effects on the chronic prostatic pain model, suggesting melittin may hold promise as a novel therapeutic for treatment of CP/CPPS.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tyagi P, Killinger K, McLennan G, Jayabalan N, Chancellor M, Peters KM. Urine chemokine levels correlate with treatment response to phosphodiesterase 4 inhibitor in prostatitis. World J Clin Urol 2017; 6:18-26. [DOI: 10.5410/wjcu.v6.i1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the association of urinary chemokines with the treatment response in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients.
METHODS Between 2007-2011, 18 out of 21 male CP/CPPS patients met the exclusion/inclusion criteria of the 16 wk longitudinal study on twice daily oral treatment with Phosphodiesterase 4 inhibitor called Apremilast for 12 wk. Symptom scores and urine specimen were collected at baseline and every visit at 4 wk interval from CP/CPPS patients who completed at least 8 wk of drug treatment. Urine collected at each visit was frozen and then analyzed together after thawing for chemokines and growth factors using MILLIPLEX™ MAP immunoassay. Cross sectional association of Chronic Prostatitis Symptom Index (CPSI) and visual analog scale (VAS) with chemokine levels in urine collected at baseline was assessed in 18 CP/CPPS patients relative to 10 asymptomatic male subjects. Longitudinal association between urine chemokine levels and symptom scores was assessed in 8 treatment-adherent CP/CPPS patients at baseline and at 4, 8, 12 and 16 wk.
RESULTS Urine chemokines levels of CXCL-1 (GRO-a), CXCL-8 (IL-8), CXCL-10 (IP-10) and CCL5 (RANTES) in CP/CPPS patients at baseline were significantly elevated relative to asymptomatic subjects, whereas levels of sIL-1RA in CP/CPPS were significantly lower compared to controls (P < 0.05). Quantitatively, urine levels of CXCL-10 were higher than other chemokines in CP/CPPS, but its 5 fold change relative to controls was lower than the 20 fold change noted for CXCL-8. The mean age of enrolled patients who completed at least 8 wk of treatment (n = 8) was 46.5 ± 9.4 years and analysis found that elevation of CXCL-8 and CCL5 increased the odds for higher score of CPSI by 54% and 25%, respectively (F test, P = 0.00007). Urine levels of CCL2 (MCP-1) and CXCL-10 together explained approximately 85% of variance in longitudinal data on multivariate analysis. Bivariate analysis of 5 patients who fully complied and completed the assigned dose regimen, showed strong linear correlation of reduced urine levels of CXCL-10, CXCL-8, CCL5, CCL2 and PDGF with improvement in clinical activity as measured by pain VAS and CPSI (Pearson r = 0.83-0.97; P < 0.05).
CONCLUSION Urine levels of CXCL-10, CCL2 and PDGF can be sensitive, objective and non-invasive markers of response to new therapeutic intervention in CP/CPPS patients.
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Liu BP, Wang YT, Chen SD. Effect of acupuncture on clinical symptoms and laboratory indicators for chronic prostatitis/ chronic pelvic pain syndrome: a systematic review and meta-analysis. Int Urol Nephrol 2016; 48:1977-1991. [PMID: 27590134 DOI: 10.1007/s11255-016-1403-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/17/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To systematically review the efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS PubMed, Cochrane library Central, Web of Science, Wang-fang Database, and CNKI were searched from their inception to June 30, 2016. Data of acupuncture for CP/CPPS following randomized controlled trials (RCTs) was included. The data were analyzed using the Cochrane Collaboration Review Manager. The primary data were the National Institute of Health-Chronic Prostatitis Index (NIH-CPSI) score at the end of follow-up. RESULTS Ten RCTs were enrolled. Acupuncture was superior to the control in NIH-CPSI (MD -3.98, [95 % CI -5.78 to -2.19]; P < 0.0001) and response rate (RR 4.12, [95 % CI 1.67-10.18]; P = 0.002). Acupuncture was superior to sham acupuncture on NIH-CPSI, response rate, pain, urinary, and quality of life (QOL). Standard medication was inferior to acupuncture in terms of NIH-CPSI (MD -3.08, [95 % CI -5.57 to -0.60]; P = 0.02) and response rate (RR 2.03, [95 % CI 1.04-3.97]; P = 0.04), but standard medication was superior to acupuncture on improving urinary symptoms. There was no significant difference in the adverse events. Acupuncture/acupuncture plus standard medication significantly down-regulated IL-1β compared with standard medication in prostatic fluid. CONCLUSION Acupuncture treating CP/CPPS is effective and safe. The effects of acupuncture on NIH-CPSI, response rate, pain symptoms, and QOF were superior to the control, but standard medication significantly improved urinary symptoms compared with acupuncture. Acupuncture can decrease the IL-1β in prostatic fluid for CP/CPPS.
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Affiliation(s)
- Bu-Ping Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuandong Road, Guangzhou University Town, Panyu District, Guangzhou, 510006, People's Republic of China.
| | - Yun-Ting Wang
- Postgraduate Academy, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Si-da Chen
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
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Pajovic B, Radojevic N, Dimitrovski A, Vukovic M. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). Aging Male 2016; 19:202-207. [PMID: 27380504 DOI: 10.1080/13685538.2016.1197899] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.
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Affiliation(s)
- B Pajovic
- a Urology and Nephrology Clinic, Clinical Centre of Montenegro , Podgorica , Montenegro
| | - N Radojevic
- b Center of Pathology and Forensic Medicine, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro , Podgorica , Montenegro , and
| | - A Dimitrovski
- c Urology Clinic, Clinical Centre of Kragujevac , Kragujevac , Serbia
| | - M Vukovic
- a Urology and Nephrology Clinic, Clinical Centre of Montenegro , Podgorica , Montenegro
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Chopra S, Satkunasivam R, Aron M. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/ chronic pelvic pain syndrome: Initial results. Indian J Urol 2016; 32:238-41. [PMID: 27555685 PMCID: PMC4970398 DOI: 10.4103/0970-1591.185105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127–259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score – 14 (1–19); Sexual Health Inventory for Men – 6 (−14–22); and NIH-CPSI total – 23.5 (13–33). Median length of follow-up (range) was 34 (24–43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.
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Affiliation(s)
- Sameer Chopra
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Raj Satkunasivam
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Monish Aron
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Li HJ, Kang DY. Prevalence of sexual dysfunction in men with chronic prostatitis/ chronic pelvic pain syndrome: a meta-analysis. World J Urol 2016; 34:1009-17. [PMID: 26546073 PMCID: PMC4921105 DOI: 10.1007/s00345-015-1720-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study aims to estimate the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) by conducting a meta-analysis. METHODS Relevant publications were searched using PubMed, Embase, CBM, China National Knowledge Infrastructure, VIP and Wanfang databases up to August 2015. Studies that reported the prevalence of erectile dysfunction, premature ejaculation and total sexual dysfunction in men with CP/CPPS were included. RESULTS A total of 24 studies involving 11,189 men were included. Overall prevalence of sexual dysfunction in men with CP/CPPS was 0.62 (95 % CI 0.48-0.75), while the prevalence of erectile dysfunction and premature ejaculation was 0.29 (95 % CI 0.24-0.33) and 0.40 (95 % CI 0.30-0.50), respectively. From 1999 to 2010, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.65 (95 % CI 0.45-0.83), 0.27 (95 % CI 0.22-0.33) and 0.41 (95 % CI 0.27-0.55), respectively. From 2011 to 2014, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.50 (95 % CI 0.22-0.75), 0.35 (95 % CI 0.29- 0.40) and 0.39 (95 % CI 0.37-0.41), respectively. CONCLUSION The prevalence of sexual dysfunction in men with CP/CPPS was high, even though overall sexual dysfunction demonstrated a slightly decreasing trend. Furthermore, erectile dysfunction prevalence rate had an increasing trend in recent years. More prospective studies are needed to evaluate sexual dysfunction improvement with better management of CP/CPPS.
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Affiliation(s)
- Hong-Jun Li
- Urological Department of Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - De-Ying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
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Abstract
INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and interstitial cystitis/bladder pain syndrome collectively referred to as urologic CPPS (UCPPS) is defined by the absence of identifiable bacterial infection as a cause for the chronic pain and urinary symptoms. METHODS A PubMed search of all recent relevant articles using the keywords/phrases: CPPS, CPPS, and male pelvic pain, was conducted. RESULTS CPPS has a high worldwide prevalence and its negative impact on quality of life compares with or exceeds common chronic morbidities. Triggers include certain comestibles as well as psychosocial factors that promote catastrophizing and illness focused behavior. Several validated tools are currently available to help diagnose and direct targeted therapy. Treatment should begin with the most simple and least invasive based on the presenting clinical phenotype. CONCLUSIONS Although no gold-standard treatment exists, a multidisciplinary approach with multimodal therapy gives the UCPPS patient the best chance of symptom relief.
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Magistro G, Wagenlehner FME, Grabe M, Weidner W, Stief CG, Nickel JC. Contemporary Management of Chronic Prostatitis/ Chronic Pelvic Pain Syndrome. Eur Urol 2015; 69:286-97. [PMID: 26411805 DOI: 10.1016/j.eururo.2015.08.061] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 08/31/2015] [Indexed: 12/27/2022]
Abstract
CONTEXT Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy. OBJECTIVE A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management. EVIDENCE ACQUISITION Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS. EVIDENCE SYNTHESIS Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management. CONCLUSIONS Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a monotherapy for management. No efficient monotherapeutic option is available. The best evidence-based management of CP/CPPS strongly suggests a multimodal therapeutic approach addressing the individual clinical phenotypic profile. PATIENT SUMMARY Chronic prostatitis/chronic pelvic pain syndrome presents a variable syndrome. Successful management of this condition is challenging. It appears that a tailored treatment strategy addressing individual patient characteristics is more effective than one single therapy.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Magnus Grabe
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Wolfgang Weidner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christian G Stief
- Department of Urology, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada
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