Network Meta-analysis of Oral Chinese Patent Medicine in Adjuvant Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome / 中国实验方剂学杂志

ObjectiveTo evaluate the efficacy and safety of various oral Chinese patent medicines in the adjuvant treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS） based on network Meta-analysis. MethodRandomized controlled trials （RCTs） of oral Chinese patent medicine in the adjuvant treatment of CP/CPPS were retrieved from the databases of China National Knowledge Infrastructure （CNKI）， Wanfang， VIP， SinoMed， PubMed， Cochrane Library， EMbase， and Web of Science from database inception to November， 2022. The quality of the included literature was evaluated according to the Cochrane risk-of-bias tool， and the data were analyzed by RevMan 5.4 and Stata 16 software. ResultA total of 63 RCTs were included， with 13 kinds of oral Chinese patent medicines involved， including Qianlie Shutong capsules， Ningmitai capsules， Qianlie Beixi capsules， Sanjin tablets， etc. The results of the network Meta-analysis showed that in terms of clinical effective rate， the intervention measure ranked first was Qianlie Beixi capsules combined with conventional western medicine. In terms of reducing pain， the intervention measure ranked first was Sanjin tablets combined with conventional western medicine. In terms of reducing urination disorder， the intervention measure ranked first was Relinqing granules combined with conventional western medicine. In terms of improving quality of life， the intervention measure ranked first was Qianlie Beixi capsules combined with conventional western medicine. In terms of reducing the total National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） score， the intervention measure ranked first was Yinhua Miyanling tablets combined with conventional western medicine. In terms of reducing leukocyte count in prostatic secretions， the intervention measure ranked first was Qianlie Jiedu capsules combined with conventional western medicine. In terms of safety， the intervention measure with the least adverse reactions was Qianlie Shutong capsules combined with conventional western medicine. The cluster analysis results showed that Qianlie Shutong capsules combined with conventional western medicine had outstanding efficacy and high safety. ConclusionOral Chinese patent medicine in the adjuvant treatment of CP/CPPS can improve the comprehensive efficacy， reduce the NIH-CPSI score and leukocyte count in prostatic secretions， and improve the quality of life of patients. For clinical treatment， the preferred choice is Qianlie Beixi capsules or Qianlie Shutong capsules combined with conventional western medicine. Limited by the quantity and quality of literature included in this study， the results need to be verified by high-quality studies with a larger sample size.

Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the short-term efficacy, long-term efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).@*METHODS@#Forty-two patients with CP/CPPS were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases). The patients in the acupuncture group were treated with acupuncture at bilateral Zhongliao (BL 33), Huiyang (BL 35), Shenshu (BL 23) and Sanyinjiao (SP 6); the needling depth of Zhongliao (BL 33) and Huiyang (BL 35) was 60 to 80 mm, while Shenshu (BL 23) and Sanyinjiao (SP 6) was directly punctured of 30 mm. The patients in the sham acupuncture group were treated with acupuncture at non-acupoints, including points 2 cm next to Shenshu (BL 23), Zhongliao (BL 33) and Huiyang (BL 35), and the midpoint of the connecting line between the spleen meridian and the kidney meridian. All the non-acupoints were treated with directly puncture of 2 to 3 mm. The needles were left for 30 min in both groups, once every other day in the first four weeks, three times a week, and twice a week in the next four weeks, totally 20 treatments. Before treatment, after treatment and in follow-up of 24 weeks after treatment completion, the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) score and urinary flow rate were observed in both groups; the clinical efficacy and safety were evaluated.@*RESULTS@#Compared with those before treatment, the pain and discomfort scores, urination symptoms scores, quality of life scores and total scores of NIH-CPSI in both groups were reduced after treatment in the two groups (P<0.01), while each item score and total score of NIH-CPSI in the acupuncture group were reduced in follow-up (P<0.01, P<0.05). After treatment and in follow-up, each item score and total score of NIH-CPSI in the acupuncture group were lower than those in the sham acupuncture group (P<0.05, P<0.01). After treatment, the maximum and average urinary flow rates in the acupuncture group were higher than those before treatment (P<0.05), and the average urinary flow rate in the acupuncture group was higher than that in the sham acupuncture group (P<0.05). The total effective rate was 75.0% (15/20) in the acupuncture group, which was higher than 42.9% (9/21) in the sham acupuncture group (P<0.05). No significant adverse reactions were observed in the two groups, and there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).@*CONCLUSION@#Acupuncture could effectively alleviate the clinical symptoms, improve quality of life, and has a sustained, safe and reliable therapeutic effect in patients with CP/CPPS.

Effect of thermophilic bacterium HB27 manganese superoxide dismutase in a rat model of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) / 亚洲男科学杂志(英文版)

We investigated the therapeutic effects of superoxide dismutase (SOD) from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its underlying mechanisms. A Sprague-Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic (Tt)-SOD intragastrically for 4 weeks. Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining, and Masson staining. Alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (CR), and blood urea nitrogen (BUN) levels were assayed for all animals. Enzyme-linked immunosorbent assays (ELISA) were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde, nitric oxide, SOD, catalase, and glutathione peroxidase. Reactive oxygen species levels were detected using dichlorofluorescein diacetate. The messenger ribonucleic acid (mRNA) expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction (RT-PCR), and infiltrating inflammatory cells were examined using immunohistochemistry. Nuclear factor-κB (NF-κB) P65, P38, and inhibitor of nuclear factor-κBα (I-κBα) protein levels were determined using western blot. Tt-SOD significantly improved histopathological changes in CP/CPPS, reduced inflammatory cell infiltration and fibrosis, increased pain threshold, and reduced the prostate index. Tt-SOD treatment showed no significant effect on ALT, AST, CR, or BUN levels. Furthermore, Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity. This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3 (CD3), cluster of differentiation 45 (CD45), and macrophage inflammatory protein 1α (MIP1α) cells. Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBα protein levels. These findings support Tt-SOD as a potential drug for CP/CPPS.

The application progress of extracorporeal shock wave in the treatment of chronic prostatitis/chronic pelvic pain syndrome and its potential mechanism / 中华泌尿外科杂志

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the common diseases in uroloandrology, which recurs easily after treatment. In recent years, the safety and efficacy of extracorporeal shock wave therapy (ESWT) for CP/CPPS has been widely demonstrated. Studies have shown satisfactory short-term (≤12 weeks) outcomes of ESWT, but lack long-term (>12 weeks) follow-up data. In addition, inconsistent indications and unexplained therapeutic mechanisms have limited the further clinical promotion of ESWT. This article summarizes the latest progress and potential mechanism of ESWT in the treatment of CP/CPPS in order to provide new insights for the standardized application of ESWT.

Is mild erectile dysfunction associated with severe psychological symptoms in Chinese patients with moderate-to-severe chronic prostatitis/chronic pelvic pain syndrome? / 亚洲男科学杂志(英文版)

This study aimed to assess the association between psychological disorders and erectile dysfunction (ED) in patients with different degrees of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This was a retrospective study conducted from June 2017 to October 2019 and included 182 outpatients. Patients were interviewed using the Structured Interview on Erectile Dysfunction (SIEDY) for pathogenic quantification. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Index of Erectile Function-5 (IIEF-5) were used for the evaluation of CP/CPPS and ED. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety symptoms and depressive symptoms. The number of patients with mild CP/CPPS and mild ED, mild CP/CPPS and moderate-to-severe ED, moderate-to-severe CP/CPPS and mild ED, and moderate-to-severe CP/CPPS and moderate-to-severe ED was 69 (37.9%), 36 (19.8%), 35 (19.2%), and 42 (23.1%), respectively. The corresponding PHQ-9 scores of the four groups were 6.22, 7.19, 10.69, and 7.71, respectively. The corresponding GAD-7 scores of the four groups were 5.26, 6.31, 8.77, and 6.36, respectively. Among patients with moderate-to-severe CP/CPPS, the PHQ-9 and GAD-7 scores of the moderate-to-severe ED group were significantly lower than those of the mild ED group (P = 0.007 and P = 0.010, respectively). The prevalence of ED and premature ejaculation (PE) in patients with moderate-to-severe CP/CPPS was significantly higher than that in patients with mild CP/CPPS (P = 0.001 and P = 0.024, respectively). Our findings proved that the severity of ED was negatively associated with psychological symptoms in outpatients with moderate-to-severe CP/CPPS.

Advances in pathogenesis of chronic prostatitis/chronic pelvic pain syndrome / 中华泌尿外科杂志

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disease in men. In recent years, it has become younger, which seriously affects the patients＇quality of life. A deep understanding of the pathogenesis of CP/CPPS will help the choice of treatment. Its pathogenesis is not only related to immune factors, but also related to local microcirculation disorders of the prostate, endocrine hormone imbalance, adjacent gut microbes and compression of lumbar intervertebral disc, but it has not been fully elucidated. Therefore, this article aims to review the pathogenesis of CP/CPPS and provide directions for its diagnosis and treatment.

Clinical efficacy of percutaneous tibial nerve stimulation in the treatment of chronic pelvic pain syndrome / 中国医师进修杂志

Objective@#To evaluate the clinical efficacy of percutaneous tibial nerve electrical stimulation in the treatment of chronic pelvic pain syndrome.@*Methods@#The clinical data of 28 patients with chronic pelvic pain syndrome from January to November 2018 in Dalian Third People′s Hospital were retrospectively analyzed. The patients were treated with percutaneous tibial nerve stimulation. The number of urination in 24 h, number of nocturnal urination, urine volume per urination, quality of life (QOL) score and digital pain intensity score before treatment and after treatment were compared; the patients were followed up for 3 months, and the recurrence and adverse reaction were observed.@*Results@#Compared with those before treatment, the number of urination in 24 h and number of nocturnal urination after treatment were significantly lower: (11.6 ± 6.4) times vs. (20.6 ± 7.8) times and (2.5 ± 1.2) times vs. (5.2 ± 2.6) times, and the urine volume per urination increased significantly: (181.2 ± 65.6) ml vs. (125.4 ± 58.2) ml, the QOL score and digital pain intensity score decreased significantly: (2.6 ± 1.4) scores vs. (5.1 ± 0.8) scores and (2.9 ± 1.3) scores vs. (6.9 ± 1.4) scores, and there were statistical differences (P<0.05). During the follow-up period, none of the patients had recurrent symptoms and obvious adverse reaction.@*Conclusions@#Percutaneous tibial nerve stimulation is an effective way to treat chronic pelvic pain syndrome.

Effect of Essential Oil on Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Pilot Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy and safety of essential oil treatment for type III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).@*METHODS@#A randomized controlled trial was conducted from December 2014 to October 2015. Seventy type III CP/CPPS patients were assigned to the essential oil group (35 cases) or almond placebo oil control group (35 cases) by a random number table. The oil was smeared by self-massage on the suprapubic and sacral region once a day for 4 weeks. The National Institutes of Health Chronic Prostatitis Syndrome Index (NIH-CPSI) and expressed prostatic secretions (EPS) were examined. The primary outcome was NIH-CPSI pain domain. The secondary outcomes included other NIH-CPSI domains and laboratory examinations of EPS. Adverse events were also observed.@*RESULTS@#Sixty-six subjects completed the full 4-week treatment. There was no significant difference between almond oil control and essential oil groups in terms of the total score of NIH-CPSI, pain, quality of life and urination domain scores of NIH-CPSI and EPS examinations (P>0.05). In the essential oil group, pain between rectum and testicles (perineum) in the domain of pain or discomfort was significantly reduced at week 2 and week 4 compared with almond oil control group (P<0.01). No serious adverse events occurred.@*CONCLUSION@#The essential oil may reduce the pain or discomfort in the perineum region in patients with CP/CPPS. (Registration No. ChiCTR-IPR-14005448).

Research progress on chronic prostatitis / chronic pelvic pain syndrome accompanied by sexual dysfunction / 医学研究生学报

The main symptom of chronicprostatitis/chronic pelvic pain syndrome (CP/CPPS) include perineal pain or discomfort, lower urinary tract symptom, mental and psychological problems, and sexual dysfunction (SD). Numerous studies confirmed a higher probability than normal in people suffering from the CP/CPPS accompanied by SD. It was characterized by repeated attacks and difficulty in curing. As a heterogeneous syndrome, the available evidence fails to indicate its pathogenesis and first-line diagnosis and treatment. This article reviews the epidemiological characteristics, pathogenesis, diagnosis and treatment of CP/CPPS with SD, and further explores the combined treatment of UPOINT(S) clinical phenotype classification system and multimodal therapy.

Triple acupuncture at the Qugu acupoint as an adjunctive therapy for type-Ⅲ chronic prostatitis: Analysis of short- and long-term clinical effects / 中华男科学杂志

Objective@#To investigate the short- and long-term effects of triple acupuncture at the Qugu acupoint as an adjunctive therapy on type-Ⅲ chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS).@*METHODS@#We equally randomized 90 CP/CPPS patients into a control and a treatment group, both treated with Levofloxacin Mesylate Tablets (0.5 g, tid) + Terazosin Hydrochloride Capsules (2 mg qd) for 4 weeks, while the latter group by triple acupuncture at the Qugu acupoint as an adjunctive therapy twice a week at the same time. Then, we followed up all the patients for 4 weeks, recorded the cases, time and rate of recurrence, obtained the scores in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), quality of life (QoL) and Zung Depression Scale (ZDS), and compared them between the two groups of patients.@*RESULTS@#Compared with the controls, the patients of the treatment group showed significantly decreased NIH-CPSI scores in pain (8.6 ± 2.12 vs 6.2 ± 2.25, P <0.05), micturition (5.8 ± 1.22 vs 3.1 ± 1.10, P <0.05), and QoL (6.0 ± 1.33 vs 3.4 ± 1.71, P <0.05) and ZDS score as well (43.9 ± 4.53 vs 33.6 ± 3.20, P <0.01). The recurrence rate was markedly lower while the recurrence time remarkably longer in the treatment than in the control group (15.56 vs 35.56% and ［20.0 ± 2.72］ vs ［12.5 ± 3.47］ d, P <0.05).@*CONCLUSIONS@#As an adjunctive therapy, triple acupuncture at the Qugu acupoint can evidently ameliorate the clinical symptoms, enhance the curative effect of antibacterials, reduce the recurrence rate, and prolong the recurrence time in the treatment of CP/CPPS.

Correlative exploration in changes of mechanical pain thresholds and autophagy levels with chronic pelvic pain syndrome mice model / 中国实验动物学报

Objective To observe the changes of mechanical pain thresholds and autophagy related proteins microtubule-associated protein 1 light chain 3 (LC3) and sequestosome 1 (SQSTM1 also known as p62) expression levels in the C57BL/6 mouse models of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS),and provide animal experimental evidence for CP/CPPS pain and autophagy study.Methods 36 male C57BL/6 mice were randomly divided into three groups: the model group,control group and na(i)ve group.The CP/CPPS model was established by subcutaneous injection in the lower abdomen region with suspension liquid,containing protein extract of male SD rat prostate gland and complete Freund adjuvant.At 1month and 6 months after modeling,the mice were sacrificed and prostate tissues were harvested for histological examination using HE staining.Mechanical tactile hyperalgesia was measured with von Frey filaments.The autophagy-related proteins LC3 and p62 expression levels were detected by immunohistochemistry,respectively.The average IOD was measured by Image Pro Plus 6.0,and the statistical analysis was performed with GraphPad Prism 5 software.Results The histopathology showed the appearance of chronic prostatitis in the model group,representing hyperplasia and lymphocytic infiltration to a different degree and lasted for 6 months after modeling.Moreover,prostate intraepithelial neoplasia (PIN) appeared in the model group at 6 months after modeling,characterized by the disappearence of basement membrane and obvious nuclear abnormality,while the control and na(i)ve groups showed normal histology during the 1-6 months.Compared with the control and na(i)ve groups,the mechanical pain threshold in the model group was significantly decreased along with the time from (0.353±0.154) g at 0 week to (0.008±0.00) g at 22 weeks (P<0.05).The average IOD of LC3 and p62 expression in the model group was significantly increased with timing from [(2.767±0.464)%,(2.872±1.642)%] at 1month to [(13.501±1.900)%,(9.07±0.49)%] at 6 month,P<0.05.Conclusions A CP/CPPS model is successfully established in C57BL/6 mice.For the model group,the mechanical pain threshold is decreased and autophagy levels are increased gradually with time.These phenomena show that chronic inflammation microenvironment may promote pain and autophagy activity in the prostate,which is closely related with the occurrence and development of prostatic intraepithelial neoplasia.

Clinical Study on Dahuang Xiaozhi Suppository in Treating Chronic Abacterial Prostatitis/Chronic Pelvic Pain Syndrome of Moist Heat and Blood Stasis Syndrome / 中国中医药信息杂志

Objective To investigate the clinical efficacy of Dahuang Xiaozhi Suppository in treating chronic abacterial prostatitis/chronic pelvic pain syndrome (CABP/CPPS) of moist heat and blood stasis syndrome. Methods Two hundred patients of CABP/CPPS were randomly divided into control group and observation group, 100 cases in each group. 2 groups were disabled anti-infective meidicne and other preparations, and received diet and life intervention. The control group received the treatment of Qianliean Suppository, and the observation group received the treatment of Dahuang Xiaozhi Suppository, one capsule each time, once a day, into the anus depth of about 3–4 cm. Ten days were a treatment course with two day interval between each course of treatment. The treatment lasted for three courses. The clinical efficacy of the two groups was observed and compared. The indexes including the scores of NIH-CPSI, leukocyte count and lecithin corpuscles in prostatic fluid, and urinary flow rate were evaluated. Results The total effective rate was 100% (100/100) in the observation group and 78% (78/100) in the control group, and the observation group was much higher than control group (P<0.05). The scores of NIH-CPSI and leukocyte count in both groups were significantly lower after treatment (P<0.01), and those in observation group weresignificantly lower than those in control group (P<0.01). The cases with lecithin corpuscles++++in both groups were significantly more after treatment (P<0.01), and those in observation group were significantly more than those in control group (P<0.01). The peak flow rate and mean flow rate in both groups were higher after treatment (P<0.01), and it was higher in observation group (P<0.01). Conclusion The efficacy of Dahuang Xiaozhi Suppository in treating CABP/CPPS of moist heat and blood stasis syndrome is remarkable, and it is better than Qianliean Suppository.

Acupuncture combined with western medicine for CP/CPPS:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy differences among acupuncture combined with western medicine, acupuncture alone and western medicine alone for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).</p><p><b>METHODS</b>Ninety patients were randomly assigned into a needle-medicine group, an acupuncture group and a western medicine group, 30 patients in each group. The patients in the needle-medicine group were treated with acupuncture combined with western medicine; the scalp points included Shenting (GV 24), Xinhui (GV 22), Qianding (GV 21), Baihui (GV 20), Chengguang (BL 6), Tongtian (BL 7), etc. The body points were Zhongji (CV 3), Guanyuan (CV 4), Pangguangshu (BL 28), Ciliao (BL 32), etc. The acupuncture was given 30 min per treatment, once a day. Besides, oral administration of 0.2g levofloxacin (twice per day) and 0.2 mg tamsulosin (once a day) was applied. The patients in the acupuncture group and western medicine group were treated by acupuncture and western medicine respectively. 12-d treatment was taken as one session, and totally 2 sessions were given. The clinical efficacy of the three groups after treatment was compared as well as the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score and pain score, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after treatment.</p><p><b>RESULTS</b>During the trial two patients dropped out, as a result, 30 patients in the needle-medicine group, 29 patients in the acupuncture group and 29 patients in the western medicine group were included in the analysis. After treatment, 21 patients were cured, 6 patients were markedly effective, 2 patients were effective and 1 patient failed in the needle-medicine group;12 patients were cured, 10 patients were markedly effective, 5 patients were effective and 2 patients failed in the acupuncture group; 11 patients were cured, 12 patients were markedly effective, 4 patients were effective and 2 patients failed in the medicine group; the efficacy in the needle-medicine group was superior to those in the acupuncture group and medicine group (both<0.05). Each score was improved after treatment in each group (all<0.01); the total score of NIH-CPSI as well as SAS and SDS scores in the needle-medicine group were superior to those in the acupuncture group and medicine group (<0.05,<0.01); the pain scores of NIH-CPSI in needle-medicine group and acupuncture group were superior to that in the medicine group (<0.05,<0.01), but the difference between the needle-medicine group and acupuncture group was not significant (>0.05).</p><p><b>CONCLUSIONS</b>The efficacy of acupuncture combined with western medicine for CP/CPPS is superior to that of acupuncture alone and western medicine alone, which could improve the symptom of prostatitis as well as status of anxiety and depression.</p>

International focuses in the studies of chronic pelvic pain syndrome: A social network analysis / 中华男科学杂志

<p><b>Objective</b>To analyze the internationally published literature relevant to chronic pelvic pain syndrome (CPPS) using bibliometrics and social network analysis, and investigate the current status and focuses of CPPS studies.</p><p><b>METHODS</b>We identified 692 publications on CPPS by searching PubMed up to December 2015, extracted their subject headings, calculated the frequencies of the headings, and constructed a co-occurrence network of the high-frequency (≥10) subject headings. Then we studied the features and structure of the co-occurrence network by analyzing its attributes and topological structure.</p><p><b>RESULTS</b>The density of the constructed co-occurrence network was 0.111, with an average distance of 2.886 and a clustering coefficient of 0.685. Its low density, long average distance and high clustering coefficient indicated that it was a sparse network, with a slow speed of information spreading among nodes but a strong potential coherence, which suggested that the current topics in the study of CPPS were scattered and weakly correlated, with a high possibility of being integrated. Based on the topological structure of the co-occurrence network, the topics in the study of CPPS were divided into six aspects: diagnosis and classification, drug therapy, treatment, etiology, microbiology, psychology, and epidemiology, the more important of which were diagnosis and classification, drug therapy, treatment and etiology.</p><p><b>CONCLUSIONS</b>A system has been formed in the studies of CPPS, focusing on the diagnosis, drug therapy, and etiology of the disease. However, the research topics are relatively scattered and frequently repeated. Therefore, more attention should be paid to the macrocosmic guidance and rational coordination of the researches on CPPS.</p>

The Efficacy of Mirodenafil for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Middle-Aged Males

PURPOSE: The aim of this study was to investigate the efficacy of mirodenafil in middle-aged male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: Eighty-eight males with CP/CPPS were randomized to receive either levofloxacin (500 mg/d) (group L, 40 patients) or levofloxacin (500 mg/d) and mirodenafil (50 mg/d) (group ML, 48 patients) for six weeks. The International Prostate Symptom Score (IPSS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) questionnaire were used to grade symptoms at baseline and 6 weeks after treatment. RESULTS: The mean change in total IPSS from baseline was higher in group ML than that in group L (group L, -1.1 vs. group ML, -4.3; p<0.05). Significant improvements were also seen in the IPSS voiding subscore (group L, -0.7 vs. group ML, -3.0; p<0.05). Changes observed in the NIH-CPSI of group ML at six weeks were greater than those at baseline (group L, -3.2 vs. group ML, -7.2; p<0.05). Significant improvements were seen in the NIH-CPSI voiding (group L, -0.5 vs. group ML, -1.7; p<0.05) and quality of life domains (group L, -1.0 vs. group ML, -1.8; p<0.05). Group ML showed a significantly greater increase in the IIEF-EF score than did group ML (group L, +0.2 vs. group ML, +7.8; p<0.05). CONCLUSIONS: Mirodenafil (50 mg once daily) was well tolerated and resulted in significant symptomatic improvement in middle-aged males with CP/CPPS.

Depression and Somatic Symptoms May Influence on Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Preliminary Study

The present study is the first one to investigate the impacts of depression and somatization on the disease severity and quality of life (QoL) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The Korean version of National Institutes of Health (NIH)- Chronic Prostatitis Symptom Index (CPSI) for severity of CP/CPPS. Korean version of Patient Health Questionnaire-9 (PHQ-9) for depression, Korean version of Patient Health Questionnaire-15 (PHQ-15) for somatization, and Korean version of EuroQol Questionnaire-5 Dimensions (EQ-5D)- [(EQ-5D utility index and visual analog scale (EQ-5D VAS)] for QoL, were administered. Eighty patients were enrolled. The NIH-CPSI total scores were significantly higher in those with depression (25.3%, p=0.01) or somatization (23.2%, p=0.03) than in those without. These trends toward significantly negative influence of depression and somatic symptoms on QoL were also observed. Our preliminary results indicate that depression and somatization may have negative influence on the symptom severity and QoL in patients with CP/CPPS. However, adequately-powered and more well-designed studies are mandatory to prove our results.

Clinical Observation on Traditional Chinese Medicine Retention-enema Combined with Tamsulsosin Hydrochloride Capsules in Treating Chronic Abacterial Prostatitis/Chronic Pelvic Pain Syndrome / 中国中医药信息杂志

Objective To investigate the effect of traditional Chinese medicine retention-enema combined with tamsulsosin hydrochloride capsules in treating chronic abacterial prostatitis/chronic pelvic pain syndrome. Methods Two hundred patients of CABP/CPPS from Affiliated Hospital of Gansu University of TCM during September 2007-October 2012 were randomly divided into control group and observation group, 100 cases in each group. The control group received the treatment of tamsulsosin hydrochloride capsules, 0.2 mg/d, qn, and the observation group received the treatment of traditional Chinese medicine retention-enema additionally. The course was 4 weeks. The clinical effects of the two groups were observed and compared. The indexes including the scores of NIH-CPSI, leukocyte count and lecithin corpuscles in prostatic fluid, urinary flow rate were evaluated. Results The total effective rate was 100%(100/100) in observation group, and 88% (88/100) in control group. There was significant difference between the two groups (P0.05). Conclusion Traditional Chinese medicine retention-enema combined with tamsulsosin hydrochloride capsules can significantly improve the clinical effect of CABP/CPPS.

<b>Four Interstitial Cystitis/Chronic Pelvic Pain Syndrome（IC/CPPS） </b><b>Cases Improved by Kampo Medicine </b> / 日本東洋医学雑誌

Four interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS) patients presenting with pain and autonomic imbatances were improved by Kampo medicine. (Case 1) a 42 year old female : Her bladder and perinial pain were relieved by ryutanshakanto and her autonomic imbalances were improved by Kamishoyosan. (Case 2) a 51 year old female : She was given anchusan which warmed the internal organs. (Case 3) a 49 year old female : Her general hypothermia was relieved by shinbuto and ninjinto. (Case 4) a 27 year old female :She was given tokishigyakukagoshuyushokyoto which warmed the lower body half. These Kampo medicines for autonomic imbalance in IC/CPPS were drugs that adjusted general condition on the basis of diagnostic processes, and logic based on states of vital energy and blood.

Chronic Prostatitis: Approaches for Best Management

Prostatitis is a prevalent condition that encompasses a large array of clinical symptoms with significant impacts on men's life. The diagnosis and treatment of this disorder presents numerous challenges for urologists, most notably, a lack of specific and effective diagnostic methods. Chronic bacterial prostatitis is successfully treated with appropriate antibiotics that penetrate the prostate and kill the causative organisms. Prostatitis category III (chronic pelvic pain syndrome) is common, very bothersome, and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased, there have been no real breakthroughs; controversies and many unanswered questions remain. Furthermore, the optimal management of category III prostatitis is not known. Conventional prolonged courses of antibiotic therapy have not proven to be efficacious. Novel therapies providing some evidence for efficacy include alpha-blocker, anti-inflammatory phytotherapy, physiotherapy, neuroleptics, and others, each offering therapeutic mechanisms. A stepwise approach involving multimodal therapy is often successful for treating patients. The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

Tamsulosin Monotherapy versus Combination Therapy with Antibiotics or Anti-Inflammatory Agents in the Treatment of Chronic Pelvic Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Chronic pelvic pain syndrome (CPPS) is treated by use of various protocols. We compared tamsulosin monotherapy with tamsulosin in combination with antibiotics or anti-inflammatory agents and evaluated the efficacy of these treatments in patients with CPPS. METHODS: Patients (n=107) who were younger than 55 years and diagnosed with CPPS were randomly assigned to treatment with tamsulosin at 0.2 mg (group A), tamsulosin at 0.2 mg plus anti-inflammatory drugs (group B) or tamsulosin at 0.2 mg plus antibiotics (group C) daily. We applied the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS) to evaluate 100 patients who were treated for 12 weeks (7 withdrew). Scores of the three groups were compared by analysis of variance and we also evaluated subscores, which included pain, voiding and quality of life (QoL). RESULTS: All three groups showed statistically significant decreases in NIH-CPSI score, IPSS and subscore scores (P<0.05). There were no statistically significant differences between the groups except for the QoL domain of the IPSS (group A vs. C; P<0.01). CONCLUSIONS: Tamsulosin monotherapy for 12 weeks was effective for treating patients with CPPS, compared with combination therapy with antibiotics or anti-inflammatory drugs.