Clinical management of chronic prostatitis/chronic pelvic pain syndrome: Literature review

Abstract

Prostatitis; it is defined as the infection and edema of the prostate gland. It may be accompanied by pelvic pain, discomfort, voiding and ejaculation dysfunction. It can affect men of all age groups and has a significant impact on patients' quality of life. It is divided into four groups according to the classification system established by the National Institutes of Health for prostatitis. These groups are; acute bacterial prostatitis (group 1), chronic bacterial prostatitis (group 2), chronic prostatitis/chronic pelvic pain syndrome (inflammatory: group 3A, non-inflammatory: group 3B) and asymptomatic prostatitis (group 4). Chronic prostatitis/chronic pelvic pain syndrome group constitutes >90% of all patients with prostatitis-like complaints. This definition represents a heterogeneous patient group and is an exclusion diagnosis. Many different types of treatment have been used for chronic prostatitis/chronic pelvic pain syndrome, such as antibiotics, anti-inflammatories, alpha blockers, hormonal treatments, neuromodulatory treatments, herbal treatments, physical therapies, acupuncture treatments. However, it has been shown that monotherapies are not effective enough. The multimodal approach to the treatment of the disease holds promise.

Keywords

• Prostatitis
• pelvic pain
• diagnose
• treatment

Kronik prostatit/kronik pelvik ağrı sendromuna klinik yaklaşım: Literatür taraması

Abstract

Prostatit; prostat bezinin enfekte olması ve ödemlenmesi olarak tanımlanır. Pelvik ağrı, rahatsızlık, işeme ve boşalma semptomları eşlik edebilir. Her yaş grubundan erkeği etkileyebilir ve hastaların yaşam kalitesi üzerinde önemli etkileri vardır. Ulusal Sağlık Enstitüleri’nin (National Institutes of Health) prostatit için oluşturduğu sınıflama sistemine göre dört gruba ayrılır. Bunlar; akut bakteriyel prostatit (grup 1), kronik bakteriyel prostatit (grup 2), kronik prostatit/kronik pelvik ağrı sendromu (inflamatuvar: grup 3A, non-inflamatuvar: grup 3B) ve asemptomatik prostatittir (grup 4). Prostatit benzeri şikayetleri olan hastaların >%90’ını kronik prostatit/kronik pelvik ağrı sendromu grubu oluşturur. Bu tanım heterojen bir hasta grubunu temsil eder ve bir dışlama tanısıdır. Tedavisinde antibiyotikler, anti-inflamatuvarlar, alfa blokerler, hormonal tedaviler, nöromodülatör tedaviler, bitkisel tedaviler, fizik tedaviler, akupunktur tedavileri gibi çok farklı tedavi çeşitleri uygulanmış ancak monoterapilerin yeterince etkinlik sağlamadığı gösterilmiştir. Hastalığın tedavisinde multimodal yaklaşım umut vadetmektedir.

Keywords

• Prostatit
• pelvik ağrı
• tanı
• tedavi

References

1. 1. Clemens JQ, Stephens-Shields AJ, Newcomb C, et al. Correlates of 1-year change in quality of life in patients with urologic chronic pelvic pain syndrome: Findings from the multidisciplinary approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. J Urol. 2020;204(4):754-9.
2. 2. Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, Kimes T, Calhoun EA. Prevalence of and risk factors for prostatitis: Population based assessment using physician assigned diagnoses. J Urol 2007;178(4 Pt 1):1333-7.
3. 3. Krieger JN, Nyberg L, Jr., Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999;282(3):236-7.
4. 4. Schaeffer AJ, Landis JR, Knauss JS, et al. Demographic and clinical characteristics of men with chronic prostatitis: The national institutes of health chronic prostatitis cohort study. J Urol 2002;168(2):593-8.
5. 5. Nickel JC, Shoskes DA, Wagenlehner FM. Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): The studies, the evidence, and the impact. World J Urol 2013;31(4):747-53.
6. 6. Krieger JN, Lee SW, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents 2008;31 Suppl 1:S85-90.
7. 7. Wagenlehner FM, van Till JW, Magri V, et al. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol 2013;63(5):953-9.
8. 8. Propert KJ, Litwin MS, Wang Y, et al. Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res 2006;15(2):299-305.

9. 9. Badía X, García-Losa M, Dal-Ré R. Ten-language translation and harmonization of the International Prostate Symptom Score: Developing a methodology for multinational clinical trials. Eur Urol 1997;31(2):129-40.
10. 10. Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822-30.
11. 11. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968;5(5):492-518.
12. 12. Engeler D, Berghmans B, Borovicka J, et al. EAU Guidelines on Chronic Pelvic Pain. European Association of Urology Guidelines, presented at the EAU Annual Congress Amsterdam 2020, ISBN978-94-92671-07-3.
13. 13. Bonkat G, Bruyère F, Cai T, et al. EAU Guidelines on Urological Infections. European Association of Urology Guidelines, presented at the EAU Annual Congress Milan Italy 2021, ISBN 978-94-92671-13-4.
14. 14. Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: A management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis 2009;12(2):177-83.
15. 15. Crane A, Lloyd J, Shoskes DA. Improving the utility of clinical phenotyping in interstitial cystitis/painful bladder syndrome: From UPOINT to INPUT. Can J Urol 2018;25(2):9250-4.
16. 16. Arda E, Cakiroglu B, Tas T, Ekici S, Uyanik BS. Use of the UPOINT classification in Turkish chronic prostatitis or chronic pelvic pain syndrome patients. Urology 2016;97:227-31.
17. 17. Guan X, Zhao C, Ou Z-Y, et al. Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: A prospective study. Asian J Androl 2015;17(1):120-3.
18. 18. Hedelin HH. Evaluation of a modification of the UPOINT clinical phenotype system for the chronic pelvic pain syndrome. Scand J Urol Nephrol 2009;43(5):373-6.
19. 19. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: A prospective study using UPOINT. Urology 2010;75(6):1249-53.
20. 20. Davis SNP, Binik YM, Amsel R, Carrier S. Is a sexual dysfunction domain important for quality of life in men with urological chronic pelvic pain syndrome? Signs "UPOINT" to yes. The Journal of Urology 2013;189(1):146-51.
21. 21. Nickel JC, Downey J, Clark J, et al. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: A randomized placebo-controlled multicenter trial. Urology 2003;62(4):614-7.
22. 22. Alexander RB, Propert KJ, Schaeffer AJ, et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: A randomized, double-blind trial. Ann Intern Med 2004;141(8):581-9.
23. 23. Zhou Z, Hong L, Shen X, et al. Detection of nanobacteria infection in type III prostatitis. Urology 2008;71(6):1091-5.
24. 24. Nickel JC, O'Leary MP, Lepor H, et al. Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: Results of a phase II multicenter, double-blind, placebo controlled study. J Urol 2011;186(1):125-31.
25. 25. Mehik A, Alas P, Nickel JC, Sarpola A, Helström PJ. Alfuzosin treatment for chronic prostatitis/chronic pelvic pain syndrome: A prospective, randomized, double-blind, placebo-controlled, pilot study. Urology 2003;62(3):425-9.
26. 26. Cheah PY, Liong ML, Yuen KH, et al. Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: A randomized, placebo controlled trial. J Urol 2003;169(2):592-6.
27. 27. Tuğcu V, Taşçi AI, Fazlioğlu A, et al. A placebo-controlled comparison of the efficiency of triple- and monotherapy in category III B chronic pelvic pain syndrome (CPPS). Eur Urol 2007;51(4):1113-7; discussion 8.
28. 28. Nickel JC, Pontari M, Moon T, et al. A randomized, placebo controlled, multicenter study to evaluate the safety and efficacy of rofecoxib in the treatment of chronic nonbacterial prostatitis. J Urol 2003;169(4):1401-5.
29. 29. Zhao WP, Zhang ZG, Li XD, et al. Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz J Med Biol Res 2009;42(10):963-7.
30. 30. Bates SM, Hill VA, Anderson JB, et al. A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. BJU Int 2007;99(2):355-9.
31. 31. Nickel JC, Atkinson G, Krieger JN, et al. Preliminary assessment of safety and efficacy in proof-of-concept, randomized clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome. Urology 2012;80(5):1105-10.
32. 32. Goldmeier D, Madden P, McKenna M, Tamm N. Treatment of category III A prostatitis with zafirlukast: A randomized controlled feasibility study. Int J STD AIDS 2005;16(3):196-200.
33. 33. Wagenlehner FM, Ballarini S, Naber KG. Immunostimulation in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): A one-year prospective, double-blind, placebo-controlled study. World J Urol 2014;32(6):1595-603.
34. 34. Nickel JC, Downey J, Pontari MA, Shoskes DA, Zeitlin SI. A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int 2004;93(7):991-5.
35. 35. De Rose AF, Gallo F, Giglio M, Carmignani G. Role of mepartricin in category III chronic nonbacterial prostatitis/chronic pelvic pain syndrome: A randomized prospective placebo-controlled trial. Urology 2004;63(1):13-6.
36. 36. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: A preliminary prospective, double-blind, placebo-controlled trial. Urology 1999;54(6):960-3.
37. 37. Wagenlehner FM, Schneider H, Ludwig M, et al. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: A multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 2009;56(3):544-51.
38. 38. Morgia G, Russo GI, Urzì D, et al. A phase II, randomized, single-blinded, placebo-controlled clinical trial on the efficacy of Curcumina and Calendula suppositories for the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome type III. Arch Ital Urol Androl 2017;89(2):110-3.
39. 39. Pontari MA, Krieger JN, Litwin MS, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: A randomized controlled trial. Arch Intern Med 2010;170(17):1586-93.
40. 40. Nickel JC, Forrest JB, Tomera K, et al. Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: A multicenter, randomized, placebo controlled study. J Urol 2005;173(4):1252-5.
41. 41. Fitzgerald M, Anderson R, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. The Journal of Urology 2009;182:570-80.
42. 42. Kabay S, Kabay SC, Yucel M, Ozden H. Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: A sham-controlled comparative study. Urol Int 2009;83(1):33-8.
43. 43. Lee SW, Liong ML, Yuen KH, et al. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med 2008;121(1):79.e1-7.
44. 44. Sahin S, Bicer M, Eren GA, et al. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: A randomized, sham-controlled trial. Prostate Cancer Prostatic Dis 2015;18(3):249-54.
45. 45. Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: Three-arm randomized trial. Urology 2009;73(5):1036-41.
46. 46. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: A randomised, double-blind, placebo-controlled study. Eur Urol 2009;56(3):418-24.
47. 47. Kessler TM, Mordasini L, Weisstanner C, et al. Sono-electro-magnetic therapy for treating chronic pelvic pain syndrome in men: A randomized, placebo-controlled, double-blind trial. PLoS One 2014;9(12):e113368.
48. 48. Giubilei G, Mondaini N, Minervini A, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments-could it represent a valid option? The physical activity and male pelvic pain trial: A double-blind, randomized study. J Urol 2007;177(1):159-65.
49. 49. Ying J, Zhou MJ, Chen HY, et al. Effect of essential oil on patients with chronic prostatitis/chronic pelvic pain syndrome: A pilot randomized controlled trial. Chin J Integr Med 2019;25(2):91-5.
50. 50. Falahatkar S, Shahab E, Gholamjani Moghaddam K, Kazemnezhad E. Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: Results of a prospective pilot double-blind and randomized placebo-controlled study. BJU Int 2015;116(4):641-9.