Chronic prostatitis.

INTRODUCTION: Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 33 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, biofeedback, local injections of antimicrobial drugs, mepartricin, nonsteroidal anti-inflammatory drugs (NSAIDs), oral antimicrobial drugs, pentosan polysulfate, prostatic massage, quercetin, radical prostatectomy, sitz baths, transurethral microwave thermotherapy, and transurethral resection. QUESTIONS What are the effects of treatments for chronic bacterial prostatitis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome?. . . . . . . . . 12 INTERVENTIONS CHRONIC BACTERIAL PROSTATITIS Likely to be beneficial Antimicrobial drugs (oral) for chronic bacterial prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Unknown effectiveness Alpha-blockers for chronic bacterial prostatitis . . . . . 7 Antimicrobial drugs (locally injected) for chronic bacterial prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 NSAIDs for chronic bacterial prostatitis . . . . . . . . . 10 Radical prostatectomy for chronic bacterial prostatitis . 1 1 TURP for chronic bacterial prostatitis . . . . . . . . . . . 11 CHRONIC ABACTERIAL PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Unknown effectiveness 5 alpha-reductase inhibitors for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . 19 Allopurinol for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Alpha-blockers for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . 12 Biofeedback for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . 22 Mepartricin for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . 22 NSAIDs for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Pentosan polysulfate for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . 25 Quercetin for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Sitz baths for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Transurethral microwave thermotherapy for chronic abacterial prostatitis/chronic pelvic pain syndrome . . 3 0 Unlikely to be beneficial Antimicrobial drugs (oral) for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . 31 Prostatic massage for chronic abacterial prostatitis/chronic pelvic pain syndrome . . . . . . . . . . . . . . . . . . . . . 33