Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome.

PURPOSE Chronic prostatitis/chronic pelvic pain syndrome is a prevalent and multifactorial condition. Many patients have the condition for years despite conventional therapies. We assess the outcomes of multimodal therapy in patients with long-standing chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS A total of 53 patients with chronic prostatitis treated at our clinic with a minimum followup of 6 months were assessed by the National Institutes of Health-Chronic Prostatitis Symptom Index and by a global assessment score. Treatments included antibiotics, prostatic massage, anti-inflammatory phytotherapy, alpha-blockers and neuromuscular agents. RESULTS Mean age patient was 45 years and median symptom history was 3.5 years. Based on localizing cultures, and microscopy of urine and prostatic fluid 13% of the cases were category II, 41% were category IIIa and 46% were category IIIb. Mean followup from the last visit was 417 days (range 185 to 1,247). Mean changes +/- SE from the initial to the final score on the National Institutes of Health-Chronic Prostatitis Symptom Index were 10.4 +/- 3.3 to 5.9 +/- 4.4 for pain, 4.2 +/- 2.9 to 2.0 +/- 2.7 for urinary, 8.2 +/- 2.9 to 4.7 +/- 3.4 for quality of life and 22.7 +/- 6.6 to 13.2 +/- 9.5 for total score (p <0.0001). Based on a global subjective assessment 43 of the patients (80%) were better, 8 were the same and 3 were worse. At final assessment 39% of the patients were on no therapy, 22% were on an alpha-blocker, 37% were on quercetin, 13% were on neuromuscular agents and 9% were on antibiotics. CONCLUSIONS An approach using stepwise therapy with antibiotics, anti-inflammatories and neuromuscular agents can be successful in the majority of patients with long-standing chronic prostatitis.

[1]  M. Litwin.  A review of the development and validation of the National Institutes of Health Chronic Prostatitis Symptom Index. , 2002, Urology.

[2]  D. Shoskes,et al.  Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. , 2002, The Journal of urology.

[3]  Rodney U. Anderson.  Management of chronic prostatitis-chronic pelvic pain syndrome. , 2002, The Urologic clinics of North America.

[4]  D. Faulds,et al.  Tamsulosin: a review of its pharmacology and therapeutic efficacy in the management of lower urinary tract symptoms. , 2002, Drugs & aging.

[5]  D. Shoskes,et al.  CORRELATION OF β-ENDORPHIN AND PROSTAGLANDIN E2 LEVELS IN PROSTATIC FLUID OF PATIENTS WITH CHRONIC PROSTATITIS WITH DIAGNOSIS AND TREATMENT RESPONSE , 2001 .

[6]  D. Shoskes.  Use of antibiotics in chronic prostatitis syndromes. , 2001, The Canadian journal of urology.

[7]  J. Nickel,et al.  Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. , 2001, The Journal of urology.

[8]  D. Shoskes,et al.  Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. , 2000, Journal of andrology.

[9]  D. Shoskes,et al.  Detection of bacterial signal by 16S rRNA polymerase chain reaction in expressed prostatic secretions predicts response to antibiotic therapy in men with chronic pelvic pain syndrome. , 2000, Techniques in urology.

[10]  L. True,et al.  Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. , 2000, The Journal of urology.

[11]  J. Weir,et al.  Terazosine and tamsulosin in non bacterial prostatitis: a randomized placebo-controlled study. , 1999, Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica.

[12]  J. Rajfer,et al.  Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. , 1999, Urology.

[13]  M. Pontari,et al.  The National Institutes of Health chronic prostatitis symptom index: Development and validation of a new outcome measure , 1999 .

[14]  D. Shoskes,et al.  Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis , 1999, Prostate Cancer and Prostatic Diseases.

[15]  O. Lukkarinen,et al.  Effects of finasteride in patients with inflammatory chronic pelvic pain syndrome: a double-blind, placebo-controlled, pilot study. , 1999, Urology.

[16]  G. Nikiforidis,et al.  Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. , 1998, The Journal of urology.

[17]  N. Webster,et al.  Effect of ciprofloxacin on the accumulation of interleukin-6, interleukin-8, and nitrite from a human endothelial cell model of sepsis. , 1997, Critical care medicine.

[18]  A. C. Buck,et al.  Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. , 1993, British journal of urology.