New treatments for chronic prostatitis/chronic pelvic pain syndrome

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition among men of a wide age range, with detrimental effects on quality of life. The etiology, pathogenesis, and optimal treatment of CP/CPPS remain unknown, although progress has been made in these domains in recent years. A wide variety of pharmacologic and nonpharmacologic therapies have been studied in clinical trials, but most have shown limited efficacy in symptom alleviation. CP/CPPS is increasingly viewed as a condition that involves variable degrees of neuropathic pain. Medications such as gabapentin, pregabalin, memantine, and tricyclic antidepressants are often used in other neuropathic pain conditions and, therefore, are considered potential treatments for CP/CPPS. Few studies of these agents in patients with CP/CPPS have been reported, but future clinical trials should help to determine their utility and to characterize the pathogenetic mechanisms of pain in CP/CPPS. Combining treatment trials with biomarker, genomic, and imaging studies, in addition to epidemiologic and symptom-based assessments, will maximize the ability to probe disease etiology and pathogenesis, as well as identify effective treatment.

New Independent Thermobalancing Treatment with Therapeutic Device for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

“…However, in men with CP/CPPS largely unresponsive to medical interventions, greater pain is associated with diminished QoL (28). Therefore, proposing that men with CP/CPPS should wear Physicians currently prescribe a wide range of medications, some of which have studied, and numerous of them have not been studied yet in randomized controlled trials (RCTs), however, none of them has shown high efficacy (29). Many new drugs for CP/CPPS treatment were found to be valueless (30,31), and most commonly used drugs have adverse effects, especially when used in longterm (32).…”

Concordance and Clinical Significance of Uncommon Variants of Bladder Urothelial Carcinoma in Transurethral Resection and Radical Cystectomy Specimens

“…The most frequent therapies for CP/CPPS include single or sequential treatments or multimodal approaches with antibacterial, analgesics, and anti-inflammatory drugs, ablockers, and pelvic floor rehabilitation to treat dysfunctional voiding, but very few studies have been performed in which anxiolytic or antidepressant medications, or both, have been used to control psychologic problems. 7 To date, no studies have used duloxetine hydrochloride to modulate pain and changes in the psychoemotional status in patients affected by CP/CPPS.…”

Prostatitis: From Diagnosis to Treatment

“…Alternatively, dysfunctional voiding may result in intraprostatic ductal reflux (Hedelin & Fall, 2008). Investigators have found an increased maximal urethral closure pressure and a decreased urinary flow rate in patients with CPPS www.intechopen.com compared with control patients (Strauss & Dimitrakov, 2010). They attributed the high maximal urethral closure pressure to increased adrenergic stimulation in the proximal urethra and bladder neck and proposed that this might cause intraprostatic reflux of urine.…”

“…Based on these observations they suggested the use of the term "painful male urethral syndrome". Furthermore, spasm of the pelvic floor muscles alone or in combination with bladder neck dysfunction may contribute to chronic pelvic pain (Strauss & Dimitrakov, 2010).…”

“…Chronic nonbacterial prostatitis and prostatodynia (category III CPPS) constitute the vast majority of prostatitis cases and are difficult to manage. Performing a lower urinary tract evaluation (at least a two-glass premassage and postmassage screen) to rule out uropathogens, microscopy of postprostatic massage urine sediment (to differentiate inflammatory from non-inflammatory CPPS), and employment of the newly validated NIH-CPSI will allow optimal management (Strauss & Dimitrakov, 2010). Available treatments include: i) antibiotics that cover potential pathogens (including Chlamydia and Ureaplasma, at least in category IIIA); ii) alpha blockers (especially in patients with obstructive voiding symptoms); iii) anti-inflammatory agents; iv) muscle relaxants; v) pento-san polysulfate (in patients with bladder or interstitial cystitis-like symptoms); and vi) physical therapy (i.e.…”