The role of anticholinergic therapy based on the upoint system in the treatment of chronic prostatitis

Abstract

Objective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common problem and severely impairs the quality of life (QoL). We aimed to investigate the effects of different treatment options on voiding symptoms and QoL in patients with urinary phenotype according to the UPOINT system. Matherial and methods: Ninety-six patients with NIH category II,III CP/CPPS were included in the study prospectively. After the diagnosis, the questionnaires including NIH Chronic prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), Overactive Bladder Screening Questionnaire (OAB-V8), and Beck depression inventory were filled by the patients. The patients with urinary phenotype were treated by alpha-blocker, antimuscarinic or both therapy modalities (combined) considering the specific therapy recommendations by UPOINT. The questionnaires applied on the first visit were reapplied after one month and treatment success was evaluated. Results: Seventy-three patients were included in ‘Urinary phenotype’ group (76%) and 23 were included in ‘other phenotypes’ (24%) group of the patients according to the UPOINT classification. Significant improvements of symptoms were observed with the all treatment modalities when the NIH-CPSI, IPSS and OAB-V8 scores were compared before and after treatment in the ‘Urinary phenotype’ group. Significant differences in the percentage of change in values were obtained in the anticholinergic group for pain subdomain of NIH-CPSI and IPSS scores.Conclusion: U-POINT clasification is useful for deciding on the treatment modality in CP/CPSS patients. We showed anticholinergic therapy might be effective option. Addition to the symptomatic recovery, there is need more further studies about effectivity cholinergic system in the prostate tissue.

Therapeutic Approaches for Urologic Chronic Pelvic Pain Syndrome; Management: Research Advances, Experimental Targets, and Future Directions

“…While there is sufficient evidence of the efficacy of anticholinergic drugs in treating LUTS in general, there is mixed data about their effectiveness in UCPPS patients. While some studies reported little to no improvement in symptom severity or QoL measures in CP/CPPS patients (Kim et al, 2011), others determined that anticholinergic drugs significantly decreased CP/CPPS symptoms in patients with the urinary-centric phenotype when combined with alphablockers or antimuscarinic drugs (Narter et al, 2019). Additional clinical trials on women with IC/BPS have demonstrated that intravesical instillations of anticholinergic drugs can reduce LUTS and pain in combination with other therapies (Barbalias et al, 2000;Raisin et al, 2023).…”

“…Block the action of acetylcholine Barbalias et al, 2000;Gerretsen & Pollock, 2011;Ghossein et al, 2023;Kim et al, 2011;Narter et al, 2019;Raisin et al, 2023…”