Therapeutic Intervention for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): A Systematic Review and Meta-Analysis

Abstract

BackgroundChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been treated with several different interventions with limited success. This meta-analysis aims to review all trials reporting on therapeutic intervention for CP/CPPS using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI).MethodsWe searched Medline, PubMed, the Cochrane Pain, Palliative & Supportive Care Trials, the Cochrane Register of Controlled Trials, CINAHL, ClinicalTrials.gov, and the NIDDK website between 1947 and December 31, 2011 without language or study type restrictions. All RCTs for CP/CPPS lasting at least 6 weeks, with a minimum of 10 participants per arm, and using the NIH-CPSI score, the criterion standard for CP/CPPS, as an outcome measure were included. Data was extracted from each study by two independent reviewers. Gillbraith and I-squared plots were used for heterogeneity testing and Eggers and Peters methods for publication bias. Quality was assessed using a component approach and meta-regression was used to analyze sources of heterogeneity.ResultsMepartricin, percutaneous tibial nerve stimulation (PTNS), and triple therapy comprised of doxazosin + ibuprofen + thiocolchicoside (DIT) resulted in clinically and statistically significant reduction in NIH-CPSI total score. The same agents and aerobic exercise resulted in clinically and statistically significant NIH-CPSI pain domain score reduction. Acupuncture, DIT, and PTNS were found to produce statistically and clinically significant reductions in the NIH-CPSI voiding domain. A statistically significant placebo effect was found for all outcomes and time analysis showed that efficacy of all treatments increased over time. Alpha-blockers, antibiotics, and combinations of the two failed to show statistically or clinically significant NIH-CPSI reductions.ConclusionResults from this meta-analysis reflect our current inability to effectively manage CP/CPPS. Clinicians and researchers must consider placebo effect and treatment efficacy over time and design studies creatively so we can more fully elucidate the etiology and role of therapeutic intervention in CP/CPPS.

WITHDRAWN: Efficacy of thermobalancing therapy for chronic prostatitis/chronic pelvic pain syndrome, confirmed by clinical study, may suggest etiology and pathophysiology of this disease

“…For instance, a meta-analysis conducted by the Harvard Medical School on different types of treatment for CP from 1947 to 2011 concludes, "Our current understanding of CP/CPPS is not complete enough to allow us to employ appropriate interventions for all patients and it is important to continue to conduct research to improve our understanding of the mechanism and treatment of the disease" [27].…”

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

“…Neither antibiotics nor nonsteroidal antiinflammatory drugs resulted in significant improvement in the NIH-CPSI total score and NIH-CPSI pain subscore compared with placebo. 26 Saw palmetto belongs to the phytotherapy family, which also includes pollen extracts and quercetin. Unfortunately, until now phytotherapy has never been compared with conventional medical therapy in a headto-head, randomized controlled trial.…”

A case of acute pelvic pain responding to escitalopram but not to anti-inflammatory drugs

“…As for the treatment of CPPS, a meta-analysis showed that mepartricin, percutaneous tibial nerve stimulation, and triple therapy comprised of doxazosin + ibuprofen + thiocolchicoside resulted in clinically and statistically significant reduction in the National Institutes of Health-Chronic Prostatitis Symptom Index (NIMH-CPSI) total scores whereas alpha-blockers, antibiotics, and combinations of the two failed to show statistically or clinically significant NIH-CPSI reductions [2]. The effects of antidepressant drugs such as amitriptyline, sertraline, duloxetine, nortriptyline, citalopram, and venlafaxine for the management of CPPS has been reported [4,5].…”

“…CPPS is defined as urologic pain or discomfort in the pelvic region, associated with urinary symptoms and/or sexual dysfunction, lasting for at least 3 of the previous 6 months . In the absence of any identifiable pathology such as cancer, culturable infection, or anatomic abnormalities, it is often accompanied by associated negative cognitive, behavioral, sexual or emotional consequences [2].…”