National Institutes Of Health Chronic Prostatitis Symptom Index Total Score Research Articles

Metabolic Aspects of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Symptoms of prostatitis, in particular, pain and urination disorders significantly affect the quality of life of patients. Metabolic mechanisms of the pathogenesis of prostatitis and the formation of prostate calcifications are of interest for modern research. The objective: to determine the relationship between the concentration of uric acid, oxalates and pH in blood serum, urine and ejaculate with symptoms of prostatitis and ultrasound signs of prostate calcifications. Materials and methods. 102 men aged 18 to 45 were included in the study. Group 1 (n=34) consisted of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Group 2 included patients with asymptomatic prostatitis (n=34). They had no complaints, but laboratory signs of prostatitis were observed (pyospermia, leukocytes more than 10 per high power field in the ejaculate). The material (urine, ejaculate) of 34 healthy men was used as a control (Group 3). Prostatitis symptoms were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scale, and depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. All participants underwent ejaculate analysis. Interleukins (IL) 1β and IL-10 were determined by enzyme immunoassay in ejaculate. In all cases, daily diuresis, pH of urine, concentration of uric acid, oxalates in urine and ejaculate were determined by methods of analytical chemistry. Patients of Group 1 received a course of extracorporeal shock wave therapy (ESWT) for 10 sessions, 2-3 times a week. Treatment success was defined as a reduction of 6 points or more on the NIH-CPSI total score. After receiving a course of ESWT, patients of Group 1 were recommended to follow a diet for 2 months (± 2 weeks), after which they were subject to re-examination. All other study participants (Group 2 and Group 3) followed the diet immediately after the initial examination. After 2 months (± 2 weeks), after which they were also subject to re-examination. Results. Both high and low values of the studied indicators were found in all patients. The analysis of the obtained data on the concentration of uric acid and oxalates in the urine, blood serum and ejaculate of the study participants showed no statistically significant difference between the groups. The concentration of uric acid in blood serum was inversely correlated with its concentration in urine and ejaculate (r=–0.238, p=0.016; r=–0.267, p=0.007, respectively). In addition, it was inversely correlated with the concentration of oxalates in urine, ejaculate and their daily excretion (r=–0.301, p=0.02; r=–0.288, p=0.003; r=–0.212, p=0.032, respectively). The ejaculate pH was correlated with the concentration of uric acid in sperm and blood serum (r=0.297, p=0.002; r=–0.467, p=0.001, respectively), as well as with the presence of flickering artifact during ultrasonography of the prostate gland (r=–0.249, p=0.011). In turn, the urine pH level was positively correlated with the presence of a flickering artifact and the assessment of depression symptoms according to the PHQ-9 questionnaire (r=0.208, р=0.036; r=–0.199, р=0.045, respectively). Correlations between metabolic indicators and evaluation of prostatitis symptoms according to the NIH-CPSI scale were absent. As a result of adherence to the diet for 2 months, there was no recurrence of the disease or deterioration of the condition of patients in Group 1, as well as the appearance of prostatitis symptoms in the participants of Groups 2 and 3. This may also have been facilitated by compliance with our general recommendations for maintaining a healthy lifestyle. Significant changes in the studied metabolic indicators were observed in all studied groups. In Group 1, the activity of prostatitis symptoms and depression decreased statistically significantly as a result of using the diet. The average difference in the total score of the NIH-CPSI questionnaire was 4.2±6.8, p<0.001; the total score of the PHQ-9 questionnaire was 4.1±2.9, p<0.001. Conclusions. The results of the study show that the concentration of uric acid, oxalates in urine, semen, and blood serum, as well as the pH values of urine and ejaculate, most of which traditionally characterize stone formation in the urinary tract, significantly affect the condition of patients with chronic calculous prostatitis. Adherence to the diet allows patients to influence the indicators of salt transport, reduce the activity of symptoms and the likelihood of disease recurrence. Along with this, no significant relationship was found between the studied indicators and the activity of prostatitis symptoms and depression in such patients.

Clinical efficacy of magnetic vibration magnetoelectric therapy in the treatment of chronic prostatitischronic pelvic pain syndrome.

The prominent symptoms of chronic pelvic pain syndrome (CPPS) are urogenital pain, lower urinary tract symptoms, psychological problems, and sexual dysfunction. Traditional pharmacological treatments have poor efficacy and more untoward reaction and complications. Magnetic vibration magnetoelectric therapy is a non-invasive form of physiotherapy. Nevertheless, its effectiveness in improving urinary discomfort and relieving pain in patients requires further exploration. To investigate the clinical efficacy of the magnetic vibration magnetoelectric therapy instrument in the treatment of chronic prostatitis (CP)/ CPPS. Seventy patients with CP/CPPS were collected from the outpatient clinic and ward of the Department of Male Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, and were treated with magnetic vibration magnetoelectric therapy once a day for a period of 14 d. National Institutes of health-chronic prostatitis symptom index (NIH-CPSI), international index of erectile function 5 (IIEF-5), premature ejaculation diagnostic tool (PEDT), generalized anxiety disorder (GAD), patient health questionnaire, the pain catastrophizing scale (PCS) and traditional Chinese medicine syndrome (TCMS) scores were performed before and after treatment. The total effective rate of treatment was 58.5%, and the total NIH-CPSI score, pain symptoms, voiding symptoms, quality of life, IIEF-5, PEDT, GAD, PCS and TCMS scores all decreased significantly (P < 0.05). Magnetic vibration magnetotherapy is effective in improving urinary discomfort, relieving pain, improving quality of life, improving sexual dysfunction and relieving negative emotions such as anxiety in patients with CP/CPPS.

Observation of the efficacy of elongated needle therapy in treating patients with ⅢB prostatitis of stagnant dampness-heat syndrome.

To observe the clinical efficacy in patients with ⅢB prostatitis of stagnant dampness-heat syndrome treated with elongated needle therapy. A total of 90 patients with ⅢB prostatitis of stagnant dampness-heat syndrome were selected and randomly divided into a treatment group(45 cases, 2 dropped out) and a control group(45 cases, 1 dropped out) using a random number table method. The control group was treated with oral administration of Qianlie Shutong Capsule, 3 capsules per dose, 3 times a day for a total of 4 weeks. The treatment group received elongated needle therapy at Qihai(CV6), Zhongji(CV3), bilateral Zhibian(BL54) and Shuidao(ST28), with one treatment per day for 4 weeks. Before and after treatment, the traditional Chinese medicine syndrome score, National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI) score were compared between the two groups, and the clinical efficacy was compared after treatment. Compared with that before treatment, the control group showed significant decrease in traditional Chinese medicine syndrome score, testicular pain, urinary frequency, unending remnants of urine, scrotal wetness, yellowish urine, urinary symptoms, and quality of life scores after treatment(P<0.05)；the treatment group showed significant decrease in traditional Chinese medicine syndrome score, and perineal pain, groin pain, pelvic pain, testicular pain, scrotal wetness, yellowish urine scores, NIH-CPSI total score, pain symptoms, urinary symptoms, and quality of life scores after treatment(P<0.05). After treatment, the treatment group showed significantly lower traditional Chinese medicine syndrome score, and perineal pain, groin pain, pelvic pain, testicular pain scores, NIH-CPSI total score, pain symptoms, and quality of life scores than those of the control group(P<0.05). The effective rate in the treatment group (63.64%, 28/43) was significantly higher than that in the control group (88.37%, 38/44, P<0.05). Elongated needle therapy can significantly improve the traditional Chinese medicine syndrome score, NIH-CPSI total score, and pain symptom scores in patients with ⅢB prostatitis of stagnant dampness-heat syndrome. It can significantly improve the cure rate in these patients and is particularly effective in relieving pain.

Multi-pharmacological treatment for young subfertile males with chronic prostatitis/chronic pelvic pain syndrome.

This study evaluated the effectiveness of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) treatments using multiple pharmaceutical agents that could simultaneously preserve or enhance fertility capability. This was a single-center-based, randomized controlled study, whereas the final analysis evaluated a total 350 CP/CPPS patients (age range, 28-40 years) and 50 patients were randomly allocated to each therapeutic group, with a 1:1 ratio. The therapeutic groups consist of tadalafil (group 1, 5 mg daily), L-carnitine (group 2, 2 g daily), Serenoa repens extract (group 3, 320 mg daily), group 4 (tadalafil+L-carnitine), group 5 (tadalafil+S. repens), group 6 (L-carnitine+S. repens), and group 7 (tadalafil+L-carnitine+S. repens). The treatment outcomes at 3 months post-therapy were analyzed. At 3 months post-therapy, the mean total sperm motility was significantly improved in all groups. A normal morphology improvement was observed in L-carnitine receiving groups. The mean total score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the mean International Prostate Symptom Score (IPSS) showed the greatest reduction in intensity in group 7. Logistic regression analyses showed that group 5 and group 7 were significantly associated with improvements in total IPSS and total NIH-CPSI scores at 3 months post-therapy. Group 7 was a significant predictor for improving total sperm motility, leukocytospermia and normal form of sperm. Tadalafil, carnitine, and S. repens combination therapy could be considered a feasible treatment option for CP/CPPS males with subfertility.

Efficacy of Targeted Mast Cell Inhibition Therapy in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

To identify a subgroup of patients with mast cell dysfunction in chronic prostatitis/chronic pelvic pain syndrome and evaluate efficacy of mast cell-directed therapy. Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were recruited and evaluated in an open-label, interventional uncontrolled trial after therapy with cromolyn sodium and cetirizine hydrochloride. The primary endpoint was a change in mast cell tryptase concentrations after treatment while secondary endpoints were changes in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and AUA-SI. Isolated cells from postprostatic massage urine were evaluated for immune changes using mRNA expression analysis. 31 patients with a diagnoses of Category III CP/CPPS were consented, 25 patients qualified and 20 completed the study after meeting a prespecified threshold for active tryptase in expressed prostatic secretions. After treatment with cromolyn sodium and cetirizine dihydrochloride for 3-week, active tryptase concentrations were significantly reduced from 49.03±14.05 ug/mL to 25.49±5.48 ug/mL (P<.05). The NIH-CPSI total score was reduced with a mean difference of 5.2±1 along with reduction in the pain, urinary and quality of life subscores (P<.001). A reduction in the AUA-SI was observed following treatment (P<.05). NanoString mRNA analysis of isolated cells revealed downregulation of immune-related pathways including Th1 and Th17 T cell differentiation and TLR signaling. Marked reduction in CD45+ cells and specifically macrophages and neutrophil abundance was observed. Identification of CP/CPPS patients with mast cell dysfunction may be achieved using tryptase as a discriminating biomarker. Mast cell-directed therapy in this targeted subgroup may be effective in reducing symptoms and modulating the immune inflammatory environment.

Comparative analysis of efficacy of different combination therapies of α-receptor blockers and traditional Chinese medicine external therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome: Bayesian network meta-analysis.

Combination therapy of α-receptor blockers (α-RBs) and traditional Chinese medicine external therapy can serve as a treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). α-RBs includes tamsulosin, terazosin and so on and the traditional Chinese medicine external therapy includes needling, moxibustion, acupoint catgut embedding, acupoint application, auricular point sticking and hot medicated compress and so forth. Currently, there is no study in which Bayesian network meta-analysis is applied to making a comparative analysis of efficacy of different combination therapies of α-RBs and traditional Chinese medicine external therapy in the treatment of CP/CPPS. Therefore, based on Bayesian algorithm, a network meta-analysis was conducted by us to make a comparison between different combination therapies of α-RBs and traditional Chinese medicine external therapy. A document retrieval was conducted in the databases PubMed, Cochrane Library, Embase, Web of science, China National Knowledge Infrastructure, WanFang Data Dissertations of China database, VIP China Science and Technology Journal Database, SinoMed. Literatures were searched for published in biomedical journals concerning clinical study on α-RBs combined with various traditional Chinese medicine external therapies in the treatment of CP/CPPS from inception of database to July 2022. Newest version risks of bias assessment tool (RoB2) was used to assess the risks of bias of studies included in this analysis. Stata 16.0 software and R4.1.3 software were used to make a Bayesian network meta-analysis and charts. 19 literatures were included involving 1739 patients concerning 12 interventions which were used in the treatment of CP/CPPS. With respect to the total effective rate, α-RBs+ needling was most likely to be the optimal treatment. Concerning National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score, α-RBs+ moxibustion+ auricular point sticking was most likely to be optimal treatment, the therapy ranking second was α-RBs+ needling, and the therapy ranking third was α-RBs+ moxibustion. Pain score, voiding score and quality-of-life score are subdomains of the NIH-CPSI total score. With regard to pain score, α-RBs+ moxibustion was most likely to be optimal treatment. In reference to voiding and quality-of-life score, there was no statistically significant difference between the efficacy of various interventions. α-RBs+ needling, α-RBs+ moxibustion and α-RBs+ moxibustion+ auricular point sticking provided relatively good efficacy in the treatment of CP/CPPS. In these treatments, attention should be paid on α-RBs+ needling and α-RBs+ moxibustion which ranked higher many times in the evaluation of various outcome indicators. However, there still were certain limitations in this study, so large-sample clinical randomized control trials with a rigor design following the evidence-based medicine standards need to be conducted to justify the results of this study. [https://www.crd.york.ac.uk/prospero/], identifier: [CRD42022341824].

Clinical Efficacy Analysis of Biofeedback Electrical Stimulation Combined with Doxycycline in the Treatment of Type IIIA Chronic Prostatitis.

Purpose To analyse the clinical efficacy of biofeedback electrical stimulation combined with doxycycline in the treatment of type IIIA chronic prostatitis. Methods Eighty patients who met the diagnostic criteria of type IIIA chronic prostatitis in our hospital between February 2020 and February 2022 were selected and equally divided into the drug group and electrical stimulation group according to the random number table method. The drug group was treated with medication alone for 4 weeks; the electrostimulation group was treated with biofeedback electrostimulation on top of medication for 12 weeks. The expressed prostatic secretious (EPS) routine (lecithin bodies, white blood cells) and the maximum urinary flow rate (Qmax) and mean urinary flow rate (Qave) were measured before and after treatment in both groups, and the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) was used to score the urinary symptom, pain or discomfort, and quality of life and determine the efficacy of the treatment in both groups. Results After treatment, the number of lecithin bodies and white blood cells in EPS improved significantly in both groups compared to before, and both the electrical stimulation group was better than the drug group (P < 0.05). After treatment, the Qmax and Qave were significantly higher in both groups than before, and both the electrical stimulation groups were higher than the drug group (P < 0.05). After treatment, the urinary symptom scores, pain or discomfort scores, quality of life scores, and total NIH-CPSI scores were significantly lower in both groups than before, and all were lower in the electrical stimulation group than in the drug group (P < 0.05). After treatment, the overall efficiency of patients in the electrical stimulation group was significantly higher than that of the drug group (P < 0.05). Conclusion Biofeedback electrical stimulation combined with doxycycline in the treatment of type IIIA chronic prostatitis can synergistically improve the patient's inflammation level, urinary dysfunction, relieve pelvic floor tension myalgia, and improve their quality of life, opening up new avenues for the rehabilitation of patients with type IIIA chronic prostatitis.

The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in Chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis.

We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). A comprehensive search was conducted of PUBMED, Cochrane Library, and Web of Science databases from inception to February 2022 for randomized controlled trials (RCTs) assessing the efficacy and safety of Li-ESWT with or without the combination of medications compared with the control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analogue Scale/Score (VAS), International Index of Erectile Function (IIEF), and International prostate symptom score (IPSS) were used to assess the improvements of symptoms in CP/CPPS patients. 651 patients from 12 randomized controlled studies were included in this study. The total NIH-CPSI scores, pain domain scores, and quality of life (QOL) scores were significantly lower in the Li-ESWT group than those in the control group at the termination of treatment, and 1, 4, 12, and 24 weeks after treatment. And these scores were significantly reduced in the Li-ESWT group than in baselines. In the subgroup analysis, reductions of these scores lasted longer and were greater in Li-ESWT combined with medications than in Li-ESWT alone. In the Li-ESWT group, the VAS score; IIEF score; and IPSS score were significant improvements than those in control group at the termination of treatment, and 1, 4, and 12 weeks after treatment; 4, 12, and 24 weeks after treatment; and 1, 4, and 12 weeks after treatment, respectively. Li-ESWT is a safe, non-invasive, and effective option for patients with CP/CPPS, whether combined with medications or not, should be recommended for widespread use in clinical practice.

A systematic review and meta-analysis of placebo effect in clinical trials on chronic prostatitis/chronic pelvic pain syndrome.

It is a common practice to control efficacy of pharmacological treatment with a placebo group. However, placebo itself may affect subjective and even objective results. The purpose of this study was to evaluate the placebo effect on symptoms of CP/CPPS to improve future clinical trials. A search at three databases (Scopus, MEDLINE, and Web of Science) was conducted to identify double-blind placebo-controlled clinical trials on the treatment of CP/CPPS published until April 2021. The primary outcome - National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score. Qmax, PVR, IPSS, and prostate volume. A total of 3502 studies were identified. Placebo arms of 42 articles (5512 patients, median 31 patients) were included in the systematic review. Systematic review identified positive changes in the primary endpoint, meta-analysis of 10 articles found that NIH-CPSI total score results were significantly influenced by placebo, mean difference -4.2 (95% confidence interval [CI]:-6.31, -2.09). Mean difference of NIH-CPSI pain domain was -2.31 (95% CI:-3.4, -1.21), urinary domain -1.12 (95% CI:-1.62, -0.62), quality of life domain -1.67 (95% CI:-2.38, -0.96); p < 0.001 for all. In case of the objective indicator - Qmax, there were three articles included in the meta-analysis. Qmax mean change from baseline was 0.68 (95% CI:-0.85, 2.22, p = 0.38). Systematic review showed no significant changes in pain, measured by VAS or other scores, IPSS and PVR. Placebo significantly affected the subjective parameters (NIH-CPSI) and limitedly affected various other measurements of pain (visual analog scale, McGill pain questionnaire). There was no long-term effect on IPSS and objective measurements (Qmax, PVR). This study can be used in further clinical trials to develop general rules of CPPS treatment assessment.

Men suffering from category III chronic prostatitis may benefit from N-acetylcysteine as an adjunct to alpha-blockers.

We designed this study to investigate the potential use of N-acetylcysteine (NAC) as an adjunct to alpha-blockers in the treatment of category III chronic prostatitis (CP). Sixty-three men with category III CP with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score of 15 or more were randomized to either the NAC treatment group or the placebo treatment group. Besides tamsulosin at a dose of 0.4 mg once daily, participants based on their allocation group received NAC or placebo at a dose of 600 mg twice daily for 12 weeks. The efficacy of the medications was assessed by measuring changes in the NIH-CPSI total score and its subscales, including pain, urinary symptoms, and quality of life. Based on the general linear model analysis of the data, over the 12-week treatment, NAC+tamsulosin was statistically superior to placebo+tamsulosin in reducing the total NIH-CPSI score, pain subscore, and quality-of-life subscore (P value <.001). Further, after 12 weeks, more patients in the NAC+tamsulosin group than in the placebo+tamsulosin group met the responder criterion, defined as a decrease of at least 6 points in the NIH-CPSI total score (65.6% vs 29.0%). A more favorable outcome was also noted in the NAC+tamsulosin group regarding the number of patients reporting moderate or marked improvement in symptoms (62.5% vs 25.80%). No significant difference was seen between the groups concerning changes in urinary symptoms. Our study provided clinical evidence that men with category III CP might benefit from NAC treatment. Further studies are needed for the validation of these findings.

Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome: An Italian prospective multicenter study

ObjectiveTo assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS). MethodsPatients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months. Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Scores (IPSS), International Index of Erectile Function (IIEF), four-glass test, uroflowmetry, and prostate-specific antigen assessments at baseline and at Week 4, and Week 12. Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score. Secondary outcomes included improvement of micturition and quality of life (QoL) domains of NIH-CPSI questionnaire. ResultsA total of 61 males were enrolled. No adverse events were reported. Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score (mean difference: −9.2; p<0.01), NIH-CPSI pain domain (mean difference: −5.5; p<0.01), NIH-CPSI micturition domain, NIH-CPSI QoL domain, and IPSS total score (mean difference: −5.6; p<0.01). No significant changes from baseline in terms of IIEF score or maximum flow rate were observed. At final follow-up (Day 90), further significant improvements in terms of NIH-CPSI total score (mean difference: −12.2; p<0.01), NIH-CPSI pain domain (mean difference: −6.6; p<0.01), NIH-CPSI micturition domain, NIH-CPSI QoL domain, and IPSS total score were reported. ConclusionRectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.

Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis.

BackgroundA systematic review of the evidence was conducted to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with chronic pelvic pain syndrome (CPPS).MethodsA comprehensive search was undertaken of the Cochrane Register, PubMed, and Embase databases for controlled trials that evaluated patients with CPPS who were treated with LI-ESWT and that were published before August 2019. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was the most frequently used tool to evaluate the treatment efficacy of LI-ESWT. The NIH-CPSI comprises subscales for pain [using a visual analog scale (VAS)], urinary function, and quality of life (QoL).ResultsSix studies analyzing 317 patients were published from 2009 to 2019. The overall meta-analysis of the data indicated that LI-ESWT demonstrated efficacy in the treatment of CPPS at 12 weeks [risk difference (RD): 0.46; 95% confidence interval (CI), 0.28–0.63; P<0.00001]. The studies were divided into 3 groups based on time after LI-ESWT (1, 12, and 24 weeks) and were compared in total NIH-CPSI scores, QoL, VAS scores, and urinary symptoms. The total NIH-CPSI scores, QoL, VAS scores, and urinary symptom scores improved significantly at 12 weeks after LI-ESWT (P<0.05), but not at 1 week or 24 weeks (P>0.05).ConclusionsBased on these studies, LI-ESWT may transiently improve the total NIH-CPSI scores, QoL, pain scores, and urinary symptom scores of patients with CPPS. Future research may elucidate the mechanisms underlying the effects of LI-ESWT on CPPS. Well-designed and long-term multicenter randomized controlled trials are urgently needed to estimate the real potential and ultimate use of these devices in patients with CPPS.

Chronic Pelvic Pain Syndrome in a Rural Area: Are We Paying Attention?

IntroductionChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a chronic, debilitating illness that mostly affects males under the age of 50 years. It is associated with myriad presentations. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score was developed to measure the impact of the disease and assess the treatment outcomes. Additionally, the UPOINT [urinary (U), psychosocial (P), organ-specific (O), infection (I), neurologic/systemic (N), and tenderness of pelvic floor skeletal muscles (T)] classification system has been developed to enable a ‘phenotypic approach’ to the treatment.ObjectiveThe objective of this study was to determine the NIH-CPSI scores as well as the positive subdomain numbers and distribution of the UPOINT classification in patients with CP/CPPS.Materials and methodsA total of 100 consecutive male patients presenting to a single centre with symptomatic CP/CPPS were included in this study.ResultsThe mean age of the patients was 34.4 years. The average total NIH-CPSI score was 24.9. The average number of positive UPOINT domains was 2.28. The positive domains were urinary (90), psychosocial (60), organ-specific (43), infection (15), neurological (12), and tenderness (8).DiscussionThe NIH-CPSI scores and UPOINT subdomain scores compared favourably with other studies conducted in the region. The lower infection subdomain score as compared to other studies may be due to the widespread use of antibiotics among patients in the region prior to presenting to a urologist.ConclusionThe use of the UPOINT classification to guide treatment is feasible even in a rural setting, such as in Kashmir.

The efficacy and safety of Serenoa repens extract for the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome: a multicenter, randomized, double-blind, placebo-controlled trial

PurposeTo perform a placebo-controlled trial to evaluate the efficacy and safety of Serenoa repens extract (SRE) for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).MethodsWe conducted a double-blind, randomized, placebo-controlled, multicenter, clinical phase 4 study of 221 patients with CP/CPPS across 11 centers. Participants were randomly assigned in a 2:1 ratio to receive SRE or placebo for 12 weeks. The primary efficacy endpoint was the change in total score on the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). Secondary efficacy endpoints included improvements within each domain of NIH-CPSI, clinical response rate, and International Index of Erectile Function 5 items (IIEF-5).ResultsIn total, 226 patients were enrolled and randomized between January 2017 and June 2018. Of these 221 patients were included in the intent-to-treat analysis: 148 in the SRE group and 73 patients in the placebo group. Compared to the placebo, SRE led to statistically significant improvements in the NIH-CPSI total score and sub-scores. The significant improvements of NIH-CPSI scores were established after 2 weeks from the first dose, and continued to the end of the treatment. Furthermore, a significantly higher rate of patients achieved a clinical response in the SRE group compared with that in the placebo group (73.0% vs 32.9%, P < 0.0001). Only minor adverse events were observed across the entire study population.ConclusionsSRE was effective, safe, and clinically superior to placebo for the treatment of CP/CPPS. ChiCTR-IPR-16010196, December 21, 2016 retrospectively registered

The association between burning mouth syndrome and urologic chronic pelvic pain syndrome: A case‐control study

The overlap between some painful conditions is widespread. The aim of this study was to evaluate the overlap between burning mouth syndrome (BMS) and urological chronic pelvic pain syndrome (UCPPS) in an outpatient clinic of a university hospital. A controlled clinical study was performed. BMS patients and healthy controls were enrolled in the study. Patients were screened through laboratory test and a complete urological examination. Two validated questionnaires were submitted to all the patients: National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptom Score (IPSS). A total of 50 BMS patients and 50 healthy controls were enrolled in the study. Statistically significant differences between the two groups regarding the items of the IPSS questionnaire of Incomplete Emptying (U=750, P<.001), Intermittency (U=768.5, P<.001), QoL (U=848, P<.002), and Total Symptom score (U=1040, P=.05) were found. Moreover, the responses of NIH-CPSI showed statistically significant differences regarding Pain subscale (U=714, P<.001), QoL Impact subscale (U=1016.500, P=.05), and NIH-CPSI total score (U=953.500, P=.002). To the best our knowledge, the reported data demonstrate for the first time an association between BMS and UCPPS. Further studies with a larger sample are needed to confirm the co-occurrence of urological symptoms in patients with burning mouth syndrome.

The use of Cinnamon (Cinnamomum Bark) for Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized Controlled Trial

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is common, yet no curative treatment identified. Cinnamon is a herbal substance, which has many applications in medicine.&#x0D; AIM: The aim of the study was to study the effect of cinnamon on patients with chronic pelvic pain syndrome.&#x0D; METHODS: Sixty patients with documented CP/CPPS randomized into two groups during 2018 and 2019 in Baghdad. The first group received 60 capsules each contained 1 g of cinnamon. The other group received 60 capsules each contained 1 g of sugar powder (placebo). All the patients instructed to take one capsule twice daily for 1 month. National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) was reported for both groups at baseline and after 1 month of treatment. The primary outcome was a patient perceivable improvement defined as a reduction of the NIH-CPSI by 6 or more points after 1 month, whereas improvement of sub-scores of NIH-CPSI (pain, urinary symptoms, and quality of life) considered as a secondary outcome, and adverse reactions reported.&#x0D; RESULTS: Thirteen patients (43.3%) of the cinnamon group have 6 or more points of reduction in the total NIH-CPSI compared to four patients (13.3%) of the control groups (p = 0.01). The improvement in total NIH-CPSI score was mainly due to improvement in pain sub-score, whereas in urinary symptoms, there was marginal change with no significant change in the quality of life score. The only reported side effect was gastric upset in one patient.&#x0D; CONCLUSION: The study concluded that cinnamon improves NIH-CPSI in patients with CP/CPPS.&#x0D; REGISTRATION: The study was registered on ClinicalTrials.gov with the ID: NCT03946163.

Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome.

BackgroundProstatitis is the most commonly diagnosed disease in men younger than 50 years and accounts for about 8% of all urologists’ consultations.ObjectiveAfter evaluating clinical trials and demonstrating the efficacy of chronic non-bacterial prostatitis treatment, it remains of clinical importance to continue studies on the use of low-energy extracorporeal shock wave therapy (ESWT) in men.Materials and methodsFrom May 2017 to April 2018, 40 patients with chronic prostatitis (CP) type IIIB/chronic pelvic pain syndrome (CPPS) were enrolled in the study. The patients underwent ESWT once a week for 4 weeks.ResultsThe mean age of the patients was 47.8 years. A statistically significant improvement in all the parameters, i.e., the International Prostate Symptom Score (IPSS), the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and the International Index of Erectile Function (IIEF), was observed at week 4. The effect of the treatment was maintained during the entire 12-week period. The NIH-CPSI total score showed the best improvement at week 4, but a slight deterioration without a statistically significant change was noticed at week 12. The greatest improvement at week 4 was documented for the NIH-CPSI and IPSS (43% and 37%, respectively). At week 12, an improvement of 52% and 39% was recorded for VAS and IPSS, respectively.ConclusionsOur findings confirmed the effectiveness and safety of ESWT in resistant cases of CPPS in the short term. ESWT is cost-effective, which takes little time or requires a small amount of staff, and is easily conducted.

Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

Efficacy of low-intensity extracorporeal shock wave therapy for the treatment of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis.

Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been applied in urolithiasis and some chronic diseases. We performed a systematic review and meta-analysis to assess the efficacy of Li-ESWT for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A comprehensive search of MEDLINE, Web of Science, EMBASE, and the Cochrane Library to January 6, 2019 was performed for randomized controlled trials (RCTs) reporting on patients with CP/CPPS treated with Li-ESWT compared with the sham group. Outcomes were evaluated based on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). The quality assessment of included studies was performed by the Cochrane System. Six publications involving five RCTs with 280 patients were assessed in this review. NIH-CPSI total score, pain domain and quality of life (QOL) were significantly better in the Li-ESWT group than those in the control group at the endpoint (P < 0.00001, P = 0.003, and P < 0.00001), 4 weeks (P < 0.00001, P = 0.0002 and P < 0.00001) and 12 weeks (P < 0.00001, P < 0.00001, and P = 0.0002) after the treatment. For urinary score, significant difference existed at 12 weeks after the treatment (P = 0.006). At 24 weeks after treatment, there was no significant difference between the two groups in NIH-CPSI total score (P = 0.26), pain domain (P = 0.32), urinary score (P = 0.07), and QOL (P = 0.29). Li-ESWT showed great efficacy for the treatment of CP/CPPS at the endpoint and during the follow-up of 4 and 12 weeks, though the efficacy of 24-week follow-up was not significantly different due to insufficient data. Generally, Li-ESWT is a promising minimal invasive method for the treatment of CP/CPPS.

Danish version of the National Institutes of Health–Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire: a linguistic translation, cross-cultural adaptation and test–re-test reliability study

Objective: To translate and cross-culturally adapt the National Institutes of Health–Chronic Prostatitis Symptom Index (NIH-CPSI) into Danish and assess the reliability of the translated version.Methods: The NIH-CPSI was translated into Danish by a formalized translation procedure. Study participants suffering from Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) were recruited from a CP/CPPS newsletter email-list. The translated questionnaire was tested for face validity by interviewing men (n = 7) suffering from CP/CPPS. Relative reliability (interclass correlations coefficient, ICC) and absolute reliability (minimal detectable change, MDC; and standard error of measurement, SEM) were assessed on an electronic version of the Danish NIH-CPSI, including a general response assessment of symptom stability at the second assessment.Results: One hundred and twenty-nine men volunteered for the test–re-test study, 43 did not fit the eligibility criteria or had incomplete tests and 27 were excluded due to symptom changes between test and re-test, leaving 59 participants for the reliability study. The relative reliability for the total NIH-CPSI score was found to be an excellent ICC of 0.93 (95% CI = 0.91–0.96). The absolute reliability for the total NIH-CPSI score revealed an MDC of 5.0 and a SEM of 1.8, corresponding to 12% and 4%, respectively, of the maximal obtainable NIH-CPSI score.Conclusion: The NIH-CPSI questionnaire was successfully translated and cross-culturally adapted into a Danish version. An electronic version of the Danish NIH-CPSI showed excellent reliability. The questionnaire is suitable for use as an outcome measure in research studies and may also be a useful tool in the clinical setting.