NIH-CPSI Scores Research Articles

Extracorporeal shockwave therapy in treatment of chronic prostatitis/chronic pelvic pain syndrome: Systematic review and meta-analyses.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health-related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well-being were analyzed in the present study. We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self-reported scores, including the NIH-CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow-up. The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH-CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long-lasting and was confirmed in the 6-month follow-up (p < 0.01). Based on the meta-analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis.

Long-term efficacy and safety of extracorporeal shock wave therapy (Li-ESWT) protocols in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients

Aim This study aims to evaluate the long-term effectiveness of Li-ESWT in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients and to compare the effect of treatment protocol differences on success. Method Between December 2019 and January 2021, the data of male patients over the age of 18 who applied to the urology outpatient clinic with CP/CPPS symptoms were retrospectively analyzed. International Prostate Symptom Index (IPSS) and International Index of Erectile Function—Erectile Function (IIEF-EF) questionnaires were filled in for the evaluation of erectile function. All patients received treatment with the Medispect Bold Li-ESWT. The treatment responses of the patients who received a total of 6 sessions from one session per week and 12 sessions from two sessions per week were compared. Results A total of 129 patients were included in the study. Significant improvements were observed in the NIH-CPSI, IPSS, and IIEF-EF scores at the third month follow-ups of the patients after EWST (p < 0.001 for each). Improvements in scores were also found to be significant in NIH-CPSI, IPSS, and IIEF-EF at the 12th month evaluation. When the patients were evaluated according to the number of Li-ESWT sessions they received, the IPSS score average of the patient group who received 12 sessions of Li-ESWT was found to be lower than the patients who received 6 sessions of Li-ESWT (5.67 ± 2, 30 vs 4.51 ± 2.21; p = 0.005). There was no significant difference in the IIEF-EF and IPSS scores in the 12th month evaluations of the patients, but the mean NIH-CPSI score was found to be higher in the group that received 12 sessions of Li-ESWT (p = 0.003). Conclusion Li-ESWT in the treatment of CP/CPPS patients shows positive improvements in urinary symptoms, erectile function, and quality of life in patients unresponsive to other medical treatments. The increase in the number of sessions does not seem to influence the symptoms of the patients.

Application of the UPOINT classification to determine indications for antibacterial therapy of chronic inflammatory process

Background. Patients with chronic prostatitis (CP) represent the majority of urological referral. The most patients, independent of their age, visit attending urologists constantly.&#x0D; Aim. To evaluate the rate of antibiotics prescriptions based on the UPOINTS chronic prostatitis classification and the estimation of its efficacy.&#x0D; Materials and methods. In 2022–2023 there were enrolled 92 CP patients in the Pletnev City Clinical Hospital and Vishnevsky National Medical Research Center for High Medical Technologies – Central Military Clinical Hospital. The age varies from 22 to 46 year (mean 34±8). The diagnosis lifespan was – 11+16.5 mo. The NIH-CPSI score was 23±6.1 (pain 8±5.5, urination – 7±2.4, life quality 8±3.6). The prostate volume was 26±8 cc. The positive Meares-Stamey test was occurred in 38/92 (41%) cases. The positive prostate or sperm culture were found in 18/92 (20%) pts. The positive PCR-tests were obtained in 32/42 (76%) urethral samples, prostate secretes 23/42 (55%) and sperm – 20/42 (48%). Fluorochinilones were prescribed in all 92 (100%) cases, tetracycline (66 patients, 72%) and macrolides – 48 patients, 52%.&#x0D; Results. Sixty eight (74%) pts have passed the follow-up. The total NIH-CSPI score decreased to 15±5.3 (pain – 6±3.6, urination – 5±2.1, life quality 4±2). The average prostate volume was 23±4 cc, at 86% (58) cases were achieved the laboratory tests normalization. The fluorchinolones efficacy was – 29% (17 patients), tetracycline – 41% (24 patients), macrolides – 29% (17 patients).&#x0D; Conclusion. The UPOINT classification use allows optimize the CP management. PCR-tets are the most sensitive in terms of the I-type CP diagnosis. The administration of Doxycycline Express® in the I-type of CP treatment is the most effective (41%) in the comparison to the other antibiotics.

The Efficacy of Flogofilm® in the Treatment of Chronic Bacterial Prostatitis as an Adjuvant to Antibiotic Therapy: A Randomized Prospective Trial.

Bacterial prostatitis (BP) is a common prostatic infection characterized by a bimodal distribution in young and older men, with a prevalence between 5-10% among all cases of prostatitis and a high impact on quality of life. Although the management of bacterial prostatitis involves the use of appropriate spectrum antibiotics, which represent the first choice of treatment, a multimodal approach encompassing antibiotics and nutraceutical products in order to improve the efficacy of chosen antimicrobial regimen is often required. To evaluate the efficacy of Flogofilm® in association with fluoroquinolones in patients with chronic bacterial prostatitis (CBP). Patients diagnosed with prostatitis (positivity to Meares-Stamey Test and symptoms duration > 3 months) at the University of Naples "Federico II", Italy, from July 2021 to December 2021, were included in this study. All patients underwent bacterial cultures and trans-rectal ultrasounds. Patients were randomized into two groups (A and B) receiving antibiotic alone or an association of antibiotics plus Flogofilm® tablets containing Flogomicina® for one month, respectively. The NIH-CPSI and IPSS questionnaires were administered at baseline, four weeks, twelve and twenty-four weeks. A total of 96 (Group A = 47, Group B = 49) patients concluded the study protocol. The mean age was comparable, with a mean age of 34.62 ± 9.04 years for Group A and 35.29 ± 10.32 years for Group B (p = 0.755), and IPSS at the baseline was 8.28 ± 6.33 and 9.88 ± 6.89 (p = 0.256), respectively, while NIH-CPSI at baseline was 21.70 ± 4.38 and 21.67 ± 6.06 (p = 0.959), respectively. At 1, 3 and 6 months, the IPSS score was 6.45 ± 4.8 versus 4.31 ± 4.35 (p = 0.020), 5.32 ± 4.63 versus 3.20 ± 3.05 (p = 0.042) and 4.91 ± 4.47 versus 2.63 ± 3.28 (p = 0.005) for Groups A and B, respectively. Similarly, the NIH-CPSI total score at 1, 3 and 6 months was 16.15 ± 3.31 versus 13.10 ± 5.03 (p < 0.0001), 13.47 ± 3.07 versus 9.65 ± 4.23 (p < 0.0001) and 9.83 ± 2.53 versus 5.51 ± 2.84 (p < 0.0001), respectively. Flogofilm®, associated with fluoroquinolones, demonstrate a significant improvement in pain, urinary symptoms and quality of life in patients affected by chronic bacterial prostatitis in both IPSS and NIH-CPSI scores compared with fluoroquinolones alone.

Acupuncture for Chronic Prostatitis or Chronic Pelvic Pain Syndrome: An Updated Systematic Review and Meta-Analysis.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex male dysfunction, mostly seen in young and middle-aged men with a history of more than 3 months. As a traditional therapy of Traditional Chinese Medicine, acupuncture has been proven an effective method to treat CP/CPPS in recent years. Though some meta-analyses on acupuncture for chronic prostatitis were published in 2018 and 2019, most of the included studies were low in quality according to the JADAD score (JADAD < 4). The conclusions of acupuncture for CP/CPPS remain indefinite. This review aims to evaluate the efficacy of acupuncture for CP/CPPS by including high-quality literature only (JADAD ≥ 4) to provide a reliable basis for clinical applications and research. Nine electronic databases were searched from inception to March 1, 2022, and only randomized controlled trials (RCT) with high-quality (JADAD ≥ 4) were included. Data were analyzed using Review Manager 5.3. and was verified through trial sequential analysis (TSA). We carried out a sensitivity analysis for the heterogeneity (I 2 ≥ 50%). Publication bias was explored using a funnel plot. Ten RCTs (11 trials) of high-quality methodology involving 798 patients were included. Meta-analysis showed that compared to sham acupuncture (SAT) and western medicine (WM), acupuncture (AT) played superior roles for CP/CPPS patients in pain score, NIH-CPSI score, quality of life score, urinary symptom, and efficacy rate. As for the adverse effects, 4 RCTs described mild hematoma and pain in AT and SAT groups, while specific symptoms including nausea, abdominal pain, dizziness, and low blood pressure were reported in WM groups. This meta-analysis indicated that acupuncture has measurable benefits on CP/CPPS, and security has also been ensured. However, this meta-analysis only included 10 RCTs; thus, RCTs with a larger sample size and longer-term observation are required to verify the effectiveness of acupuncture further in the future.

The impact of the coronavirus disease 2019 (covid-19) on male sexual health

<h3>Objectives</h3> During the Coronavirus Disease 2019 (COVID-19) pandemic, there was an increase in the amount of men seeking treatment at urology outpatient clinics for sexual complaints. However, it is unknown whether this condition is directly related to COVID-19. The impact of COVID-19 on male sexual health was explored in the present study. <h3>Methods</h3> Individuals in the male sexual health cohort of our clinic were retrospectively examined. Men who applied to our clinic in the last 6 months and had a history of COVID-19 afterward were invited for an assesment at the 3rd month post COVID-19. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), and prolactin (PRL) levels were all measured. Furthermore, the Premature ejaculation diagnostic tool (PEDT), the Chronic prostatitis symptom index (NIH-CPSI), the International Index of erectile function-5 (IIEF-5), the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI) scores were recorded. The pre-covid and post-covid data of the subjects were compared. <h3>Results</h3> The mean age of the participants was 34.8±7.7, the mean body mass index was 26.82±5.3, and the mean modified Charlson comorbidity index was 0.2±0.41. COVID-19 severity was mild in 19/25 (76%) and moderate in 6/25 (24%) of the subjects. LH, FSH, TT, and PRL levels did not differ between precovid and postcovid periods (p>0.05). There was no significant change in PEDT, NIH-CPSI, IIEF-5, or BAI scale scores in the postcovid period (p>0.05), although there was an remarkable decrease in BDI scores as compared to the precovid period (p>0.05). <h3>Conclusions</h3> While there was no difference in sex hormone levels or scale scores used to assess premature ejaculation, erectile dysfunction, chronic prostatitis, or anxiety, we noticed an unanticipated decrease in depression levels in individuals recovering from COVID-19. More precise results on the impact of COVID-19 on male sexual health could be revealed in future cohort studies with higher case numbers. <h3>Conflicts of Interest</h3> The authors declare no conflict of interest.

The impact of the coronavirus disease 2019 (covid-19) on male sexual health

During the Coronavirus Disease 2019 (COVID-19) pandemic, there was an increase in the amount of men seeking treatment at urology outpatient clinics for sexual complaints. However, it is unknown whether this condition is directly related to COVID-19. The impact of COVID-19 on male sexual health was explored in the present study. Individuals in the male sexual health cohort of our clinic were retrospectively examined. Men who applied to our clinic in the last 6 months and had a history of COVID-19 afterward were invited for an assesment at the 3rd month post COVID-19. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), and prolactin (PRL) levels were all measured. Furthermore, the Premature ejaculation diagnostic tool (PEDT), the Chronic prostatitis symptom index (NIH-CPSI), the International Index of erectile function-5 (IIEF-5), the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI) scores were recorded. The pre-covid and post-covid data of the subjects were compared. The mean age of the participants was 34.8±7.7, the mean body mass index was 26.82±5.3, and the mean modified Charlson comorbidity index was 0.2±0.41. COVID-19 severity was mild in 19/25 (76%) and moderate in 6/25 (24%) of the subjects. LH, FSH, TT, and PRL levels did not differ between precovid and postcovid periods (p>0.05). There was no significant change in PEDT, NIH-CPSI, IIEF-5, or BAI scale scores in the postcovid period (p>0.05), although there was an remarkable decrease in BDI scores as compared to the precovid period (p>0.05). While there was no difference in sex hormone levels or scale scores used to assess premature ejaculation, erectile dysfunction, chronic prostatitis, or anxiety, we noticed an unanticipated decrease in depression levels in individuals recovering from COVID-19. More precise results on the impact of COVID-19 on male sexual health could be revealed in future cohort studies with higher case numbers. The authors declare no conflict of interest.

Metabolomics Analysis Reveals the Differential Metabolites and Establishes the Therapeutic Effect Prediction Nomogram Among CP/CPPS Patients Who Respond or Do Not Respond to LiST.

ObjectiveLow-intensity shockwave therapy (LiST) has been applied in the clinical treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but few studies have focused on the prediction of its therapeutic effect before treatment.MethodsSeventy-five CP/CPPS patients from our institute between July 2020 and May 2021 were enrolled and received 3 Hz, 0.25 mJ/mm2 LiST once a week over the course of four weeks. The scores of the NIH-CPSI, IPSS questionnaire and demographic features before treatment were recorded. The plasma before LiST treatment was also collected, while liquid chromatography-tandem mass spectrometry was used to detect the metabolites. Least absolute shrinkage and selection operator (LASSO) regression analysis was employed to identify the prediction metabolites and generate the metabolism score. Receiver operating characteristic curves and calibration curves were drawn to assess the prediction accuracy of the nomogram.ResultsTwelve metabolites were identified at incomparable levels before and after LiST treatment. The metabolism score generated by LASSO analysis presented a perfect prediction value (AUC: 0.848, 95% CI: 0.719-0.940) in the training cohort and further increased to 0.892 (95% CI: 0.802-0.983) on the nomogram, which accompanied with the NIH-CPSI scores and age. Similar results of the metabolism score (AUC: 0.732, 95% CI: 0.516-0.889) and total nomogram (AUC: 0.968, 95% CI: 0.909-1.000) were obtained in the testing cohort. Further enrichment of the 12 metabolites indicated that the glycine and serine metabolism pathway was involved in the LiST treatment.ConclusionWe used our system to accurately and quantitatively measure plasma metabolites and establish a predictive model to identify suitable patients for LiST treatment.

Clinical Phenotyping and Multimodal Treatment of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome From the Middle East and North Africa: Determining Treatment Outcomes and Predictors of Clinical Improvement

To evaluate the effectiveness of UPOINT based multimodal treatment on patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and determine factors that could be associated with clinical improvement. A retrospective study was conducted in Doha, Qatar including patients with CP/CPPS from the Middle East and North Africa. The UPOINT phenotyping system was used to classify patients and guide their multimodal therapy. NIH-CPSI scores were computed initially and after 3 months of treatment, and predictors of clinical improvement were assessed. The total NIH-CPSI improved significantly with a mean reduction of 8.21 after 3 months of treatment (P < .001). 66.2% of patients had a clinical improvement demonstrated as a total NIH-CPSI score reduction by at least 6 points after 3 months of treatment. No significant association was found between clinical improvement, and extent of pain (ORa=1.198, 95% CI 0.392-3.662, P=.751), initial total NIH-CPSI (ORa=0.983, 95% CI 0.886-1.089, P=.738), number of positive UPOINT domains (ORa=0.871, 95% CI 0.451-1.681, P=.681), and number of prescribed therapies (ORa=1.118, 95% CI 0.699-1.789, P=.641). UPOINT phenotyping and directed therapy is associated with an important improvement in the CP/CPPS. Therapeutic response does not appear to related to age or ethnicity. Clinical improvement is also not predicted by initial extent and severity of the disease, whether relating to NIH-CPSI or the number of positive UPOINT phenotypes, neither to the number of therapies involved in the multimodal treatment strategy.

Acupuncture Treatment of Non-inflammatory Chronic Prostatitis with "Tiao Shen Jie Yu" Method: A Randomized Controlled Study

Objective: To compare the clinical efficacy of "Tiao Shen Jie Yu" acupuncture, conventional acupuncture, and tamsulosin to treat non-inflammatory chronic prostatitis (type IIIB CP). Methods: 105 patients were randomly divided into the "Tiao Shen Jie Yu" acupuncture group, conventional acupuncture group, and tamsulosin group, 35 cases in each group. In the "Tiao Shen Jie Yu" acupuncture group, PC6 (Neiguan), PC7 (Daling), HT7 (Shenmen), RN6 (Qihai), RN4 (Guanyuan), ST28 (Shuidao), ST36 (Zusanli), SP9 (Yinlingquan), SP6 (Sanyinjiao), and LR3 (Taichong) were selected; In the conventional acupuncture group, RN4 (Guanyuan), RN3 (Zhongji), KI3 (Taixi), SP6 (Sanyinjiao), BL54 (Zhibian) through ST28 (Shuidao), BL20 (Pishu), and BL23 (Shenshu) were set. Acupuncture was given once every other day, 30 minutes each time, three times a week, 12 times in a row as a course of treatment. Tamsulosin group took tamsulosin 0.2mg orally, once a day for four weeks. The three groups were observed for two methods. The NIH-CPSI total score, NIH-CPSI pain symptom score, Hamilton Depression Scale (HAMD) score, and Hamilton Anxiety Scale (HAMA) score were compared among the three groups. After one course of treatment and after two methods of treatment, and the recurrence rate and clinical efficacy were evaluated. Results: The NIH-CPSI total score, NIH-CPSI pain symptom score, HAMD and HAMA scores of the three groups after one course of treatment and two courses of treatment were lower than those before treatment (all P &lt;0.01). After one course of treatment and two courses of treatment, the total NIH-CPSI score, NIH-CPSI pain score, HAMD, and HAMA score in the "Tiao Shen Jie Yu" acupuncture group decreased more than those in the conventional acupuncture group and tamsulosin group (all P&lt;0.05). The recurrence rate of the "Tiao Shen Jie Yu" acupuncture group was lower than that of the conventional acupuncture group and tamsulosin group, and the difference was statistically significant (P &lt;0.05). The total effective rates of the conventional acupuncture group and tamsulosin group were 78.13% (25/32) and 69.70% (23/33), respectively, which were lower than 97.06% (33/34) of the "Tiao Shen Jie Yu" acupuncture group. No severe adverse reactions occurred in the safety evaluation. Conclusion: The therapeutic effect of "Tiao Shen Jie Yu" Acupuncture on type III BCP is better than that of conventional acupuncture and tamsulosin, and it is better than that of traditional acupuncture and tamsulosin in relieving prostatitis symptoms, anxiety, and depression.

Soybean Extracts (Glycine Max) with Curcuma, Boswellia, Pinus and Urtica Are Able to Improve Quality of Life in Patients Affected by CP/CPPS: Is the Pro-Inflammatory Cytokine IL-8 Level Decreasing the Physiopathological Link?

The present study evaluates the efficacy of a combination of soyabean extracts associated with Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica (PROSTAFLOG®) in patients affected by CP/CPPS, through the evaluation of interleukin-8 (IL-8) plasma seminal levels. All patients diagnosed with CP/CPPS, attending the same urologic center, were enrolled in this randomized, controlled phase III study. Participants were randomized to receive oral capsules of PROSTAFLOG® (two capsules at bedtime every 24 h) or Ibuprofen 600 mg (1 tablet daily), lasting for a period of four weeks. NIH-CPSI and SF-36 questionnaires, as urological evaluations with a transrectal ultrasound (TRUS), the Meares–Stamey test, and IL-8 dosage in seminal plasma were performed at baseline and at 3 months follow-up. A total of 77 patients (mean age of 34.5 ± 6.1) were enrolled (PROSTAFLOG® (n = 39); ibuprofen (n = 38)) in the study. At 3 months, in the PROSTAFLOG® series, 69.2% of patients showed a significant reduction in the NIH-CPSI score, compared with 34.2% in the ibuprofen group (p &lt; 0001). The mean IL-8 levels were significantly lower in the PROSTAFLOG® cohort compared with the ibuprofen series (p &lt; 0.0001), while a significant reduction in the IL-8 level between the enrolment and last follow-up evaluation was also observed in this group (p &lt; 0.0001). Additionally, a significant reduction in the volume of the seminal vesicles assessed by TRUS was also found in the PROSTAFLOG® series during the observational timeframe (18.3 ± 7.1 mL vs. 11.2 ± 2.4 mL (p &lt; 0.0001). In conclusion, PROSTAFLOG® significantly improves the QoL in patients affected by CP/CPPS and it provides a significant reduction in IL-8 seminal levels as the overall seminal vesicles volume.

Effects of Electroacupuncture with Different Waveforms on Chronic Prostatitis/Chronic Pelvic Pain Syndromes: A Randomized Controlled Trial.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in adult men. Evidence has demonstrated that acupuncture is effective for treating CP/CPPS. Electroacupuncture (EA) is a combination of traditional acupuncture and electrical stimulation, and the waveform is one of the key factors influencing EA effects. Different waveforms contain different stimulating parameters, thus generating different effects. However, the effects of different waveforms of EA on CP/CPPS remain unclear and there is no recommended standard for the application of EA waveforms. At the same time, the waveform prescription of CP/CPPS is also different, so exploring the influence of different waveforms on CP/CPPS patients will also provide a certain treatment basis for clinical treatment. A total of 108 eligible patients were recruited from the Seventh People's Hospital affiliated to the Shanghai University of Traditional Chinese Medicine from March 18, 2021, to January 31, 2022, according to inclusion and exclusion criteria. All subjects were randomly divided into three groups (continuous wave 4 Hz, continuous wave 20 Hz, and extended wave 4/20 Hz) in a ratio of 1 : 1 : 1. Patients in all three groups were treated for the same duration of 20 minutes, with intervention twice a week for 4 weeks. The changes in chronic prostatitis index (NIH-CPSI), erectile function index 5 (IIEF-5), Hospital Anxiety and Depression Scale (HADS), and NIH-CPSI response rate in three groups were compared after the intervention, and the occurrence of adverse events in patients during treatment was observed. After 4 weeks of treatment, the CP/CPPS response rates were 66.7%, 62.5%, and 88.2% in the 4 Hz, 20 Hz, and 4/20 Hz groups, respectively. The reaction rate of CP / CPPS in 4 / 20 Hz group was higher than that in 4 Hz group and 20 Hz group. (P < 0.05). During treatment, the difference between NIH-CPSI scores between 4 Hz and 4/20 Hz was insignificant (P > 0.05). NIH-CPSI scores were lower in the 4/20 Hz group than in the 4 Hz and 20 Hz groups (P < 0.05). After treatment, there was no significant difference in the pain and discomfort subscales (P > 0.05) between the 4 Hz and 20 Hz groups and there were significantly lower pain and discomfort scores in the 4/20 Hz group (P < 0.05) compared to the 4 Hz and 20 Hz groups. There was no significant difference in the reduction of urination symptoms and quality of life among the three groups (P > 0.05). Compared with before treatment, IIEF-5 scores of the three groups were improved (P < 0.05). After treatment, there was no significant difference between the IIEF-5 scores in 4 Hz and 20 Hz (P > 0.05), while the IIEF-5 score in 4/20 Hz was significantly higher than that in 4 Hz and 20 Hz, and the change was significant (P < 0.05). The HADS scores decreased in all the three groups (P < 0.05), but there was no significant difference in HADS scores between the three groups (P > 0.05). Adverse events were mild and transient, and no serious adverse events occurred in each group. Both the expansive and continuous waveforms of EA can effectively alleviate symptoms such as prostatitis, erectile dysfunction, anxiety, and depression in patients with CP/CPPS. Expansion waves are superior to continuous waves in improving erectile function and pain symptoms in chronic prostatitis and can be used as a preferred waveform for the treatment of CP/CPPS. Trial Registration. This trial is registered with Chinese Clinical Trial Registry, ChiCTR2100044418.

Outcomes and clinical predictors of extracorporeal shock wave therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome: a prospective randomized double-blind placebo-controlled clinical trial.

To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy. A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT. A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT (p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased. ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

MP35-13 NEUROINFLAMMATORY GENE EXPRESSION IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS): INSIGHTS INTO ETIOLOGY AND PHENOTYPE BIOLOGY

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-13 NEUROINFLAMMATORY GENE EXPRESSION IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS): INSIGHTS INTO ETIOLOGY AND PHENOTYPE BIOLOGY Johnathan Doolittle, Karen Keslar, Paige Gotwald, Sarah Vij, and Daniel Shoskes Johnathan DoolittleJohnathan Doolittle More articles by this author , Karen KeslarKaren Keslar More articles by this author , Paige GotwaldPaige Gotwald More articles by this author , Sarah VijSarah Vij More articles by this author , and Daniel ShoskesDaniel Shoskes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CP/CPPS has diverse clinical phenotypes and its etiology is multifactorial with inflammatory, immune and neuromuscular pathways implicated. Studies to date of gene expression in humans have been limited to small numbers of target genes. NanoString uses barcoded probes to simultaneously measure hundreds of genes. We wished to study gene expression in blood and urine of CP/CPPS patients compared to controls for a broad variety of neuroinflammatory genes and characterize the results by patient phenotype. METHODS: Blood and urine were collected from 10 men with CP/CPPS and 7 asymptomatic controls. RNA was isolated from urine pellets using Qiagen RNeasy kits. Whole blood was collected and RNA isolated using the Tempus Spin RNA isolation kit. 100 ng of RNA was used for gene expression analysis with the 770-gene NanoString Human Neuroinflammation gene panel. Data was imported into Rosalind (OnRamp Bioinformatics) for normalization, calculation of fold-changes and p values, and identification of enriched pathways. Gene expression was considered significantly different if there was a greater than 1.5x change compared to controls and corrected p was <0.05. RESULTS: Mean patient age was 42.2 years, median symptom duration was 15.5 months, median UPOINT domains was 3 and mean total NIH-CPSI score was 28.8. In blood, there were 5 genes with significantly different expression to controls, the largest differences found in FOS1 (neuropathic pain control), PROS1 (blood clotting and found in prostate cancer cells) and DDX58 (antiviral innate immunity). Gene set analysis showed differences in inflammation, angiogenesis and cytokine signaling. In urine there were 48 genes with significantly different expression including SLAMF8 (CD2 mediated lymphocyte activation) and LAIR1 (inhibits B and T cell function). Gene set analysis showed differences in Wnt (adaptive immune response in neuropathic pain), microglial function and inflammatory signaling. Subgroup analysis by UPOINT domain showed unique gene expression in the Psychosocial, Organ Specific and Neurologic/Systemic domains in both blood and urine for neurogenic pain and cytokine signaling associated genes. CONCLUSIONS: Men with CP/CPPS have a diverse set of neuroinflammatory genes with differential expression compared to controls including some never before implicated in the etiology of this condition. Furthermore, clinical phenotypes have distinct patterns of gene expression. These findings could lead to novel biomarker development, novel treatment options and further validates the biologic basic of clinical phenotyping. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e632-e632 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Doolittle More articles by this author Karen Keslar More articles by this author Paige Gotwald More articles by this author Sarah Vij More articles by this author Daniel Shoskes More articles by this author Expand All Advertisement Loading ...

Reliability and validity of the National Institutes of Health Chronic Prostatitis Symptom Index questionnaire in the Turkish Population

Background/aimTo develop the first Turkish version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire and to investigate its validity and reliability in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and healthy controls.Material and methodsA total of 204 patients, 116 CP/CPPS and a control group which consisted of 88 healthy individuals were included in this prospective study. The NIH-CPSI form was first translated into Turkish and later on back into English. Using the Turkish version of the NIH CPSI, 40 patients completed the same questionnaires twice at 2-week intervals for test-retest concordance. To evaluate internal consistency and test-retest reliability, Cronbach’s alpha value, and the Spearman correlation test were utilized respectively.ResultsOur findings demonstrated statistically significant differences in NIH-CPSI scores between the patients and control groups (P <0.001). Cronbach’s alpha coefficient value of NIH-CPSI was 0.864. Reliability of test-retest was 0.909 (P <0.001). Additionally, the Spearman correlation test showed that the results obtained using the Turkish NIH-CPSI were significantly correlated.ConclusionThe first Turkish version of the NIH-CPSI was found to be a reliable and valid instrument for Turkish patients with chronic prostatitis in both clinical and research settings.

Lithogenic Potential of Ureaplasma in Chronic Prostatitis

Introduction: The role of Ureaplasma spp. (UPs) in the pathogenesis of chronic prostatitis is debated. The lithogenic potential of UPs could be a risk factor for the development of chronic prostatitis. Methods: A total of 143 patients with identification of UPs were retrospectively selected from a database including patients with prostatitis-like symptoms who were studied according to the same protocol including clinical, microbiological and microscopic evaluation, and transrectal prostate ultrasound. A control group of patients with negative UPs was considered including 393 with chronic bacterial prostatitis (CBP), 42 patients with Chlamydia trachomatis (CT), and 781 patients with chronic pelvic pain syndrome. UPs and Mycoplasma hominis (MH) were identified using a semiquantitative assay. Results: Calcifications were observed more frequently in patients with UPs (64%) than in patients with CBP without UPs (39%), CT infection (37%), and chronic pelvic pain syndrome (29%) (p < 0.0001). UPs were isolated in VB1 alone in 35 patients (urethral UPs), in expressed prostatic secretion (EPS) or post-massage urine (VB3) or sperm in 77 patients (prostatic UPs) and associated with other pathogens in 31 patients (associated UPs). Calcifications were more frequent in prostatic UPs (71%) and associated UPs (73%) than in urethral UPs (34%). Mean NIH-CPSI scores were not significantly different between groups, although mean WBC counts of sperm of patients with urethral UPs were significantly lower than in patients with prostatic UPs (p = 0.000) and associated UPs (p = 0.002). Conclusions: UPs identification in the urogenital fluids is related to higher rates of prostate calcifications. The ability of UPs to promote the formation of calcifications could be related to the chronicization of prostate infection. In particular, the presence of UPs in VB3/EPS/sperm is associated with higher rates of calcifications and high WBC sperm counts, suggesting a partial or full causative role of UPs in the pathogenesis of this disease.

Use of Acetylcysteine in the Treatment of Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Antioxidants are recommended for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The efficacy and safety of quercetin in the treatment of patients with CP/CPPS have been studied most. To increase the effectiveness of treatment, we propose to use acetylcysteine, which, along with antioxidant properties, has secretolytic properties.The objective: to provide a comparative assessment of the efficacy and safety of quercetin and acetylcysteine in the treatment of patients with CP/CPPS.Materials and methods. The study involved 60 patients with CP/CPPS aged 18–45 years. Patients were randomized into two comparison groups. Patients in group 1 (n=30) were prescribed quercetin1 g per day for 1 month. Patients in group 2 (n=30) received acetylcyteine orally at a dose of 600 mg per day for 1 month. The condition of patients was assessed according to the NIH-CPSI scale, spermogram parameters and dynamics interlekin-10 (IL-10) and tumor necrosis factor α (TNF-α) in ejaculate. The efficiency criterion was considered to be a 25 % decrease in the NIH-CPSI.Results. As a result of the treatment of patients with CP/CPPS with the use of antioxidants in both groups symptoms of the prostatitis were reduced: NIH-CPSI total (group 1 – 22,5±0,5 vs. 15,0±0,8; group 2 – 22,7±0,5 vs. 15,1±1,1); pain (group 1 – 11,5±0,3 vs. 7,1±0,4; group 2 – 10,0±0,5 vs. 6,6±0,6); urinary symptoms (group 1 – 3,4±0,3 vs. 2,1±0,2; group 2 – 4,8±0,4 vs. 2,2±0,4), quality of life (group 1 – 7,7±0,4 vs. 5,8±0,3; group 2 – 7,8±0,3 vs. 6,3±0,4). The fertility was improved significantly (p&lt;0,05): increased sperm concentration, progressive sperm motility, decreased number of pathological sperm, leukocyte TNF-α concentration and increased IL-10 concentration in ejaculate. In group 2 only ejaculate viscosity decreased significantly (p&lt;0,05), improved sperm motility, decreased white blood cell count, decreased TNF-α concentration in ejaculate were significantly greater than in group 1. The clinical efficacy of acetylcysteine and quercetin in the treatment of patients with CP/CPPS was 63,3 % and 60,0 % respectively (subject to the efficacy criterion of reducing the NIH-CPSI score by 25 %).Conclusion. The use of acetylcysteine can be useful for patients with CP/CPPS.

Psychological factors and pain catastrophizing in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a meta-analysis.

BackgroundChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a chronic disease with a variety of psychosocial and somatic symptoms. CP/CPPS has substantial health care costs with unclear etiology, which may be caused by psychosocial factors. Moreover, previous studies suggested that cognitive processes played a crucial role in the perception of somatic pain. Therefore, the aim of this meta-analysis was to analyze the psychosocial characteristics in men with CP/CPPS, especially the symptom of pain catastrophizing.MethodsRelevant publications were searched in different databases including PubMed, MEDLINE, EMBASE, Google Scholar and the Cochran Library using the search terms of “Chronic prostatitis”, “Chronic pelvic pain syndrome”, “Psychosocial” and “Catastrophizing”. The prevalence of psychological factors and pain catastrophizing in men with CP/CPPS were extracted and calculated.ResultsTen studies inclusive of 1,308 patients were included. Analysis of NIH-CPSI scores showed that the severity of CP/CPPS was 23.20 (95% CI: 21.13–25.28). The severity of pain catastrophizing was 13.81 (95% CI: 9.83–17.79) estimated by coping strategies questionnaire (CSQ), while the severity of pain catastrophizing was 24.83 (95% CI: 9.19–40.47) estimated by pain catastrophizing scale (PCS). The prevalence of psychosocial symptom was 0.43 (95% CI: 0.32–0.55), while the prevalence of pain catastrophizing was 0.26 (95% CI: 0.21–0.31).ConclusionsThe psychological factors and pain catastrophizing in men with CP/CPPS was serious. Furthermore, the prevalence of psychosocial symptom and pain catastrophizing was high. There might be a link between pain catastrophizing and somatic symptoms in CPPS. Thus, further prospective studies are needed to evaluate the importance of psychosocial factors in symptom severity of CP/CPPS.

The effect of transurethral prostatic dilatation on NIH-CPS, IPSS and related prostate symptoms in patients with benign prostatic hyperplasia and urinary retention

Objective To investigate the effect of transurethral prostatic dilatation on national institute of the health chronic prostatitis symptom index(NIH-CPS), international prostate symptom score(IPSS) and related prostate symptoms in patients with BPH and urinary retention. Methods From August 2017 to August 2018, 90 patients with benign prostatic hyperplasia(BPH) and urinary retention were selected in our hospital as subjects, were randomly divided into two groups according to computer-generated number table method, with 45 cases in each group. The control group was treated with transurethral prostate plasma resection. Transurethral prostatic dilatation was performed in the experimental group.The NIH-CPS, IPSS socre and the improvement of prostate symptoms before and after treatment were compared between the two groups. Results The duration of operation, intraoperative blood loss, bladder washing time, postoperative indwelling catheter and hospitalization time in the experimental group were less than those in the control group, with statistically significant(P<0.05). After the operation, the NIH-CPSI and IPSS scores of the experimental group were lower than those of the control group, with statistically significant(P<0.05). After the operation, the maximum urinary flow rate(Qmax) of the experimental group was higher than that of the control group, and residual urine volume(RUV) and international index of erectile dysfunction5(IIEF-5) scores were lower than those of the control group, with statistically significant(P<0.05). The incidence of complications in the experimental group was 4.44%, lower than that in the control group (17.78%), with statistically significant(P<0.05). Conclusions Transurethral prostatic dilatation for BPH can shorten the operation time, reduce the surgical trauma, improve the prostate symptoms with few complications. Key words: Prostatic Hyperplasia; Urinary Retention; transurethral columnar balloon dilation of prostate

Is Acupuncture Another Good Choice for Physicians in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome? Review of the Latest Literature.

This study aimed to evaluate the efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A search of PUBMED, EMBASE, Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese Biomedicine Literature (CBM), China National Knowledge Infrastructure (CNKI), Wang-Fang Database, Chinese Scientific Journal Database (VIP), and other available resources was made for studies (up to February 2019). Searches were limited to studies published in English and Chinese. Only randomized controlled trials (RCTs) related to the efficacy and/or safety of acupuncture for CP/CPPS were included. Two investigators independently evaluated the quality of the studies. A total of 11 studies were included, involving 748 participants. The results revealed that compared with sham acupuncture (MD: −6.53 [95% CI: −8.08 to −4.97]) and medication (MD: −4.72 [95% CI: −7.87 to −1.56]), acupuncture could lower total NIH-CPSI score more effectively. However, there are no significant differences between acupuncture and sham acupuncture in terms of IPSS score. In terms of NIH-CPSI voiding domain subscore, no significant differences were found between acupuncture and medication. Compared with sham acupuncture (OR: 0.12 [95% CI: 0.04 to 0.40) and medication (OR: 3.71 [95% CI: 1.83 to 7.55]), the results showed favorable effects of acupuncture in improving the response rate. Acupuncture plus medication is better than the same medication in improving NIH-CPSI total score and NIH-CPSI pain domain subscore. In conclusion, the evidence suggests that acupuncture may be an effective intervention for patients with CP/CPPS. However, due to the heterogeneity of the methods and high risk of bias, we cannot draw definitive conclusions about the entity of the acupuncture's effect on alleviating the symptoms of CP/CPPS. The adverse events of acupuncture are mild and rare.