The optimal management of category III prostatitis (chronic pelvic pain syndrome) is not known. Conventional therapy usually consists of prolonged courses of antibiotics; however, clinical trials have never shown their efficacy. Newer therapies with some evidence for efficacy include alpha-blockers, anti-inflammatory phytotherapy (quercetin, bee pollen), physiotherapy, neuroleptics, and others with unique actions such as antinanobacterial treatment. A stepwise approach involving multiple treatment modalities is often successful for patients with this common and frustrating condition.
"The list of proposed second-line treatment strategies is excessive: physiotherapy; trigger-point massage; electromagnetic treatment; acupuncture; traditional Chinese medicine; rectal massage; hyperthermia; thermotherapy ; balloon dilatation; laser coagulation; invasive neuromodulation; and, most recently, intraprostatic injection of botulinum toxin A  . Alternative medical approaches such as antidepressants, steroids, plant extracts, 5a-reductase inhibitors, anticholinergics, antispasmics , and so forth have been proposed  . None of these approaches are supported by convincing evidence based on randomised trials, and none has entered clinical practice on a broader scale. "
"Individual therapies are being increasingly scrutinised in relation to their effects. Regrettably, the pathophysiologic backgrounds remain unclear at present, which makes the search for the most effective therapy even more difficult and necessitates a multimodal therapy approach  . CPPS is assumed either to be a myofascial pain syndrome or to involve neurologic components, thus leading to dysfunctional effects. "
[Show abstract][Hide abstract] ABSTRACT: There is no sufficiently validated therapy for chronic pelvic pain syndrome (CPPS).
To investigate the effects of extracorporeal shock wave therapy (ESWT) in 60 patients suffering from CPPS.
Sixty patients suffering from CPPS for at least 3 mo were investigated in two groups. Both groups were treated four times (once per week), each by 3000 impulses; group 2 was performed as a sham procedure. The investigation was designed as a placebo-controlled, prospectively randomised, double-blind phase 2 study. Standardised follow-up was performed 1, 4, and 12 wk after ESWT.
Low-energy-density ESWT was performed using a perineal approach without anaesthesia. In the placebo group, the same setting was used without shock wave energy transmission.
ESWT effects on pain, quality of life (QoL), erectile function (EF), and micturition were evaluated. The parameters were investigated using validated questionnaires (National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function [IIEF]) and the Visual Analog Scale (VAS) for pain evaluation.
All patients completed outpatient treatments and follow-ups without any problems. All 30 patients in the verum group showed statistically (highly) significant improvement of pain, QoL, and voiding conditions following ESWT in comparison to the placebo group, which experienced a continuous deterioration of the same parameters during the follow-up period. Perineal ESWT was easy and safe to perform without anaesthesia or any side-effects.
This is the first prospectively randomised, double-blind study to reveal perineal ESWT as a therapy option for CPPS with statistically significant effects in comparison to placebo. ESWT may in particular be interesting because of its easy and inexpensive application, the lack of any side-effects, and the potential for repetition of the treatment at any time.
European Urology 04/2009; 56(3):418-24. DOI:10.1016/j.eururo.2009.03.043 · 13.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Different murine models of autoimmune prostatitis have been developed and characterized, proving the autoimmune origin of this pathology. Autoimmune prostatitis models have also provided a wealth of information on the mechanisms involved in disease development, shedding light on inciting autoantigens, regulatory and pathogenic T cells, and mediators of prostatic autoimmunity. Unfortunately, the clinical counterparts of experimental autoimmune prostatitis are still poorly defined. In this review, we will discuss evidence for the autoimmune origin of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and the chronic inflammatory nature of benign prostatic hyperplasia (BPH). The autoimmune pathogenesis of CP/CPPS and the chronic inflammation characteristic of BPH will be reviewed within the context of the recent demonstration that human prostate stromal cells from BPH tissue can act as antigen-presenting cells and are not only able to activate CD4(+) T lymphocytes, but can also produce IL-12 and IL-23, which are key cytokines for the induction of pathogenic Th1 and Th17 cells.
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