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

BACKGROUND 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.AIM To investigate the clinical efficacy of the magnetic vibration magnetoelectric therapy instrument in the treatment of chronic prostatitis(CP)/CPPS.METHODS 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 healthchronic 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.RESULTS 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).CONCLUSION 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.

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men： a preliminary investigation

The expressed prostatic secretions （EPSs） of men with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）, infertile men and normal men were subjected to microbiological study. EPSs were collected from the subjects, which included 26 normal men, 11 infertile patients and 51 CP/CPPS patients. DNA was extracted from each specimen, and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers. The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men, but without any difference among the three patient groups. The denaturing gradient gel electrophoresis （DGGE） method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues. Principal component analysis （PCA） and partial least squares （PLS） analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups. Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients （P〈O.05）. Two bands were identified as priority factors in the discrepancy of category IliA and category IIIB prostatitis patients （P〈O.05）. According to this research, the ecological balance of the prostate and low urethra tract, when considered as a microenvironment, might play an important role in the maintenance of a healthy male reproductive tract.

Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）

Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients （case group） and 341 nonCP/CPPS patients （control group）. Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin （odds ratio （OR）： 1.66, 95% confidence interval （CI）： 1.04-2.66）. In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 （95% CI, 1.2-2.88）. The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

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

Objective:To 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).Methods:Patients 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.Results:A 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.Conclusion:Rectal 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.

Updates on therapies for chronic prostatitis/chronic pelvic pain syndrome

Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Objective：To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome （CPPS）. Methods： A total of 36 men with recalcitrant （TPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl （10 ml of 0. 125% Bupivacaine, 0.05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12） into sacral space once a week for 4 weeks. The National Institute of Heahh Chronic Prostatitis Symptom Index （NIH-CPSI）, maximum and average flow rate were performed al the start and the end of 4 weeks＇ therapy. Results：Mean NIH-CPSI total score was decreased from 26. 5±1.6 to 13.4±2.0 （p〈0.001）. Significant improvement was seen in each subscore domain. A total of 32 patients （89%） had at least 25% improvement on NIH-CPSI and 22 （61%） had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3. 8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3±2.4 respectively. Conclusion： Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacred spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

Impact of Chronic Pelvic Pain on Female Sexual Function

The objective of the present study was to determine the prevalence of sexual dysfunction and depression in women with chronic pelvic pain (CPP). A case-control study was conducted on 66 women, 36 of them with CPP and 30 without this diagnosis. Depression was evaluated using the Beck Depression Inventory (BDI) and sexual dysfunction was evaluated using the Female Sexual Function Index (FSFI). Data were analyzed statistically by the Mann-Whitney test, Fisher exact test, chisquare test, and Spearman correlation test. Regarding sociodemographic data, no significant differences were detected between populations with respect to the variables studied (age, schooling, number of children, income, salary, and marital status), indicating group homogeneity and thus increasing the reliability of the data. A cut-off of 26.55 points was used to calculate the total score for sexual function. In the group of women with CPP, 94.4% were at high risk for sexual dysfunction. Comparison of FSFI scores showed that the domains of sexual function, such as orgasm, lubrication and pain differed significantly between women with and without CPPP. Correlations were detected between the following items: orgasm × age (r = -0.01904), orgasm × number of children (r =-0. 00947), orgasm × body mass index (BMI) (r =-0.00 955), relationship × age (r = 0.03952), income × relationship (r =-0.014680), relationship × number of children (r =-0.03623), depression × relationship (r =-0.16091), desire × age (r = -0.45255), desire × number of children (r = -0.01824), lubrication × excitement (r = 0.04198), and lubrication × BMI (r = -0.01608). The prevalence of depression detected in the present study was 38.9% among women with pain and 3.3% among control women. It was observed that women with CPP suffer a negative interference regarding sexual function compared to controls. Thus, it can be seen that a specific approach related to sexuality is extremely important within the context of women with CPP. Depression was clearly associated with CPP and therefore an interdisciplinary approach is fundamental in order to solve this problem.

Management of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):an evidence-based approach

Objective：To evaluate the efficacy and safety of the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods- The randomized controlled trials （RCTs） about the treatment for CP/CPPS all over the world were searched. MEDLINE （January 1966 to June 2007）, EMBASE （January 1988 to June 2007）, and 4 Chinese databases were electronically searched. The studies included in the refer- ences of eligible studies were additionally searched. Two reviewers independently screened the studies for eli- gibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross- checking. Divergences of opinion were settled by discussion or consulted by the experts. Meta-analysis was performed by using RevMan 4.2 software. Results： Twelve original studies involving 1 003 participants met inclusion criteria. Compared with placebo, alpha-blockers could improve the symptoms of CP/CPPS obvious- ly with WMD of NIH-CPSI, total score and pain score were -4.10 （95%CI： -6. 92 to -1.28） and -1.68 （95 %CI： -2.54 to -0. 82）. Antibiotics could not improve the symptoms obviously with WMD of NIH-CP- SI; total score and pain score were -2.71 （95%CI： -4. 78 to -0. 64） and -0.86 （95%CI： -2.07 to 0.36）. Flavoxate could not improve the NIH-CPSI total score obviously, but could relieve the pain, with WMD of NIH-CPSI total score and pain score being -2.96 （95%CI： -5.17 to -0. 74） and --2.31 （95%CI.. -4.05 to 0.03）. Prostat could improve the NIH-CPSI total score obviously, but could not relieve the pain, with WMD of NIH-CPSI total score and pain score being --7. 60 （95%CI.. -9. 97 to -5.23） and -2. 02 （95%CI： -4.07 to 0. 04）. Conclusion： Drug intervention could improve total symptoms of CP/CPPS in some degree, but no universally effective treatment is available that can prove significant lasting benefit for all the symptoms of CP/CPPS. Future RCT must use an appropriate sample size and optimal duration and fol- low-up of participants. It is important to improve the quality of internal original studies.

The Impact of Chronic Pelvic Pain in Women

Chronic pelvic pain (CPP) is a prevalent condition with a significant impact on the personal, social, professional and marital life of women. It is a complex condition that may have no specific causal diagnosis or may be associated with multiple diagnoses, frequently involving treatment failure. The definition of health care strategies fundamentally depends on the way women live with this condition. Thus, the objective of the present study is to learn how women with CPP experience their diagnosis and the meaning they attribute to it. A qualitative study was conducted by interviewing a focus group of 11 women. The content of the interviews was recorded and fully transcribed, and the speeches were interpreted by Bardin’s content analysis. The topics most frequently dealt with in the interview were diagnosis, beginning of pain, worsening and improving factors, marital and interpersonal relationships, interference with daily activities, association with emotional aspects, and perspectives for the future. It could be perceived how much these women need to be better heard and how much the association between psychic and physical questions must be visualized by the professionals who provide care for them. The approach used by professionals from different areas, when properly structured, can minimize the problem of the division of a sick person into separate parts. Psychological care is very important, especially in relation to the discovery of more effective strategies for living with pain.

Biomedical Perspectives About Women with Chronic Pelvic Pain:A Qualitative Analysis

Because the aetiology of chronic pelvic pain is complex, studies of the condition involve extensive investigation but provide few conclusions. Numerous studies have addressed the experiences of women with chronic pelvic pain, as well as the interaction between those women and their health care providers. Our objective was to investigate how physicians at a specialised clinic perceive the medical care provided to such women. This was a qualitative study employing semi-structured interviews and content analysis. We interviewed seven physicians at the Chronic Pelvic Pain Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeir?o Preto, University of S?o Paulo, Brazil. Medical training and practice constituted the central theme of the study, which was subdivided into categories addressing the influence that the current medical training has on the type of medical care provided to women with chronic pelvic pain. Medical practice has been characterised by a reductionist approach to health and illness, as well as by the fragmentation of health care. These characteristics are, to a certain extent, the result of the biomedical model of education, which has been predominant, ignoring social, cultural, psychological and emotional aspects. There is a need to shift the medical paradigms toward a humanistic model of health care. We hope that we have provided a critical view of current medical training and practice, as well as of their effects in various health care settings, particularly in the provision of care to women with chronic pelvic pain.

Biofeedback therapy for chronic pelvic pain syndrome

<abstract>Aim: To evaluate the efficacy of biofeedback therapy in patients with chronic pelvic pain syndrome (CPPS). Methods: From November 2001 to April 2002, patients visiting the Urological Outpatient Clinic of this Hospital were evaluated by means of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and classified by the NIH classification standard. Sixty-two patients of CPPS category Ⅲwere involved in this study. All patients had been treated by conventional approaches such as antibiotics and alpha-blockers for more than half a year without any improvement. The expressed prostatic secretion results were as follows: WBC 5 to 9/high power field, lipid +-+++and bacterial culture negative. Their NIH-CPSI were 12-40. All the 62 cases complained of micturitional irritation (frequency, urgency, splitted stream and sense of residual urine), 32 cases, of pain or discomfort at the testicular, penile, scrotal, pelvic or rectal region and 13 cases, of white secretion-dripping. The patients were treated by the Urostym Biofeedback equipment (Laborie Co., Canada) 5 times a week for 2 weeks with a stimulus intensity of 15 mA-23 mA and duration of 20 minutes. Results: Sixty patients were significantly improved or cured, while no significant improvement in the remaining 2. No apparent side effect was observed. The NIH-CPSI dropped to 6 to 14 with an average reduction of 21 (P<0.01). In the 60 improved cases, pain was relieved after 2-3 treatment courses and other symptoms disappeared after 4-5 courses. Conclusion: Biofeedback therapy is a safe and effective treatment for CPPS. Large randomized clinical trials are needed to confirm its efficacy and to explore the mechanism of action.

Combined Sacral Nerve Roots Stimulation and Low Thoracic Spinal Cord Stimulation for the Treatment of Chronic Pelvic Pain

Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency [1]-[3], can be successfully used for the treatment of chronic pelvic pain [4]-[7]. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain [8] and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain [9]. We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.

Berberine hydrochloride alleviates chronic prostatitis/chronic pelvic pain syndrome by modifying gut microbiome signaling

Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is highly prevalent worldwide and poses a significant threat to men’s health,particularly affecting young men.However,the exact causes and mechanisms behind CP/CPPS remain unclear,leading to challenges in its treatment.In this research,a CP/CPPS rat model was established with complete Freund’s adjuvant(CFA),and berberine hydrochloride was administered through daily gavage to assess its therapeutic effects.The alterations in the gut microbiome induced by CP/CPPS and berberine hydrochloride were investigated through 16S ribosomal RNA sequencing of cecum content and colonic epithelial cells.To investigate the impact of the gut microbiome on CP/CPPS,a pseudo germ-free rat model was established,and fecal microbiome transplantation(FMT)was performed on these rats.In all,berberine hydrochloride demonstrated effective reduction of inflammation and oxidative stress in the prostate,offering significant therapeutic advantages for CP/CPPS.Through analysis of the gut microbiome using 16S ribosome RNA sequencing,distinct differences were observed between CP/CPPS rats and control rats,and Clostridium butyricum was identified as a key bacteria.Pseudo germ-free rats that underwent FMT from CP/CPPS rats or rats treated with berberine hydrochloride displayed varying levels of inflammatory cytokine production,oxidative stress,and activity of associated signaling pathways.In conclusion,the therapeutic potential of berberine hydrochloride in addressing CP/CPPS is highly significant.The gut microbiome has emerged as a critical factor in the development of CP/CPPS and plays a pivotal role in mediating the therapeutic effects of berberine hydrochloride.

Molecular mechanism and promising treatments of chronic prostatitis/chronic pelvic pain syndrome:An exploratory bibliometric analysis and literature review of preclinical studies

Background:As one of the most common diseases in urology,a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).Methods:In this study,we systematically evaluated the current status of preclinical research on CP/CPPS through bibliometrics analysis using VOSviewer and Citespace.Characteristics of publication such as year,country/region,institution,author,journal,citation,and keywords were analyzed.Based on the bibliometrics analysis results of keywords,we summarized the possible mechanisms and promising treatments for CP/CPPS narratively.Results:According to the results of this study,the most common mechanisms involved in CP/CPPS were as follows:Disturbed immune and inflammation mediators,immune cell dysfunction,oxidative stress,dysregulated signaling pathways,apoptosis,gut microbiota,and testosterone metabolism.Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS.Conclusion:Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.

Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome： a prospective study

The urinary, psychosocial, organ-specific, infection, neurological/systemic and tenderness （UPOINT） phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS） in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CPICPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re-examined after 6 months. A minimum 6-point drop in National Institutes of Health-Chronic Prostatitis Symptoms Index （NIH-CPSI） was set to be the primary endpoint. Finally, 140 patients were enrolled in the study. The percentage of patients with each domain was 59.3%, 45.0%, 49.3%, 22.1%, 37.9%, and 56.4% for the UPOINT, respectively. The number of positive domains significantly correlated with symptom severity, which is measured by total NIH-CPSI scores （r = 0.796, P 〈 0.001）. Symptom duration was associated with a greater number of positive domains （r = 0.589, P〈 0.001）. With 6 months follow-up at least, 75.0% （105/140） had at least a 6-point improvement in NIH-CPSI after taking the therapy. All NIH-CPSI scores were significantly improved from original ones： pain 10.14 ± 4.26 to 6.60 ± 3.39, urinary 6.29 ± 2.42 to 3.63 ± 1.52, quality of life 6.56 ± 2.44 to 4.06 ± 1.98, and total 22.99 ± 7.28 to 14.29 ±5.70 （all P〈 0.0001）. Our study indicates that the UPOINT system is clinically feasible in classifying Chinese patients with CP/CPPS and directing therapy.

A preliminary evaluation of the psychometric profiles in Chinese men with chronic prostatitis/chronic pelvic pain syndrome

Background As one of the most commonly diagnosed diseases, chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS） is characterized by a variety of complex symptoms. Anxiety and depression are two of the most prevalent clinical manifestations of patients with CP/CPPS, and have adverse effects on the health of the subjects and prognosis of comorbidities. Such psychological disorders, however, have not been deeply and thoroughly studied in China. The aim of this study was to investigate the prevalence and severity of psychological disorders in Chinese adults with CP/CPPS.Methods From April 2008 to June 2009, 80 patients and 40 age-matched healthy men participating in a voluntary health examination were recruited. The majority of the subjects completed the questionnaires on the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） as well as the hospital anxiety and depression scale （HADS）.Results Of all the participants, 77 （96.3%） patients and 37 （92.5%） healthy controls completed the questionnaires. The average NIH-CPSI total score was 21.0±9.5 for the patients and 2.2±1.5 for the controls （P=0.03）. Of the 77 patients with CP/CPPS, 48 （62.3%）, 5 （6.5%）, and 1 （1.2%） had anxiety symptoms, depression symptoms, or both anxiety and depression symptoms, respectively. For the controls, the average HADS anxiety and depression scores in patients were 14.5±6.8 and 5.2±4.5, which were both significantly higher than in controls. Moreover, the prevalence and the symptom scores of both the HADS anxiety and depression were higher for the younger age group （〈35 years） than for the older age group （〈35 years）.Conclusions This preliminary study revealed that male patients with CP/CPPS had a higher prevalence of psychological disorders than in the control subjects. Moreover, the differences of the prevalence and severity of the psychological symptoms between the two different age groups may imply that psychological disorders related to CP/CPPS may be relieved with increasing age. The present study indicated that psychological evaluation is important in men with CP/CPPS, especially in younger men.

Fluoxetine ameliorates symptoms of refractory chronic prostatitis/chronic pelvic pain syndrome

Background Category Ⅲ chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS） is a common syndrome of unclear etiology with significant impact on quality of life. Because the outcomes of multiple therapies for CP/CPPS have been far from approving, the possible psychological factors have been considered to play an important role in CP/CPPS.Based on this, we investigated the role of antidepressant drug （fluoxetine） in men with refractory CP/CPPS.Methods In this study, 42 men diagnosed with refractory CP/CPPS without response to standard therapy （include multiple antibiotic courses and a-blockers） were referred for fluoxetine therapy. All patients received fluoxetine （20 mg/d） for three months and were clinically evaluated before （baseline）, and after 4, 8 and 12 weeks of therapy. The evaluation included a National Institutes of Health-chronic prostatitis symptom index （NIH-CPSI） and a Beck depression inventory （BDI） questionnaire. Moreover, the subjective global assessment （SGA） was assessed at the 4th, 8th and 12th week of therapy.Results Significant decreases were observed for total NIH-CPSI （28.55 to 9.29）, NIH-CPSI pain （14.69 to 5.19）,NIH-CPSI urinary （4.95 to 1.88 ）, NIH-CPSI quality of life （8.83 to 2.20）, and BDI （34.67 to 13.95） scores compared with baseline, all P values ＜0.05. Twenty-nine （69.05%） reported marked improvement on the subjective global assessment and 33 （78.57%） had a greater than 50% decrease in NIH-CPSI at the end of therapy （12th week）. At the same time, the Pearson correlation coefficient analysis demonstrated a positive correlation between BDI score and each CPSI score. No adverse events were reported in this study.Conclusions Fluoxetine appears to be a safe and effective treatment in improving symptoms in, and the quality of life of, men with difficult CP/CPPS. Moreover, amelioration of difficult CP/CPPS-related symptoms could be related to a decrease in depressive symptoms.

Is mild erectile dysfunction associated with severe psychological symptoms in Chinese patients with moderate-to-severe chronic prostatitis/chronic pelvic pain syndrome?

This study aimed to assess the association between psychological disorders and erectile dysfunction(ED)in patients with different degrees of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).This was a retrospective study conducted from June 2017 to October 2019 and included 182 outpatients.Patients were interviewed using the Structured Interview on Erectile Dysfunction(SIEDY)for pathogenic quantification.The National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI)and the International Index of Erectile Function-5(IIEF-5)were used for the evaluation of CP/CPPS and ED.The Generalized Anxiety Disorder-7(GAD-7)and Patient Health Questionnaire-9(PHQ-9)were used to assess anxiety symptoms and depressive symptoms.The number of patients with mild CP/CPPS and mild ED,mild CP/CPPS and moderate-to-severe ED,moderate-to-severe CP/CPPS and mild ED,and moderate-to-severe CP/CPPS and moderate-to-severe ED was 69(37.9%),36(19.8%),35(19.2%),and 42(23.1%),respectively.The corresponding PHQ-9 scores of the four groups were 6.22,7.19,10.69,and 7.71,respectively.The corresponding GAD-7 scores of the four groups were 5.26,6.31,8.77,and 6.36,respectively.Among patients with moderate-to-severe CP/CPPS,the PHQ-9 and GAD-7 scores of the moderate-to-severe ED group were significantly lower than those of the mild ED group(P=0.007 and P=0.010,respectively).The prevalence of ED and premature ejaculation(PE)in patients with moderate-to-severe CP/CPPS was significantly higher than that in patients with mild CP/CPPS(P=0.001 and P=0.024,respectively).Our findings proved that the severity of ED was negatively associated with psychological symptoms in outpatients with moderate-to-severe CP/CPPS.

Effect and Safety of Kangfuyan Capsules(抗妇炎胶囊)for Relieving Chronic Pelvic Pain:A Multicenter,Randomized,Controlled,Double-Blind,Parallel-Group Clinical Trial

Objective To evaluate the effect and safety of Kangfuyan Capsules(抗妇炎胶囊)for treating pelvic inflammatory disease(PID)in patients with chronic pelvic pain(CPP)in a multicenter,randomized,controlled,double-blind,parallel-group clinical trial.Methods Totally,240 PID patients with CPP were randomized into 2 groups using a computer generated random number at a 1:1 ratio from 10 hospitals in China between September 2014 and November 2015.Patients received either oral Kangfuyan Capsules or Gongyanping Capsules(宫炎平胶囊,control);the regimen for both groups comprised 4 capsules(3 times daily)for 12 weeks,with follow-up visit 4 weeks after treatment.The visual analogue scale(VAS)scores,clinical responses,remarkable cure rates for each symptom,and quality of life scores were assessed at baseline,and after 1,2,and 3 months.Adverse events were also recorded.Results The VAS scores were significantly lower(P<0.05),whereas the clinical responses,remarkable cure rates for lower abdominal pain,uterine tenderness,adnexal mass,and adnexal tenderness,and Health-related quality of life(EQ-5D)scores were higher in the Kangfuyan group than in the control group at 3 months(P<0.05).Common treatment-related adverse events included high hepatic enzyme levels,reduced hemoglobin levels,and elevated platelet counts,although all the adverse events were either mild or moderate in severity.Conclusion Compared with Gongyanping therapy,Kangfuyan therapy yielded markedly better analgesia effects for CPP caused by PID,with obvious long-term efficacy and good safety.(Registration No.ChiCTR190022732)