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Chronic prostatitis: approaches for best management.

Lee KS, Choi JD - Korean J Urol (2012)

Bottom Line: Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory.A stepwise approach involving multimodal therapy is often successful for treating patients.The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.

ABSTRACT
Prostatitis is a prevalent condition that encompasses a large array of clinical symptoms with significant impacts on men's life. The diagnosis and treatment of this disorder presents numerous challenges for urologists, most notably, a lack of specific and effective diagnostic methods. Chronic bacterial prostatitis is successfully treated with appropriate antibiotics that penetrate the prostate and kill the causative organisms. Prostatitis category III (chronic pelvic pain syndrome) is common, very bothersome, and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased, there have been no real breakthroughs; controversies and many unanswered questions remain. Furthermore, the optimal management of category III prostatitis is not known. Conventional prolonged courses of antibiotic therapy have not proven to be efficacious. Novel therapies providing some evidence for efficacy include alpha-blocker, anti-inflammatory phytotherapy, physiotherapy, neuroleptics, and others, each offering therapeutic mechanisms. A stepwise approach involving multimodal therapy is often successful for treating patients. The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

No MeSH data available.


Related in: MedlinePlus

A suggested therapeutic algorithm for the treatment of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). TUMT, transurethral microwave thermotherapy. *Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation.
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Figure 2: A suggested therapeutic algorithm for the treatment of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). TUMT, transurethral microwave thermotherapy. *Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation.

Mentions: Neuromuscular and neuroleptic treatments have been observed to beneficially alter nervous system conditions found in chronic pain syndrome. Therefore, therapies designed to improve relaxation and encourage proper use of the pelvic floor muscle are expected to provide symptomatic improvement. Although no large, published clinical trials exist, preliminary evidence suggests potential efficacy in the use of biofeedback and bladder retraining in alleviating symptoms [52]. When trigger-point massage was combined with relaxation therapy in an uncontrolled study, 72% of patients reported improvement [53]. Amitriptyline can be effective for the treatment of pain from chronic muscle spasm and it has been found to be helpful in the management of CPPS [54]. A suggested treatment algorithm based on these assessments is presented in Fig. 2.


Chronic prostatitis: approaches for best management.

Lee KS, Choi JD - Korean J Urol (2012)

A suggested therapeutic algorithm for the treatment of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). TUMT, transurethral microwave thermotherapy. *Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3285711&req=5

Figure 2: A suggested therapeutic algorithm for the treatment of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). TUMT, transurethral microwave thermotherapy. *Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation.
Mentions: Neuromuscular and neuroleptic treatments have been observed to beneficially alter nervous system conditions found in chronic pain syndrome. Therefore, therapies designed to improve relaxation and encourage proper use of the pelvic floor muscle are expected to provide symptomatic improvement. Although no large, published clinical trials exist, preliminary evidence suggests potential efficacy in the use of biofeedback and bladder retraining in alleviating symptoms [52]. When trigger-point massage was combined with relaxation therapy in an uncontrolled study, 72% of patients reported improvement [53]. Amitriptyline can be effective for the treatment of pain from chronic muscle spasm and it has been found to be helpful in the management of CPPS [54]. A suggested treatment algorithm based on these assessments is presented in Fig. 2.

Bottom Line: Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory.A stepwise approach involving multimodal therapy is often successful for treating patients.The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.

ABSTRACT
Prostatitis is a prevalent condition that encompasses a large array of clinical symptoms with significant impacts on men's life. The diagnosis and treatment of this disorder presents numerous challenges for urologists, most notably, a lack of specific and effective diagnostic methods. Chronic bacterial prostatitis is successfully treated with appropriate antibiotics that penetrate the prostate and kill the causative organisms. Prostatitis category III (chronic pelvic pain syndrome) is common, very bothersome, and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased, there have been no real breakthroughs; controversies and many unanswered questions remain. Furthermore, the optimal management of category III prostatitis is not known. Conventional prolonged courses of antibiotic therapy have not proven to be efficacious. Novel therapies providing some evidence for efficacy include alpha-blocker, anti-inflammatory phytotherapy, physiotherapy, neuroleptics, and others, each offering therapeutic mechanisms. A stepwise approach involving multimodal therapy is often successful for treating patients. The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

No MeSH data available.


Related in: MedlinePlus