UNASSIGNED: Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS.
UNASSIGNED: Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King\'s Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks.
UNASSIGNED: Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King\'s Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period.
UNASSIGNED: ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome is a highly prevalent syndrome. Previous studies showed that extracorporeal shockwave therapy and myofascial release therapy could improve the quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Theoretically, combined therapy with extracorporeal shockwave therapy and myofascial release therapy will likely have significant advantages in treating CP/CPPS. We, therefore, present a protocol for conducting a well-designed randomized controlled trial to compare the efficacy and safety of each therapy.
METHODS: The proposed study will be a three-group randomized control trial (RCT) design that includes 150 participants from Zhongda Hospital Affiliated to Southeast University, with equal allocation of participants to the three intervention groups. The study duration will be 8 weeks, which includes a 4-week treatment period and a 4-week follow-up period. The primary outcome will be the changes in surface electromyography (sEMG) assessment and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). The secondary outcomes will include the changes in three-dimensional quantification, shear wave elastography (SWE), and sympathetic skin response (SSR) testing. Assessments will be conducted before the intervention (T0), before the 5th intervention (T1), immediately after the 8th intervention (T2), and the 4th week after the end of the 8th intervention (T3).
CONCLUSIONS: This trial will compare the differences in efficacy between single extracorporeal shockwave therapy, single myofascial release therapy, and combined therapy to select the most appropriate treatment option for patients with CP/CPPS. The possible pathogenesis of CP/CPPS would also be analyzed by comparing the intercorrelation between each objective and subjective measurement (NIH-CPSI score, sEMG, SWE, SSR).
BACKGROUND: The name of the registry: Extracorporeal Shockwave and Myofascial Release Therapy in Chronic Pelvic Pain Syndrome.
BACKGROUND: NCT05659199. Date of registration: December 2022.

BACKGROUND: A large number of both preclinical and clinical studies demonstrates the efficiency of bioregulatory peptides for the treatment of prostatitis and chronic pelvic pain syndrome (CPPS). A relatively new drug in this group is Prostatex, the active ingredient of which is bovine prostate extract.
OBJECTIVE: To evaluate the effect of taking Prostatex on the intensity of CPPS, the sexual function, and the results of microscopy of expressed prostate secretions and urinalysis.
METHODS: A cohort of patients aged 25-65 years with chronic abacterial prostatitis and complaints of chronic pelvic pain was analyzed. The abacterial type of prostatitis was confirmed by bacteriological examination of expressed prostate secretions. The patients received Prostatex for 30 days according to the following scheme: 1 suppository rectally 1 time per day. The follow-up was 30 days. Before starting the drug and at the end of the 30-day course, patients completed the Chronic Prostatitis Symptom Index (NIH-CPSI) and the sexual function questionnaire. In addition, urinalysis and microscopic study of expressed prostate secretions was performed.
RESULTS: A total of 1700 patients were included in the study. While taking the drug, there was a significant decrease in pain during digital rectal examination, as well as in the intensity of pain as a symptom of CPPS. The severity of symptoms after treatment was lower in all domains of NIH-CPSI. Microscopic study of the expressed prostate secretions during treatment showed a decrease in the number of patients with excessive number of leukocytes. The sexual function improved, while urinalysis and microscopy of expressed prostate secretions returned to the reference values.
CONCLUSIONS: The use of Prostatex for the treatment of patients with CPPS reduces the severity of pain and other symptoms of chronic prostatitis, increases sexual function and normalizes the expressed prostate secretions and urinalysis. In order to obtain data of a higher level of evidence, it is necessary to carry out randomized, blind, placebo-controlled studies.

UNASSIGNED: Acupuncture can improve chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Ejaculation frequencies might impact the conditions of CP/CPPS. The present study aimed to explore the impact of different ejaculation frequencies on the effect of acupuncture among men with CP/CPPS.
UNASSIGNED: This was a secondary analysis of the data from a multicenter, randomized, clinical trial. Eligible participants were patients with moderate to severe CP/CPPS, who had taken 8-week acupuncture treatment, and followed until week 32. Participants fell into the category of 0-3, 4-7, or at least 8 according to their monthly ejaculation frequencies reported at baseline. The primary outcome was the proportion of responders, defined as men who reported at least 6 points reduction from baseline in the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32.
UNASSIGNED: 214 participants were included in this secondary analysis, of whom 42 reported a monthly ejaculation frequency of 0-3, 89 reported a frequency of 4-7, and 83 reported a frequency of at least 8. At week 8, 52.20% participants with an ejaculation frequency of 0-3 responded to the acupuncture treatment, 65.38% participants with a frequency of 4-7 responded, and 63.09% participants with a frequency of at least 8 responded. At week 32, 56.14%, 59.57%, and 68.36% participants responded in the three groups, respectively. No significant differences were observed between three groups (all P>0.05).
UNASSIGNED: Acupuncture can improve symptoms of CP/CPPS, regardless of ejaculation frequencies. Ejaculation frequencies may not affect the efficacy of acupuncture on CP/CPPS among Chinese men.
UNASSIGNED: ClinicalTrials.gov, NCT03213938.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogenous condition that impacts the Quality of life severely, and it has multimodal complex treatment options. We aimed to compare the efficacy of two well-described neuromodulation therapies, transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in the treatment of category IIIB CP/CPPS.
This study was designed as a randomized prospective clinical trial. We randomized category IIIB CP/CPPS patients into two treatment groups as TTNS and PTNS groups. Category IIIB CP/CPPS was diagnosed by two or four-glass Meares-Stamey test. All patients included in our study were antibiotic/anti-inflammatory resistant. Transcutaneous and percutaneous treatments were applied 30 min sessions for 12 weeks. Patients were evaluated by Turkish-validated National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI) and visual analogue scale (VAS) initially and after treatment. Treatment success was evaluated within each group and also compared with each other.
A total of 38 patients in the TTNS group and 42 patients in the PTNS group were included in the final analysis. The mean VAS scores of the TTNS group were lower than the PTNS group initially (7.11 and 7.43, respectively), (p = 0.03). The pretreatment NIH-CPSI scores were similar between groups (p = 0.07). VAS scores, total NIH-CPSI, NIH-CPSI micturation, NIH-CPSI pain, and NIH-CPSI QoL scores decreased significantly at the end of the treatment in both groups. We found a significantly higher VAS and NIH-CPSI scores decrease in the PTNS group compared to the TTNS group (p < 0.01).
Both PTNS and TTNS are effective treatment methods in category IIIB CP/CPPS. Comparing the two methods, PTNS provided a higher level of improvement in terms of pain and quality of life.

UNASSIGNED: To evaluate the short-term efficacy of Dutasteride in the management of chronic prostatitis (CP)/chronic pelvic pain syndrome.
UNASSIGNED: A randomized placebo-controlled double-blind study was conducted that including 50 patients diagnosed with CP based on the presence of pelvic pain for ≥3 months of the preceding 6 months. Patients were randomized into 2 equal groups to evaluate Dutasteride of 0.5 mg once daily that was given for 3 months compared to a placebo.
UNASSIGNED: Forty-nine patients were evaluated after the follow-up period with no statistically significant difference in the perioperative demographic data. The mean age of the Dutasteride group was 48.3 (range 41-62) compared to a mean age of 46.5 (range 44-60) in the placebo group. There was a highly statistically significant improvement in the Dutasteride group compared to its preoperative parameters and the placebo compared group in the terms of pain, urinary scores, and total National Institutes of Health CP symptom score. Moderate and marked improvement in patients\' symptomatology was seen in 56% of the dutasteride group, while only 8% in the dutasteride group failed to show an improvement with no significant side effects noted in our study.
UNASSIGNED: The short-term outcome of dutasteride therapy showed an improvement in the National Institutes of Health-CP symptom score compared to a placebo in the treatment of category IIIB CP.
UNASSIGNED: NCT04756206.

BACKGROUND: Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized.
METHODS: The aim of this exploratory matched case-control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the \"Strengthening the Reporting of Observational Studies in Epidemiology\" (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: \"National Institutes of Health Chronic Prostatitis Symptom Index\" (NIH-CPSI), \"Hospital Anxiety and Depression Scale\" (HADS), \"Fear Avoidance Belief Questionnaire\" (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area.
RESULTS: The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms\' impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings.
CONCLUSIONS: This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.

UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

OBJECTIVE: However, the pathogenesis and etiology of CP/CPPS are still poorly understood. Therefore, there is a need for further research through the Image J software to develop models capable of imitating the pathogenesis and etiology of CP/CPPS with different doses of the pathogenesis and the etiology of CP/CPPS is still poorly understood. The aim was to determine the area of the prostatic interstitium, the localization of the inflammation, and the impact of different doses on the group model.
METHODS: A total of 30 male ICR mice were randomly grouped into 5 (n = 6): 45 μg group = 6, 60  μg group = 6, 90  μg group = 6, 120  μg group = 6, 120  μg group = 6, control group = 6. With the exception of the control group, all the groups were immunized by injecting 0.2 mL of T2 peptide emulsion and immune adjuvant CFA to induce non-bacterial chronic prostatitis on days 0 and 14 of the mice and finally executed on day 28. All injections were administered subcutaneously. HE staining was used to evaluate changes in prostate pathology. Image J was used to calculate the area of the prostate interstitium, which represents the degree of prostate edema. To compare statistical differences between groups, the ANOVA test was used.
RESULTS: From the perspective of pathological scoring, the 60 μg, 90  μg, and 120  μg groups had the highest scores using Image J to treat inflammatory cells. In addition, in the prostate interstitium area treated, it was found that the 90  μg group attained the largest prostate interstitial area as well as the highest degree of swelling.
CONCLUSIONS: From the results, Image J software is an effective tool in the calculating the surface of the prostatic interstitium and the specific localization of the inflammation.

OBJECTIVE: To assess the safety and effect of the multifocal low-intensity extracorporeal shockwave therapy (MESWT) in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
METHODS: We randomly separated 30 patients with CP/CPPS into a MESWT and placebo group of same number using prospective-randomized, double-blind design. The participants\' National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total and subdomain scores, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and visual analogue scale (VAS) were assessed and compared at baseline and at finishing immediately and 4 weeks after procedure and also were compared between MESWT and placebo group.
RESULTS: A total of 30 participants were randomized a MESWT or placebo group. Twenty of thirty participants completed this trial. NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS had significantly ameliorated compared with baseline in the MESWT group at 4 weeks assessment. Furthermore, comparison of the results from MESWT and placebo groups represented statistically significant differences in NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS. No side effects or events were occurred in both groups of the participants during study periods.
CONCLUSIONS: MESWT can be an effective treatment modality in patients with CP/CPPS as it improves pain and QoL.