Eur Urol. 2016 Feb;69(2):286-97. doi: 10.1016/j.eururo.2015.08.061. Epub 2015 Sep 26.
Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Magistro G1, Wagenlehner FM2, Grabe M3, Weidner W2, Stief CG4, Nickel JC5. Author information
Abstract
CONTEXT:
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying
this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to
identify an efficient monotherapy.
OBJECTIVE:
A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management.
EVIDENCE ACQUISITION:
Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with
expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS.
EVIDENCE SYNTHESIS:
Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify
bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the
individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical
best evidence recommendations for management.
CONCLUSIONS:
Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a monotherapy for management. No efficient monotherapeutic option is available. The best evidence-based management
of CP/CPPS strongly suggests a multimodal therapeutic approach addressing the individual clinical phenotypic profile.
PATIENT SUMMARY:
Chronic prostatitis/chronic pelvic pain syndrome presents a variable syndrome. Successful management of this condition is challenging. It appears that a tailored treatment strategy addressing individual patient characteristics is more effective than one
single therapy.
Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
KEYWORDS:
Chronic pelvic pain syndrome; Chronic prostatitis; Monotherapies; Phenotypically directed multimodal management
Comment in
Chronic Pelvic Pain Syndrome: Light at the End of the Tunnel? [Eur Urol. 2016] PMID: 26411805 DOI: 10.1016/j.eururo.2015.08.061
[Indexed for MEDLINE]


https://www.ncbi.nlm.nih.gov/pubmed/26411805?dopt=Abstract

--- SoupGate-Win32 v1.05
* Origin: fsxNet Usenet Gateway (21:1/5)