Self Management Activation Randomised Trial for Prostatitis (SMART-P): study protocol for a randomised controlled trial

INTERSTITIAL CYSTITIS, CHRONIC NONBACTERIAL PROSTATITIS AND CHRONIC PELVIC PAIN SYNDROME IN MEN: A COMMON AND FREQUENTLY IDENTICAL CLINICAL ENTITY

THE CHRONIC PROSTATITIS-CHRONIC PELVIC PAIN SYNDROME CAN BE CHARACTERIZED BY PROSTATIC TISSUE PRESSURE MEASUREMENTS

BACKGROUND: Chronic pelvic pain syndrome against the background of chronic abacterial prostatitis is most often associated with emotional and behavioral disorders, asthenic syndrome, erectile dysfunction, lower urinary tract symptoms, which significantly reduce the quality of life of patients and require additional medication correction. Despite the fact that there are currently more than 15 groups of drugs used in this case, their effectiveness remains insufficiently high. In this regard, the search for new innovative technologies for non-drug therapy of chronic pelvic pain and chronic abacterial prostatitis is relevant.
 AIM: Study of the effect of extracorporeal magnetic stimulation of the pelvic floor and transcranial magnetic therapy on the parameters of the psycho-emotional status and clinical parameters in patients with chronic pelvic pain syndrome against the background of chronic abacterial prostatitis.
 MATERIALS AND METHODS: The study included 52 patients with chronic pelvic pain syndrome against the background of chronic abacterial prostatitis aged 28 to 45 years. Subject to the principles of simple randomization, patients were divided into 2 groups. Patients of the control group (n=26) received a basic sanatorium complex with the inclusion of therapeutic exercises, dosed walking, drinking mineral water. Patients of the main group (n=26) in addition to the basic complex received extracorporeal magnetic stimulation of the pelvic floor and transcranial magnetic therapy.
 RESULTS: The use of extracorporeal magnetic stimulation of the pelvic floor and transcranial magnetic therapy in patients with chronic pelvic pain syndrome against the background of chronic abacterial prostatitis is accompanied by a significant decrease in the severity of pain syndrome, clinical symptoms of the disease and improvement in psycho-emotional status parameters.
 CONCLUSION: The inclusion of extracorporeal magnetic stimulation of the pelvic floor and transcranial magnetic therapy in the treatment complex of patients with chronic pelvic pain syndrome against the background of chronic abacterial prostatitis contributes to the regression of the clinical manifestations of the disease, pain syndrome, dysuria disorders, and a significant improvement in the parameters of the psycho-emotional state.

Chronic Pelvic Pain Syndrome in Men is Associated with Reduction of Relative Gray Matter Volume in the Anterior Cingulate Cortex Compared to Healthy Controls

Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study.

ANOTATION.The most common urological disease among men of working age is chronic prostatitis, and its symptoms are a frequent reason for seeking urological care. PURPOSE OF THE RESEARCH. Тo assess the state of local and systemic immunity in patients with various forms of chronic prostatitis MATERIALS AND METHODS. 84 patients with chronic prostatitis, with a long recurrent course of the disease, were under observation. Among them, there were 15 (17.9%) with chronic bacterial prostatitis, 69 (82.1%) with chronic bacterial prostatitis, of which 44 patients had chronic inflammatory pelvic pain syndrome (CPPS) and 25 — non-inflammatory chronic pelvic pain syndrome (CPPS). The average age of the patients was 37.4±8.2 years, the duration of the disease from 4 to 7 years (5.7±1.3 years on average). An evaluation of symptoms and indicators of immune status was carried out in groups of patients according to the level of interferon-γ in the blood (IFN-γ), interleukins-6 and 8 (IL-6, IL-8), α-tumor necrosis factor (TNF-α) in the blood and ejaculate and also the level of secretory immunoglobulin A (sIgA) in ejaculate. RESULTS AND THEIR DISCUSSION. According to the questionnaire according to the questionnaire "Chronic Prostatitis Symptom Index" (NIH-CPSI, 1999) with an assessment of the quality of life of patients (QоL) in patients with chronic bacterial prostatitis (CBP), the total score was — 23.96±0.18, with chronic abacterial (CAP) — according to SICPP — 21.20±0.16 and SNICPP — 24.59±0.17, which corresponded to the average and severe degree (SNICPP and CBP) of the course of the disease. The results of indicators of systemic and local immunity of patients with chronic prostatitis indicated changes that depended on the form of chronic prostatitis, and were more pronounced at the local level. A more pronounced increase in pro-inflammatory cytokines (IL-6 and IL-8) both in the blood and in the ejaculate is observed in patients with the inflammatory form of chronic bacterial prostatitis (CBP), and an increase in secretory immunoglobulin A (sIgA) was observed in the ejaculate of patients with chronic bacterial prostatitis. Also, the most pronounced decrease in blood IFN-γ was also observed in patients with chronic bacterial prostatitis. An increase in the level of TNF-α, both in the blood and in the ejaculate, was observed in all patients with chronic prostatitis, but there was no significant difference in the indicators between the groups. There is no correlation between the level of cytokines and the activity of the leukocyte reaction in the secretion of the prostate gland. CONCLUSION. Changes in cytokine status are more pronounced at the local level and depend on the form of chronic prostatitis. Determination of indicators of immune status, especially in ejaculate, can increase the capabilities of the diagnostic algorithm for verifying the form of chronic prostatitis

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Mental stress and imbalance of its two neural stress systems, the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis, are associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED). However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms (LUTS) and ED. Participants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), Type A Personality Test (TAPT) and Symptom Checklist 90 (SCL-90) were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability (HRV) as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed. The BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group (p < 0.01). The PSS scores of both groups with ED were significantly higher than the control group (p < 0.01). Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients (p < 0.01). The IPSS scores were shown to have significantly positive correlations with BAI (r = 0.32, p < 0.0001), PSS (r = 0.18, p < 0.01) and SCL-90 (r = 0.19, p < 0.01) in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI (r = -0.17，p < 0.001), PSS (r = -0.25，p < 0.0001), SCL-90 (r = -0.20，p < 0.001) and quality of life score in NIH-CPSI (r = -0.14，p = 0.0075). Cortisol awakening response (CAR) parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency (LF) was significantly lower in ED patients when compared with CP/CPPS+ED patients (p = 0.044) and healthy controls (p = 0.005), high frequency (HF) power was significantly higher in healthy controls compared to patients with ED (p < 0.001), CP/CPPS (p < 0.001) and CP/CPPS+ED (p < 0.001), and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group (p = 0.001). CP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not.

Demographic and Clinical Characteristics of Chronic Prostatitis: Prospective Comparison of the University of Sciences Malaysia Cohort With the United States National Institutes of Health Cohort

Noninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. We evaluated the significance of potassium chloride sensitivity test and urinary CTAB-precipitable uronate level in patients with chronic pelvic pain syndrome (CPPS). We included 25 patients with interstitial cystitis (IC), and 30 patients with chronic prostatitis (CP) who applied to our outpatient clinic with the complaints of frequency, dysuria and pain on urination between the years 2003 and 2005. Thirty-five subjects were studied as healthy controls. All patients underwent cystoscopy, cystometry, voiding diary, sodium chloride, and potassium chloride filling tests. Visual analog scale (VAS) was used to determine pain scores. Patients with CP also underwent NaCl and KCl voiding tests. Urinary CTAB-precipitable uronate levels were obtained in all subjects. KCl test had a good sensitivity for IC. As for the patients with CP, KCl voiding test was useful, but KCl filling test was not. Urinary CTAB-precipitable uronate level was found to be significantly higher in patients with IC and CP than controls, and in patients with IC than in patients with CP. The results of our study suggest that KCl voiding test is a good candidate to be used in the diagnostic workup of patients with category III CP, and urinary CTAB-precipitable uronate level measurement may be a noninvasive diagnostic aid for IC and CP.

Among men of working age chronic prostatitis is the most frequent urological illness, and characteristic symptoms of it are frequent reason of the urological recourse. Nowadays, there is no single universal successful therapy of chronic prostatitis. Therefore, this excuses a search for new methods of treatment of the patients with this pathology.The objective: was to evaluate the efficiency of transurethral radio wave bipolar thermotherapy (TURF) of the prostate in patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS (NIH III A)).Materials and methods. There were 57 patients with chronic nonbacterial prostatitis under supervision, with inflammatory chronic pelvic pain syndrome (NIH IIIA), with a disease duration of more than 4 years, and low treatment efficiency on the background of standard therapy. All patients received standard therapy according to the clinical protocol. Part of the patients (Group 37) received transurethral bipolar prostate radiotherapy using the Tempro apparatus on the background of standard therapy, with subsequent comparative evaluation of clinical results relatively to the control group (20 – I group), which received only standard therapy after 3,6 and 12 months after treatment.Results. It was found that the use of transurethral radio wave bipolar thermotherapy with the Tempro system on the background of standard therapy in patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS – NIH III A), facilitated more extended and clinical result, in contrast to the results in the group of patients who received only standard therapy. If, according to the assessment of general condition (S+QoL) in group II of patients, after 3 and 6 months after the standard course of treatment, the indicator improved by 38,9 % and 41,4 %, respectively (p&lt;0,05), after 12 months only by 10,3 %, with no significant statistical difference with an indicator before treatment (p&gt;0,05). Whereas in group II of patients who additionally recieved transurethral radio wave bipolar thermotherapy, the score (S+QoL) after 3 months and 6 months was 64,0 % and 68,2 %, respectively, lower than before treatment (p&lt;0,05). After 12 months after treatment, this result remained without negative dynamics, 68,4 % below the pre-treatment index (p&lt;0,05). Appropriate results were also obtained in a detailed assessment of the dynamics of the main symptoms 3, 6 and 12 months after treatment. Manifestations of pain, discomfort, or discomfort in typical areas returned to patients in group I 12 months after treatment, whereas in group II, such patients had a small percentage, except for discomfort over the womb in 27 % of patients. TURF has also been shown to be highly effective in the severity of the inflammatory process as a result of prostate secretion microscopy. Accordingly, after 12 months, less than 10 leukocytes in the field of view were in 35 % of patients of group I, while in group II it was – 73 %, from 11 to 20 leukocytes were in 60 % of patients – group I, and 37 % – group II. According to the TRUSD of the prostate, the median volume of the prostate 12 months after treatment in group II was 28,1 % lower than the indicator before treatment (p&lt;0,05). If, after 3 and 6 months after treatment, the average prostate volume in group I of patients decreased significantly by 14,1 % and 11,9 % respectively, there was no statistically significant difference after 12 months (p&gt;0,05).Conclusion. The use of transurethral bipolar radiotherapy on the background of standard therapy in patients with inflammatory CP/CPPS who are hardly succumbed to traditional therapy, is safe with long-lasting and sustained clinical effects against standard therapy.

Estimation of efficiency of shock wave therapy in patients with chronic nonbacterial prostatitis / chronic pelvic pain syndrome

Effectiveness of Acupuncture on Chronic Prostatitis–Chronic Pelvic Pain Syndrome Category IIIB Patients: A Prospective, Randomized, Nonblinded, Clinical Trial

Numerous studies have established that chronic prostatitis/ chronic pelvic pain syndrome ( CP/CPPS) is the focus of attention of the global medical community, because it is the most common type of disease, the treatment of which has largely unsatisfactory results.Purpose of the work: to conduct a comparative analysis of the microbiota of prostate secretions in patients with CP/CPPS IIIa and IIIb using mass spectrometry of microbial markers (MSMM).Material and methods. A prospective comparative study was conducted from 2018 to 2023 at the SM-Clinic medical center. 205 patients with prostatitis-like symptoms and 70 males who applied for a screening examination with no complaints at the age of 25 to 50 years were selected. The subjects were divided into three groups: group 1 – patients with CP/CPPS category IIIa, group 2 ( n = 85) patients with CP/CPPS category IIIb with clinical manifestations of chronic prostatitis and group 3 ( n = 70) – without clinical manifestations prostatitis/control group. A study of the microbiota of prostate secretions was carried out using gas chromatograph mass spectrometer "Maestro" (LLC "Interlab", Russia).Results. The results of statistical analysis showed that the level of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and the control group, was significantly higher ( p = 0.0020 ; p &lt; 0.0001; p &lt; 0.0001; p = 0.0254; p = 0.0254). It was revealed that in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and healthy people, there was a significant increase in the total load of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses . When analyzing the relationship between the absolute number of microorganisms, it was revealed that an increase in the level of many microorganisms is associated with an increase in the probability of detecting a leukocyte level 10. An analysis of the relationship between the occurrence of individual microorganisms and leukocyte values in prostate secretions ≥10 showed that an increase in the indicators of many microorganisms, compared with the control group, increased the chances of having a leukocyte level ≥10 several times.Conclusion. Identification of microbial associations in prostate secretions using the MSMM method and an increase in the total load of microorganisms in patients with CP/CPPS IIIa, compared with CP/CPPS IIIa and the control group, suggests the role of infection in a certain part of patients with CP/CPPS IIIa, which dictates the need to change the view of the urologist in the diagnosis and treatment strategy of these patients.

Background: Type-III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common type of prostatitis. Patients and methods: We ascertained the effect of ‘thermobalancing’ therapy (TT; using Dr Allen’s therapeutic device (DATD)) on CP/CPPS. We measured National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores, prostatic volume (PV), and maximum urinary flow rate (Qmax) in one group of 45 patients who underwent TT and a control group that did not have TT, and compared these parameters between groups. Results: Baseline evaluation (pretreatment) of both groups showed no significant difference with regard to age, NIH-CPSI score, PV or Qmax. Pain score decreased in both groups but, in the treatment group, the difference between scores was considerably higher (8.72:1) than that of the non-treatment group. TT decreased quality of life (QoL) significantly whereas, in the control group, it decreased QoL slightly. TT reduced PV significantly whereas, in the control group, PV increased. TT increased Qmax significantly in CP/CPPS patients whereas, in the control group, TT did not elicit a significant change in Qmax. Conclusions: Six-month TT with DATD: (a) reduces CP/CPPS symptoms and improves QoL; (b) reduces PV; (c) increases Qmax. TT could be effective treatment for CP/CPPS.