Non‐pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome

Abstract

Background

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non‐pharmacological interventions. The National Institute of Health ‐ Chronic Prostatitis Symptom Index (NIH‐CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms.

Objectives

To assess the effects of non‐pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Search methods

We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017.

Selection criteria

We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non‐pharmacological interventions.

Data collection and analysis

Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods.

Main results

We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.

1. Acupuncture: (three studies, 204 participants) based on short‐term follow‐up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure (mean difference (MD) in total NIH‐CPSI score ‐5.79, 95% confidence interval (CI) ‐7.32 to ‐4.26, high QoE). Acupuncture likely results in little to no difference in adverse events (moderate QoE). It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants (MD ‐6.05, 95% CI ‐7.87 to ‐4.24, two studies, 78 participants, moderate QoE).

2. Circumcision: (one study, 713 participants) based on short‐term follow‐up, early circumcision probably decreases prostatitis symptoms slightly (NIH‐CPSI score MD ‐3.00, 95% CI ‐3.82 to ‐2.18, moderate QoE) and may not be associated with a greater incidence of adverse events compared with control (a waiting list to be circumcised, low QoE).

3. Electromagnetic chair: (two studies, 57 participants) based on short‐term follow‐up, we are uncertain of the effects of the use of an electromagnetic chair on prostatitis symptoms. It may be associated with a greater incidence of adverse events compared with sham procedure (low to very low QoE).

4. Lifestyle modifications: (one study, 100 participants) based on short‐term follow‐up, lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control (risk ratio (RR) for improvement in NIH‐CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events.

5. Physical activity: (one study, 85 participants) based on short‐term follow‐up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH‐CPSI score MD ‐2.50, 95% CI ‐4.69 to ‐0.31, low QoE). We found no information regarding adverse events.

6. Prostatic massage: (two studies, 115 participants) based on short‐term follow‐up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events.

7. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short‐term follow‐up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH‐CPSI score MD ‐6.18, 95% CI ‐7.46 to ‐4.89, high QoE). These results may not be sustained at medium‐term follow‐up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE).

8. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short‐term follow‐up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH‐CPSI score MD ‐2.50, 95% CI ‐3.82 to ‐1.18, low QoE). One included study reported that participants may experience transient adverse events.

9. Other interventions: there is uncertainty about the effects of other interventions included in this review. We found no information regarding psychological support or prostatic surgery.

Authors' conclusions

Some of the interventions can decrease prostatitis symptoms in an appreciable number without a greater incidence of adverse events. The QoE was mostly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient‐important outcomes including potential treatment‐related adverse events and appropriate sample sizes.

Intervention for treating chronic prostatitis and chronic pelvic pain in men

Review question

What are the effects of non‐medicine therapies in men with longstanding pain and discomfort around their prostate and pelvis, so‐called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?

Background

CP/CPPS is a common disorder in which men feel pelvic pain or have bothersome symptoms (or both of these) when urinating. Its cause is unknown and there are many different treatments for this condition.

Study characteristics

The evidence was current to August 2017. We found 38 studies that were conducted between 1993 and 2016 with 3187 participants that made 23 comparisons between different treatments in men with CP/CPPS. The evaluated interventions usually implied the use of devices, medical advice or some form of physical therapy. In many cases, these therapies were given to men in an outpatient setting. Most studies did not specify their funding sources; three studies reported funding from device makers.

Key results

Acupuncture: we found that acupuncture (an alternative medicine where thin needles are inserted into the skin at specific points) decrease symptoms in an appreciable number of men and is probably not associated with side effects when compared with pretend acupuncture. It probably decreases symptoms when compared with standard medical therapy.

Circumcision: we found that men who were circumcised (removal of the foreskin of the penis) probably have fewer symptoms (small effect) and may not have more side effects when compared to men who delay circumcision.

Electromagnetic chair: we are uncertain of the effects of the use of an electromagnetic chair (a device that provides magnetic stimulation to the pelvis) on men's symptoms; however, it may not be associated with a greater incidence of side effects when compared with a simulated procedure (where researchers pretended to but did not actually use the device).

Lifestyle modifications: we are uncertain whether the recommendation of lifestyle modifications reduces symptoms when compared to the continuation of the same lifestyle. We had no information regarding side effects.

Physical activity: we found that a physical activity programme may reduce symptoms (small effect) when compared with a non‐specific activity used as a control. We have no information regarding side effects.

Prostatic massage: we are uncertain whether the prostatic massage reduces or increases symptoms when compared with no massage. We found no information regarding side effects.

Extracorporeal shockwave therapy: we found that extracorporeal shockwave therapy (where shock waves are passed through the skin to the prostate) decreases appreciably symptoms compared to a simulated procedure. These results may not be lasting after more continued treatment. This treatment may not be associated with side effects.

Transrectal thermotherapy compared to medical therapy: we found that transrectal thermotherapy (which applies heat to the prostate and pelvic muscle area) alone or in combination with medical therapy may cause a small decrease in symptoms compared to medical therapy alone. One of the included studies reported that participants may experience transient side effects.

There is uncertainty about the effects of other interventions.

Quality of the evidence

The quality of the evidence was low in most cases, meaning that there is much uncertainty surrounding the results. The included studies were not well designed, had a small sample size and had a short follow‐up time (usually 12 weeks).