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      Current treatment options in the management of chronic prostatitis

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          Abstract

          Chronic prostatitis is a disease with an unknown etiology that affects a large number of men. The optimal management for category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is unknown. The recent years have seen a significant increase in research efforts to understand, classify and treat CP/CPPS. Standard treatment usually consists of prolonged courses of antibiotics, even though well-designed clinical trials have failed to demonstrate their efficacy. Recent treatment strategies with some evidence of efficacy include: alpha-blockers, anti-inflammatory agents, hormonal manipulation, phytotherapy (quercetin, bee pollen), physiotherapy and chronic pain therapy. A stepwise, multimodal approach can be successful for the majority of patients who present with this difficult condition.

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          Most cited references 60

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          Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial.

          Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men is principally defined by pain in the pelvic region lasting more than 3 months. No cause of the disease has been established, and therapies are empirical and mostly untested. Antimicrobial agents and alpha-adrenergic receptor blockers are frequently used. To determine whether 6-week therapy with ciprofloxacin or tamsulosin is more effective than placebo at improving symptoms in men with refractory, long-standing CP/CPPS. Randomized, double-blind trial with a 2 x 2 factorial design comparing 6 weeks of therapy with ciprofloxacin, tamsulosin, both drugs, or placebo. Urology outpatient clinics at 10 tertiary care medical centers in North America. Patients were identified from referral-based practices of urologists. One hundred ninety-six men with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score of at least 15 and a mean of 6.2 years of symptoms were enrolled. Patients had received substantial previous treatment. The authors evaluated NIH-CPSI total score and subscores, patient-reported global response assessment, a generic measure of quality of life, and adverse events. Ciprofloxacin, 500 mg twice daily; tamsulosin, 0.4 mg once daily; a combination of the 2 drugs; or placebo. The NIH-CPSI total score decreased modestly in all treatment groups. No statistically significant difference in the primary outcome was seen for ciprofloxacin versus no ciprofloxacin (P = 0.15) or tamsulosin versus no tamsulosin (P > 0.2). Treatments also did not differ significantly for any of the secondary outcomes. Treatment lasting longer than 6 weeks was not tested. Patients who had received less pretreatment may have responded differently. Ciprofloxacin and tamsulosin did not substantially reduce symptoms in men with long-standing CP/CPPS who had at least moderate symptoms.
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            Bacteriologic localization patterns in bacterial prostatitis and urethritis.

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              Seminal oxidative stress in patients with chronic prostatitis.

              An association between prostatitis and male infertility has been suspected, yet is poorly understood. Prostatitis is often associated with granulocytes in the prostatic fluid that generate reactive oxygen species (ROS), known to impair male fertility. We compared ROS, the total antioxidant capacity (TAC), and a novel index of oxidative stress (ROS-TAC score) in patients with chronic prostatitis and in healthy controls. Semen specimens from 36 men with chronic prostatitis (National Institutes of Health category IIIa), 8 men with prostatodynia (National Institutes of Health category IIIb), and 19 controls attending our urologic clinic were examined according to the World Health Organization criteria. Leukocytospermia was measured by the Endtz test (myeloperoxidase assay). ROS and TAC production was measured by chemiluminescence assay. A composite ROS-TAC score was also calculated in patients and controls. The sperm concentration, percentage of motility, and morphology among the groups did not differ. The mean +/- standard error log-transformed ROS level was significantly higher in patients with leukocytospermia (3.2 +/- 0.6) than in patients without leukocytospermia (1.8 +/- 0.2; P = 0.04) and controls (1.3 +/- 0.3, P = 0.01). TAC was significantly lower in patients with or without leukocytospermia (859.69 +/- 193.0 and 914.9 +/- 65.2, respectively) than in controls (1653.98 +/- 93.6, P = 0.001). The mean ROS-TAC score of controls (50.0 +/- 4.1) was significantly higher than those of patients with chronic prostatitis and leukocytospermia (8.2 +/- 9.2) and those without leukocytospermia (34.2 +/- 2.9; P <0.001). Men with chronic prostatitis or prostatodynia have seminal oxidative stress, irrespective of their leukocytospermia status. These observations may help shed light on the long-standing controversy surrounding prostatitis and infertility.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                August 2007
                August 2007
                : 3
                : 4
                : 507-512
                Affiliations
                Glickman Urological Institute, The Cleveland Clinic 9500 Euclid Ave, Cleveland OH 44195, USA
                Author notes
                Correspondence: Daniel A Shoskes Glickman Urological Institute, The Cleveland Clinic, 9500 Euclid Ave, Desk A100, Cleveland OH 44195, USA Email dshoskes@ 123456gmail.com
                Article
                2374945
                18472971
                © 2007 Dove Medical Press Limited. All rights reserved
                Categories
                Review

                Medicine

                treatment, management, prostatitis, chronic, cpps

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