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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.

          Most cited references61

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          NIH consensus definition and classification of prostatitis.

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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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                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
                e2b17ba2-d0ce-42a9-8758-68211d794dae
                © 2007 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Review

                Medicine
                cpps,chronic,prostatitis,management,treatment
                Medicine
                cpps, chronic, prostatitis, management, treatment

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