To assess the effects of non‐pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Patients and 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. We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non‐pharmacological interventions. 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 Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression.
We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons, reporting outcomes mostly on short‐term follow‐up. Acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with sham procedure (mean difference (MD) in total NIH‐CPSI score ‐5.79, 95% confidence interval (CI) ‐7.32 to ‐4.26, moderate QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD ‐6.05, 95% CI ‐7.87 to ‐4.24, two studies, 78 participants, low QoE). Lifestyle modifications may be associated with a reduction in prostatitis symptoms 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. 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. 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. 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). 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.
Based on the findings of moderate to high‐quality evidence, this review found that some non‐pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly 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.
Autors: Juan V A Franco, Tarek Turk ,Jae Hung Jung ,Yu‐Tian Xiao ,Stanislav Iakhno , Virginia Garrote , Valeria Vietto
Published in: First published (18 July 2018): https://doi.org/10.1111/bju.14492