Management of patients with chronic prostatitis and chronic pelvic pain syndrome: results of a systematic review and meta-analysis
In patients with chronic prostatitis and chronic pelvic pain syndrome, the use of antibiotics and alpha-blockers improves the clinical picture of the disease.
Despite the fact that chronic prostatitis and chronic pelvic pain syndrome are quite common in patients with a urologic profile, the approaches to treating the nosological units listed above and the evidence for their effectiveness obtained in clinical trials are contradictory. Therefore, it is entirely reasonable to carry out a systematic review and meta-analysis, the aim of which was to study the efficacy of treatment with α-blockers, antibiotics, anti-inflammatories and other drugs (herbal preparations, glycosaminoglycans, finasteride, neuromodulators) compared to placebo.
The searches were carried out in the MEDLINE databases from 1949 and EMBASE from 1974 to November 16, 2010.
A systematic review and meta-analysis included randomized controlled trials comparing different treatment regimens in patients with chronic prostatitis or chronic pelvic pain syndrome.
Two researchers, independently of each other, extracted data from the publications found concerning the mean score on the symptom severity scale, the patient's quality of life assessment scale and the response to treatment between the treatment groups compared. The normalized mean difference and the random effects method were used to combine the continuous and dichotomous results, respectively.
262 studies were found, however, they met the criteria for inclusion in the meta-analysis and were found to be suitable only at 23. During the meta-analysis, it was shown that during treatment with α-blockers compared to placebo, the clinical picture of the disease was normalized, i.e. all symptoms in general, pain, dysuria and improvement in quality of life: -1.7 (95% confidence interval (CI) of -2.8 to -0.6), -1.1 (95% CI from -1.8 to -0.3), -1.4 (95% CI from -2.3 to -0, 5) and -1.0 (95% CI -1.8 to -0.2), respectively. Patients treated with α-blockers or anti-inflammatory drugs had a much higher probability of a favorable response to treatment compared to placebo: a combined relative risk of 1.6 (95% CI 1.1–2.3) and 1.8 (95% CI 1.2-2.6), respectively. At the same time, we cannot exclude the possibility of a systematic error linked to the publication of only homogeneous consistent results from small studies on α-blocking therapy and included in the meta-analysis. During the meta-analysis, it was hypothesized that antibiotic therapy was accompanied by a decrease in the score for the total number of symptoms (-9.8; 95% CI, from -15.1 to -4.6), pain (-4.4; 95% CI, -7.0 to -1.9), urination disorders (-2.8; 95% CI, from -4, 1 to -1.6) and quality of life assessment (-1.9; 95% CI, -3.6 to -0.2) compared to placebo.
The joint administration of α-blockers and antibiotics made it possible to obtain the best results: for example, a decrease of -13.8 points was noted on the scale of assessment of the symptoms of the disease (CI 95% from -17.5 to -10.2), -5.7 points (95% CI from -7.8 to -3.6) on the pain intensity scale , from -3.7 (95% CI from -5.2 to -2.1) on the urination disturbance rating scale and -2.8 (95% CI, from -4.7 at -0.9) on a quality of life rating scale. According to the researchers, anti-inflammatory drugs, finasteride, and herbal remedies have a less pronounced but significant effect on only one specific symptom: pain, impaired urination, and treatment effectiveness, respectively.
Thus, the management of patients with chronic prostatitis and chronic pelvic pain syndrome using α-blockers, antibacterial drugs and, in particular, their combined use is accompanied by a significant improvement in the clinical picture of the disease compared to placebo.