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Meta-Analysis
. 2018 Jan 26;1(1):CD012551.
doi: 10.1002/14651858.CD012551.pub2.

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

Juan Va Franco  1 , Tarek Turk, Jae Hung Jung, Yu-Tian Xiao, Stanislav Iakhno, Virginia Garrote, Valeria Vietto
Affiliations
Meta-Analysis

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

Juan Va Franco et al. Cochrane Database Syst Rev. .

Update in

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.

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Conflict of interest statement

JVAF: none known.

TT: none known.

JHJ: none known.

YX: none known.

SI: none known.

VG: none known.

VV: none known.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: review authors' judgements about each risk of bias item for each study.
Figure 4
Figure 4
Forest plot of comparison: 22 Acupuncture treatments versus medical treatment. Sensitivity analysis, outcome: 22.1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 1.1
Analysis 1.1
Comparison 1 Acupuncture versus sham procedure, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 1.2
Analysis 1.2
Comparison 1 Acupuncture versus sham procedure, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 1.3
Analysis 1.3
Comparison 1 Acupuncture versus sham procedure, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 1.4
Analysis 1.4
Comparison 1 Acupuncture versus sham procedure, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 1.5
Analysis 1.5
Comparison 1 Acupuncture versus sham procedure, Outcome 5 Prostatitis symptoms.
Analysis 1.6
Analysis 1.6
Comparison 1 Acupuncture versus sham procedure, Outcome 6 Prostatitis symptoms (NIH‐CPSI total) ‐ medium term.
Analysis 1.7
Analysis 1.7
Comparison 1 Acupuncture versus sham procedure, Outcome 7 Prostatitis symptoms: pain subscore ‐ medium term.
Analysis 1.8
Analysis 1.8
Comparison 1 Acupuncture versus sham procedure, Outcome 8 Prostatitis symptoms: micturition subscore ‐ medium term.
Analysis 1.9
Analysis 1.9
Comparison 1 Acupuncture versus sham procedure, Outcome 9 Prostatitis symptoms: quality of life subscore ‐ medium term.
Analysis 1.10
Analysis 1.10
Comparison 1 Acupuncture versus sham procedure, Outcome 10 Adverse events.
Analysis 1.11
Analysis 1.11
Comparison 1 Acupuncture versus sham procedure, Outcome 11 Sexual dysfunction.
Analysis 1.12
Analysis 1.12
Comparison 1 Acupuncture versus sham procedure, Outcome 12 Urinary symptoms.
Analysis 2.1
Analysis 2.1
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 2.2
Analysis 2.2
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 2.3
Analysis 2.3
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 2.4
Analysis 2.4
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 2.5
Analysis 2.5
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 5 Prostatitis symptoms.
Analysis 2.6
Analysis 2.6
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 6 Adverse events.
Analysis 2.7
Analysis 2.7
Comparison 2 Acupuncture treatments versus medical treatment, Outcome 7 Urinary symptoms.
Analysis 3.1
Analysis 3.1
Comparison 3 Acupuncture with or without moxibustion, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 4.1
Analysis 4.1
Comparison 4 Circumcision versus waiting list, Outcome 1 Prostatitis symptoms.
Analysis 4.2
Analysis 4.2
Comparison 4 Circumcision versus waiting list, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 4.3
Analysis 4.3
Comparison 4 Circumcision versus waiting list, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 4.4
Analysis 4.4
Comparison 4 Circumcision versus waiting list, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 4.5
Analysis 4.5
Comparison 4 Circumcision versus waiting list, Outcome 5 Adverse events.
Analysis 5.1
Analysis 5.1
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 5.2
Analysis 5.2
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 5.3
Analysis 5.3
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 5.4
Analysis 5.4
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 5.5
Analysis 5.5
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 5 Adverse events.
Analysis 5.6
Analysis 5.6
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 6 Urinary symptoms.
Analysis 5.7
Analysis 5.7
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 7 Prostatitis symptoms (NIH‐CPSI total) ‐ medium term.
Analysis 5.8
Analysis 5.8
Comparison 5 Electromagnetic chair versus sham procedure, Outcome 8 Prostatitis symptoms: pain subscore ‐ medium term.
Analysis 6.1
Analysis 6.1
Comparison 6 Lifestyle modifications versus control, Outcome 1 Prostatitis symptoms.
Analysis 7.1
Analysis 7.1
Comparison 7 Physical activity versus control, Outcome 1 Prostatitis symptoms.
Analysis 7.2
Analysis 7.2
Comparison 7 Physical activity versus control, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 7.3
Analysis 7.3
Comparison 7 Physical activity versus control, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 7.4
Analysis 7.4
Comparison 7 Physical activity versus control, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 7.5
Analysis 7.5
Comparison 7 Physical activity versus control, Outcome 5 Anxiety.
Analysis 7.6
Analysis 7.6
Comparison 7 Physical activity versus control, Outcome 6 Depression.
Analysis 8.1
Analysis 8.1
Comparison 8 Prostatic massage versus control, Outcome 1 Prostatitis symptoms.
Analysis 8.2
Analysis 8.2
Comparison 8 Prostatic massage versus control, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 8.3
Analysis 8.3
Comparison 8 Prostatic massage versus control, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 8.4
Analysis 8.4
Comparison 8 Prostatic massage versus control, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 9.1
Analysis 9.1
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 9.2
Analysis 9.2
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 9.3
Analysis 9.3
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 9.4
Analysis 9.4
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 9.5
Analysis 9.5
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 5 Prostatitis symptoms.
Analysis 9.6
Analysis 9.6
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 6 Prostatitis symptoms (total score) ‐ long term.
Analysis 9.7
Analysis 9.7
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 7 Prostatitis symptoms: pain subscore ‐ long term.
Analysis 9.8
Analysis 9.8
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 8 Prostatitis symptoms: micturition subscore ‐ long term.
Analysis 9.9
Analysis 9.9
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 9 Prostatitis symptoms: quality of life subscore ‐ long term.
Analysis 9.10
Analysis 9.10
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 10 Adverse events.
Analysis 9.11
Analysis 9.11
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 11 Sexual dysfunction.
Analysis 9.12
Analysis 9.12
Comparison 9 Extracorporeal shockwave therapy (ESWT) versus control, Outcome 12 Urinary symptoms.
Analysis 10.1
Analysis 10.1
Comparison 10 Transrectal thermotherapy (TRT) versus medical treatment, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 10.2
Analysis 10.2
Comparison 10 Transrectal thermotherapy (TRT) versus medical treatment, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 10.3
Analysis 10.3
Comparison 10 Transrectal thermotherapy (TRT) versus medical treatment, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 10.4
Analysis 10.4
Comparison 10 Transrectal thermotherapy (TRT) versus medical treatment, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 11.1
Analysis 11.1
Comparison 11 Biofeedback with or without electrical stimulation versus usual care, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 11.2
Analysis 11.2
Comparison 11 Biofeedback with or without electrical stimulation versus usual care, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 11.3
Analysis 11.3
Comparison 11 Biofeedback with or without electrical stimulation versus usual care, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 11.4
Analysis 11.4
Comparison 11 Biofeedback with or without electrical stimulation versus usual care, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 12.1
Analysis 12.1
Comparison 12 External radiofrequency hyperthermia with or without terazosin, Outcome 1 Prostatitis symptoms.
Analysis 12.2
Analysis 12.2
Comparison 12 External radiofrequency hyperthermia with or without terazosin, Outcome 2 Adverse events.
Analysis 13.1
Analysis 13.1
Comparison 13 Laser therapy versus medical treatment, Outcome 1 Prostatitis symptoms.
Analysis 13.2
Analysis 13.2
Comparison 13 Laser therapy versus medical treatment, Outcome 2 Adverse events.
Analysis 14.1
Analysis 14.1
Comparison 14 Tibial nerve stimulation versus no intervention, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 14.2
Analysis 14.2
Comparison 14 Tibial nerve stimulation versus no intervention, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 14.3
Analysis 14.3
Comparison 14 Tibial nerve stimulation versus no intervention, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 14.4
Analysis 14.4
Comparison 14 Tibial nerve stimulation versus no intervention, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 15.1
Analysis 15.1
Comparison 15 Myofascial therapy versus control intervention, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 15.2
Analysis 15.2
Comparison 15 Myofascial therapy versus control intervention, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 15.3
Analysis 15.3
Comparison 15 Myofascial therapy versus control intervention, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 15.4
Analysis 15.4
Comparison 15 Myofascial therapy versus control intervention, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 15.5
Analysis 15.5
Comparison 15 Myofascial therapy versus control intervention, Outcome 5 Sexual dysfunction.
Analysis 15.6
Analysis 15.6
Comparison 15 Myofascial therapy versus control intervention, Outcome 6 Quality of life ‐ physical.
Analysis 15.7
Analysis 15.7
Comparison 15 Myofascial therapy versus control intervention, Outcome 7 Quality of life ‐ mental.
Analysis 16.1
Analysis 16.1
Comparison 16 Osteopathy versus sham procedure, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 16.2
Analysis 16.2
Comparison 16 Osteopathy versus sham procedure, Outcome 2 Prostatitis symptoms: quality of life subscore.
Analysis 16.3
Analysis 16.3
Comparison 16 Osteopathy versus sham procedure, Outcome 3 Urinary symptoms.
Analysis 17.1
Analysis 17.1
Comparison 17 Sono‐electromagnetic therapy versus placebo, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 17.2
Analysis 17.2
Comparison 17 Sono‐electromagnetic therapy versus placebo, Outcome 2 Prostatitis symptoms.
Analysis 17.3
Analysis 17.3
Comparison 17 Sono‐electromagnetic therapy versus placebo, Outcome 3 Prostatitis symptoms: pain subscore.
Analysis 17.4
Analysis 17.4
Comparison 17 Sono‐electromagnetic therapy versus placebo, Outcome 4 Prostatitis symptoms: micturition subscore.
Analysis 17.5
Analysis 17.5
Comparison 17 Sono‐electromagnetic therapy versus placebo, Outcome 5 Prostatitis symptoms: quality of life subscore.
Analysis 18.1
Analysis 18.1
Comparison 18 Transelectrical nerve stimulation (TENS) versus control, Outcome 1 Prostatitis symptoms: pain subscore.
Analysis 19.1
Analysis 19.1
Comparison 19 Transurethral microwave thermotherapy, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 19.2
Analysis 19.2
Comparison 19 Transurethral microwave thermotherapy, Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 19.3
Analysis 19.3
Comparison 19 Transurethral microwave thermotherapy, Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 19.4
Analysis 19.4
Comparison 19 Transurethral microwave thermotherapy, Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 19.5
Analysis 19.5
Comparison 19 Transurethral microwave thermotherapy, Outcome 5 Urinary symptoms.
Analysis 20.1
Analysis 20.1
Comparison 20 Transurethral needle ablation (TUNA) versus sham procedure, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 20.2
Analysis 20.2
Comparison 20 Transurethral needle ablation (TUNA) versus sham procedure, Outcome 2 Urinary symptoms.
Analysis 21.1
Analysis 21.1
Comparison 21 Ultrasound (non‐intrusive), Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
Analysis 21.2
Analysis 21.2
Comparison 21 Ultrasound (non‐intrusive), Outcome 2 Prostatitis symptoms: pain subscore.
Analysis 21.3
Analysis 21.3
Comparison 21 Ultrasound (non‐intrusive), Outcome 3 Prostatitis symptoms: micturition subscore.
Analysis 21.4
Analysis 21.4
Comparison 21 Ultrasound (non‐intrusive), Outcome 4 Prostatitis symptoms: quality of life subscore.
Analysis 21.5
Analysis 21.5
Comparison 21 Ultrasound (non‐intrusive), Outcome 5 Prostatitis symptoms.
Analysis 22.1
Analysis 22.1
Comparison 22 Acupuncture treatments versus medical treatment ‐ sensitivity analysis, Outcome 1 Prostatitis symptoms (NIH‐CPSI total).
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References

References to studies included in this review

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References to other published versions of this review

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