Chronic bacterial prostatitis and chronic pelvic pain syndrome

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Chronic prostatitis can cause pain and urinary symptoms, and can occur either with an active infection (chronic bacterial prostatitis [CBP]) or with only pain and no evidence of bacterial causation (chronic pelvic pain syndrome [CPPS]). Bacterial prostatitis is characterised by recurrent urinary tract infections or infection in the prostate with the same bacterial strain, which often results from urinary tract instrumentation. However, the cause and natural history of CPPS are unknown and not associated with active infection.

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Focus of the review

CBP and CPPS can often be confusing for practitioners to manage given the disparate presentation of men's symptoms. This overview attempts to clarify and inform current management based on the most current literature. It is important to recognise that these two topics are distinctly different clinical, microbiological, and therapeutic entities.

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Comments on evidence

There were 33 studies included in this overview, some of which are case-control studies. No placebo-controlled studies were found; however, control groups are probably unnecessary to evaluate the efficacy of antibiotics in CBP, as would be the case in other fields.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, August 2010, to February 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 131 studies. After deduplication and removal of conference abstracts, 67 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 51 studies and the further review of 16 full publications. Of the 16 full articles evaluated, three systematic reviews and one RCT were included at this update.

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Additional information

Although there are no placebo-controlled studies, it is well established that appropriate antibiotic treatment for CBP is associated with improved outcomes in terms of elimination of infection from the prostate and ancillary cystitis or other related symptoms. CPPS is a syndrome with an unclear aetiology that does not have any effective treatments. Chronic abacterial prostatitis is another term for CPPS; however, it is inaccurate as bacteria not responsible for the symptoms may occasionally be localised in the prostate. It is possible, but there is currently no evidence that an infection leads to the syndrome.

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Substantive changes at this update

Antimicrobial drugs (oral) for CBP One systematic review added.[23] Evidence re-evaluated. Categorisation changed from 'likely to be beneficial' to 'beneficial' (by consensus).

Antimicrobial drugs (locally injected) for CBP One systematic review added.[23] Categorisation unchanged (unknown effectiveness).

Alpha-blockers for CPPS Two systematic reviews added,[35][36] and one subsquent RCT.[37] Categorisation unchanged (unknown effectiveness).

5 alpha-reductase inhibitors for CPPS One systematic review added.[35] Categorisation unchanged (unknown effectiveness).

Mepartricin for CPPS One systematic review added.[36] Categorisation unchanged (unknown effectiveness).

NSAIDs for CPPS Two systematic reviews added.[35][36] Categorisation unchanged (unknown effectiveness).

Pentosan polysulfate for CPPS Two systematic reviews added.[35][36] Categorisation unchanged (unknown effectiveness).

Quercetin for CPPS One systematic review added.[35] Categorisation unchanged (unknown effectiveness).

Abstract

INTRODUCTION: Chronic prostatitis can cause pain and urinary symptoms, and can occur either with an active infection (chronic bacterial prostatitis [CBP]) or with only pain and no evidence of bacterial causation (chronic pelvic pain syndrome [CPPS]). Bacterial prostatitis is characterised by recurrent urinary tract infections or infection in the prostate with the same bacterial strain, which often results from urinary tract instrumentation. However, the cause and natural history of CPPS are unknown and not associated with active infection. METHODS AND OUTCOMES: We conducted a systematic overview and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 131 studies. After deduplication and removal of conference abstracts, 67 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 51 studies and the further review of 16 full publications. Of the 16 full articles evaluated, three systematic reviews and one RCT were included at this update. We performed a GRADE evaluation for 14 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 12 interventions based on information relating to the effectiveness and safety of 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs (NSAIDs), oral antimicrobial drugs, pentosan polysulfate, quercetin, sitz baths, transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP).

Cite as

Bowen DK, Dielubanza E, Schaeffer AJ. Chronic bacterial prostatitis and chronic pelvic pain syndrome. Systematic review 1802. BMJ Clinical Evidence. . 2015 August. Accessed [date].

Latest citations

Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. ( 29 July 2015 )

Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia. ( 29 July 2015 )