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Review
. 2018 May 12;5(5):CD012551.
doi: 10.1002/14651858.CD012551.pub3.

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
Review

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

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

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 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, high QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may not reduce sexual dysfunction when compared with sham procedure (MD in the International Index of Erectile Function (IIEF) Scale -0.50, 95% CI -3.46 to 2.46, 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). We found no information regarding quality of life, depression or anxiety.2. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, 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, sexual dysfunction, quality of life, depression or anxiety.3. 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). This programme may not reduce anxiety or depression (low QoE). We found no information regarding adverse events, sexual dysfunction or quality of life.4. 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, sexual dysfunction, quality of life, depression or anxiety.5. 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). This treatment probably improves sexual dysfunction (MD in the IIEF Scale MD 3.34, 95% CI 2.68 to 4.00, one study, 60 participants, moderate QoE). We found no information regarding quality of life, depression or anxiety.6. 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. We found no information regarding sexual dysfunction, quality of life, depression or anxiety.7. Other interventions: there is uncertainty about the effects of most of the other interventions included in this review. We found no information regarding psychological support or prostatic surgery.

Authors' conclusions: Based on the findings of moderate 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.

PubMed Disclaimer

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

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

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Shen 2006 {published data only}
    1. Shen SL, He DL, Luo Y. Clinical trials of combined therapy of an oral Chinese medicine with massage for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue 2006;12(9):851‐3. - PubMed
Sikiru 2008 {published data only}
    1. Sikiru L, Shmaila H, Muhammed SA. Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo‐control randomized trial. International Brazilian Journal of Urology 2008;34(6):708‐13; discussion 714. - PubMed
Vahdatpour 2013 {published data only}
    1. Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B. Long‐term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. Journal of Research in Medical Sciences 2014;19(4):293‐6. - PMC - PubMed
    1. Vahdatpour B, Alizadeh F, Moayednia A, Emadi M, Khorami MH, Haghdani S. Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial. ISRN Urology 2013;2013:972601. - PMC - PubMed
Vassily 1999 {published data only}
    1. Vassily O, Andrey S, Evgenii D, Otabek I, Boris L, Sergey R. Efficacy of transrectal microwave hyperthemia (TRMH) in the treatment of chronic prostatitis. A randomized sham controlled comparative study (Abstract). Journal of Urology 1999;161(4 Suppl):33A.
Wang 2002 {published data only}
    1. Wang J, Li J, Lu R, Wang JM. Treatment of external RF hyperthermia combining with alpha 1‐adrenergic receptor blocker for patients with prostatodynia and chronic non‐bacterial prostatitis. Zhonghua Nan Ke Xue 2002;8(1):48‐50. - PubMed
Yang 2011 {published data only}
    1. Yang ZS, Zu XB, Qi L, Song LM, Liu TR. Combination therapy of biofeedback with electrical stimulation for chronic prostatitis/chronic pelvic pain syndrome. Zhonghua Nan Ke Xue 2011;17(7):611‐4. - PubMed
Yoo 2009 {published data only}
    1. Chung H, Choi H, Yoo TK, Cho JM, Kim HS. The effects of microwave thermotherapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized study. Urogenital Tract Infection 2017;12(1):35‐41.
    1. Kim H, Chung H, Yang S, Yoo T, Cho J. Effects of thermotherapy and medical therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Urology 2011;78(3):S85‐6.
    1. Yoo TK, Moon KT, Lee SW, Kim HS, Chung H, Kim JY. Effect of the combination treatment of URO‐DrG and medical therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Journal of Urology 2009;181(4):122.
Zeng 2012 {published data only}
    1. Zeng X, Ye Z, Yang W, Chen Z, Du G. Extracorporeal shock wave treatment for noninflammatory chronic pelvic pain syndrome: a prospective, randomized, sham‐controlled study. Journal of Urology 2009;181(4):122‐3.
    1. Zeng XY, Liang C, Ye ZQ. Extracorporeal shock wave treatment for non‐inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham‐controlled study. Chinese Medical Journal 2012;125(1):114‐8. - PubMed
Zhang 2011a {published data only}
    1. Zhang DY, Pan XC. Chinese medicine union Taijiquan treatment chronicity non‐bacterial prostatitis curative effect observation. Chinese Manipulation & Rehabilitation Medicine 2011;15(2):181.
Zhao 2015 {published data only}
    1. Zhao Y, Zhao W, Lang G, Chen Y, Liu J, Wang G, et al. Circumcision plus antibiotic, anti‐inflammatory, and alpha‐blocker therapy for the treatment for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, multicenter trial. World Journal of Urology 2015;33(5):617‐22. - PubMed
Zimmermann 2009 {published data only}
    1. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double‐blind, placebo‐controlled study. European Urology 2009;56(3):418‐24. - PubMed
    1. Zimmermann RP, Cumpanas A, Miclea F, Janetschek G. One year follow up of extracorporeal shock wave therapy (ESWT) for chronic pelvic pain syndrome (CPPS) in a randomised placebo‐controlled double‐blind study. European Urology (Suppl) 2010;9(2):214.

References to studies excluded from this review

Aboumarzouk 2012 {published data only}
    1. Aboumarzouk OM, Nelson RL. Pregabalin for chronic prostatitis. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD009063.pub2] - DOI - PubMed
Aliaev 2006 {published data only}
    1. Aliaev IuG, Vinarov AZ, Lokshin KL, Spivak LG. Efficiency and safety of prostamol‐Uno in patients with chronic abacterial prostatitis. Urologiia 2006;1(1):47‐50. - PubMed
Allen 2017 {published data only}
    1. Allen S, Aghajanyan IG. Effect of thermobalancing therapy on chronic prostatitis and chronic pelvic pain syndrome. Journal of Clinical Urology 2017;10(4):347‐54.
    1. Allen S, Aghajanyan IG. New independent thermobalancing treatment with therapeutic device for chronic prostatitis/chronic pelvic pain syndrome. Nephro‐Urology Monthly 2017;9(2):1‐6.
Anothaisintawee 2011 {published data only}
    1. Anothaisintawee T, Attia J, Nickel JC, Thammakraisorn S, Numthavaj P, McEvoy M, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta‐analysis. JAMA 2011;305(1):78‐86. - PubMed
Barbalias 1998 {published data only}
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Bschleipfer 2007 {published data only}
    1. Bschleipfer T, Wagenlehner FM, Weidner W. Intraprostatic botulinum toxin A injection in chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) [Intraprostatische Botulinumtoxin‐A‐Injektion bei chronischer Prostatitis und chronischem Beckenschmerzsyndrom (CP/CPPS)]. Der Urologe. Ausg. A 2007;46(9):1030‐2. - PubMed
    1. Department of Urology, Pediatric Urology ‐ Justus‐Liebig‐University Giessen. Intraprostatic injection of Botulinumtoxin type A in patients with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) ‐ CP(BTX)PS. https://www.clinicaltrialsregister.eu/ctr‐search/trial/2007‐001602‐24/DE (accessed 22 January 2018) 2009.
Capodice 2005 {published data only}
    1. Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evidence‐based Complementary and Alternative Medicine : ECAM 2005;2(4):495‐501. - PMC - PubMed
Chambo 2009 {published data only}
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Chang 2016 {published data only}
    1. Chang SC, Hsu CH, Hsu CK, Yang SS, Chang SJ. The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: a systemic review and meta‐analysis. Neurourology and Urodynamics 2016;1:474‐81. - PubMed
Chen 2006 {published data only}
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Chuang 2006 {published data only}
    1. Chuang YC, Chancellor MB. The application of botulinum toxin in the prostate. Journal of Urology 2006;176(6 Pt 1):2375‐82. - PubMed
Cohen 2012 {published data only}
    1. Cohen JM, Fagin AP, Hariton E, Niska JR, Pierce MW, Kuriyama A, et al. Therapeutic intervention for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta‐analysis. PloS One 2012;7(8):e41941. - PMC - PubMed
Colleen 1975 {published data only}
    1. Colleen S, Mrdh PA. Effect of metacycline treatment on non‐acute prostatitis. Scandinavian Journal of Urology and Nephrology 1975;9(3):198‐204. - PubMed
DRKS00009352 {published data only}
    1. DRKS00009352. Effect of the physiotherapeutic device and thermobalancing therapy compared with no therapy on pain, urinary symptoms, quality of life and prostate volume in men with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). http://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID... (accessed 22 January 2018 via http://apps.who.int/trialsearch/ search portal).
Erickson 2008 {published data only}
    1. Erickson BA, Schaeffer AJ, Le B. Chronic prostatitis. BMJ Clinical Evidence 2008;2008:1802. - PMC - PubMed
Evliyaoglu 2002 {published data only}
    1. Evliyaoglu Y, Burgut R. Lower urinary tract symptoms, pain and quality of life assessment in chronic non‐bacterial prostatitis patients treated with alpha‐blocking agent doxazosin; versus placebo. International Urology and Nephrology 2002;34(3):351‐6. - PubMed
Feng 2011 {published data only}
    1. Feng H, Hu C, Li L. Influence of whole‐range systematic nursing intervention of therapeutic effect and compliance of patients with chronic prostatitis. Chinese Nursing Research 2011;25(5A):1146‐8.
Galeone 2012 {published data only}
    1. Galeone G, Spadavecchia R, Balducci MT, Pagliarulo V. The role of Proxelan in the treatment of chronic prostatitis. Results of a randomized trial [Ruolo di Proxelan nel trattamento delle prostatitit croniche. Risultati di un trial randomizzato]. Minerva Urologica e Nefrologica [Italian Journal of Urology and Nephrology] 2012;64(2):135‐41. - PubMed
Glybochko 2014 {published data only}
    1. Glybochko PV, Alyaev Yu G, Chalyj ME, Voskanyan GA. Primary assessment of electrode pharmaphoresis efficacy in treatment of chronic bacterial prostatitis. European Urology Supplements 2014;13(1):e571.
Golubchikov 2005 {published data only}
    1. Golubchikov VA, Sitnikov NV, Kochetov AG, Perekhodov SN, Sidorov OV, Roiuk RV, et al. Optimal treatment of benign prostatic hyperplasia (BPH) with comorbid chronic prostatitis (category IIIA). Urologiia 2005;1(4):9‐12. - PubMed
Hong 2008 {published data only}
    1. Hong JY, Zhang YY. Observation on therapeutic effect of abdominal cluster‐needling on chronic non‐bacterial prostatitis. Chinese Acupuncture & Moxibustion 2008;28(1):24‐6. - PubMed
Ikeuchi 1990 {published data only}
    1. Ikeuchi T. Clinical studies on chronic prostatitis and prostatitis‐like syndrome (4). The kampo treatment for intractable prostatitis. Hinyokika Kiyo 1990;36(7):801‐6. - PubMed
ISRCTN43221600 {published data only}
    1. ISRCTN43221600. Pilot study for the evaluation of a combined psycho‐ and physiotherapeutic treatment program for patients with chronic pelvic pain syndrome (CPPS). www.isrctn.com/ISRCTN43221600 (accessed 4 November 2017). [ISRCTN43221600]
Jimenez‐Pacheco 2014 {published data only}
    1. Jimenez‐Pacheco A, Jimenez‐Pacheco A, Nogueras‐Ocaña M. Analysis of therapeutic alternatives in the treatment of chronic prostatitis/syndrome chronic pelvic pain. Urology 2014;84(4):S241.
Kalinina 2015 {published data only}
    1. Kalinina SN, Koren'kov DG, Fesenko VN, Demidov DA, Tiktinskij NO. Pathogentic treatment of chronic nonbacterial prostatitis complicated by sperm disorders. Urologiia 2015;1(4):64‐6, 68. - PubMed
Kamalov 2006 {published data only}
    1. Kamalov AA, Efremov EA, Dorofeev SD, Paniushkin SM. Use of oral vitaprost in the treatment of chronic abacterial prostatitis. Urologiia 2006;1(5):45‐50. - PubMed
Kogan 2010 {published data only}
    1. Kogan MI, Shangichev AV, Belousov II. Efficacy of magnetolaser therapy of patients with an inflammatory form of chronic abacterial prostatitis. Urologiia 2010;1(2):42‐4. - PubMed
Kotarinos 2009 {published data only}
    1. Kotarinos R, Fortman C, Neville C, Badillo S, O'Dougherty B, Fraser L, et al. Physical findings in patients with urologic chronic pelvic pain syndromes (UCPPS). Neurourology and Urodynamics 2009;28(7):911‐2.
Le 2011 {published data only}
    1. Le B, Schaeffer AJ. Chronic prostatitis. BMJ Clinical Evidence 2011;2011:1802. - PMC - PubMed
Lee 2006 {published data only}
    1. Lee HN, Kim JS, Shim BS. The recurrence of chronic pelvic pain syndrome and the role of Uro‐Vaxom. Korean Journal of Urology 2006;47(1):42‐6.
Lee 2007 {published data only}
    1. Lee SW, Liong ML, Yuen KH, Liong YV, Krieger JN. Chronic prostatitis/chronic pelvic pain syndrome: role of alpha blocker therapy. Journal of Urology 2007;78(2):97‐105. - PubMed
Leng 2007 {published data only}
    1. Leng J, Lv J, Dai S, Chen B, Wang Y. The cocktail treatment of chronic nonbacterial prostatitis. Chinese Journal of Andrology 2007;21(1):26‐8.
Liu 2016 {published data only}
    1. Liu BP, Wang YT, Chen SD. Effect of acupuncture on clinical symptoms and laboratory indicators for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta‐analysis. International Urology and Nephrology 2016;48(12):1977‐91. - PubMed
Lokshin 2010 {published data only}
    1. Lokshin KL, Alyaev YG, Vinarov AZ, Spivak LG. Randomized open label comparative study of efficacy and safety of combination (ciprofloxacin+doxazosin) versus monotherapy (ciprofloxacin) in patients with category II or category IIIA prostatitis. Urologiia 2010;9(2):140.
Lopatkin 2009 {published data only}
    1. Lopatkin NA, Kamalov AA, Mazo EB, Dorofeev SD, Efremov EA, Kozdoba AS, et al. Administration of oral vitaprost for prevention of exacerbations of chronic abacterial prostatitis. Urologiia 2009;1(1):29‐35. - PubMed
Loran 2003 {published data only}
    1. Loran OB, Pushkar' DIu, Tedeev VV, Nosovitskii PB. Gentos in the treatment of chronic abacterial prostatitis. Urologiia 2003;1(6):30‐2. - PubMed
Ma 2015 {published data only}
    1. Ma Y, Li X, Li F, Yu W, Wang Z. Clinical research of chronic pelvic cavity pain syndrome treated with acupoint catgut embedding therapy. Zhongguo Zhen Jiu 2015;35(6):561‐6. - PubMed
    1. Ma Y, Wang ZL, Sun ZX, Men B, Shen BQ. Efficacy observation on chronic pelvic pain syndrome of damp‐heat stagnation pattern treated with acupoint catgut embedding therapy. Zhongguo Zhen Jiu 2014;34(4):351‐4. - PubMed
Magistro 2016 {published data only}
    1. Magistro G, Wagenlehner FM, Grabe M, Weidner W, Stief CG, Nickel JC. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. European Urology 2016;69(2):286‐97. - PubMed
Marx 2013 {published data only}
    1. Marx S, Cimniak U, Rutz M, Resch KL. Long‐term effects of osteopathic treatment of chronic prostatitis with chronic pelvic pain syndrome: a 5‐year follow‐up of a randomized controlled trial and considerations on the pathophysiological context [Langzeiteffekte osteopathischer Behandlungen bei chronischer Prostatitis/chronischem Beckenschmerzsyndrom: 5‐Jahres‐Follow‐up einer randomisiert kontrollierten Studie und Überlegungen zum pathophysiologischen Kontext]. Der Urologe. Ausg. A 2013;52(3):384‐90. - PubMed
McNaughton 2000 {published data only}
    1. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Annals of Internal Medicine 2000;133(5):367‐81. - PubMed
McNaughton 2001 {published data only}
    1. McNaughton Collins M, MacDonald R, Wilt TJ. Interventions for chronic abacterial prostatitis. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD002080] - DOI - PMC - PubMed
McNaughton 2002 {published data only}
    1. McNaughton Collins M, Wilt TJ. Allopurinol for chronic prostatitis. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD001041; CD001041] - DOI - PubMed
Mishra 2008 {published data only}
    1. Mishra VC, Browne J, Emberton M. Role of repeated prostatic massage in chronic prostatitis: a systematic review of the literature. Urology 2008;72(4):731‐5. - PubMed
NCT00194597 {published data only}
    1. NCT00194597. Trial of Viagra' in men with chronic pelvic pain syndrome type III. clinicaltrials.gov/ct2/show/NCT00194597 Date first registered: 19 September 2005.
NCT00194623 {published data only}
    1. NCT00194623. Botox as a treatment for chronic male pelvic pain syndrome. ClinicalTrials.gov/show/NCT00194623 Date first registered: 19 September 2005.
NCT00194636 {published data only}
    1. NCT00194636. Effectiveness of sympathetic plexus block on male pelvic pain (prostatitis, prostatodynia). clinicaltrials.gov/ct2/show/NCT00194636 Date first registered: 19 September 2005.
NCT00301405 {published data only}
    1. NCT00301405. Open‐label study of thalidomide for chronic prostatitis/chronic pelvic pain. clinicaltrials.gov/ct2/show/NCT00301405 Date first registered: 10 March 2006.
NCT00464373 {published data only}
    1. NCT00464373. Botulinum toxin type A for the treatment of male chronic pelvic pain syndrome. clinicaltrials.gov/ct2/show/NCT00464373 Date first registered: 23 April 2007.
NCT00529386 {published data only}
    1. NCT00529386. Botox for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). clinicaltrials.gov/ct2/show/NCT00529386 Date first registered: 14 September 2007.
NCT01678911 {published data only}
    1. NCT01678911. Efficacy of Gralise® for chronic pelvic pain. clinicaltrials.gov/ct2/show/NCT01678911 Date first registered: 5 September 2012.
NCT01830829 {published data only}
    1. NCT01830829. JALYN for benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). ClinicalTrials.gov/show/NCT01830829 Date first registered: 12 April 2013.
NCT02042651 {published data only}
    1. NCT02042651. A sham controlled study of the effects of ultrasonic shockwaves as a treatment for chronic pelvic pain. ClinicalTrials.gov/show/NCT02042651 Date first registered: 23 January 2014.
Nickel 2011 {published data only}
    1. Nickel JC, Roehrborn C, Montorsi F, Wilson TH, Rittmaster RS. Dutasteride reduces prostatitis symptoms compared with placebo in men enrolled in the REDUCE study. Journal of Urology 2011;186(4):1313‐8. - PubMed
Osborn 1981 {published data only}
    1. Osborn DE, George NJR, Rao PN. Prostatodynia ‐ physiological characteristics and rational management with muscle relaxants. British Journal of Urology 1981;53(6):621‐3. - PubMed
Pavone 2010 {published data only}
    1. Pavone C, Abbadessa D, Tarantino ML, Oxenius I, Lagana A, Lupo A, et al. Associating Serenoa repens, Urtica dioica and Pinus pinaster. Safety and efficacy in the treatment of lower urinary tract symptoms. Prospective study on 320 patients [Associazione di Serenoa repens, Urtica dioica e Pinus pinaster. Sicurezza ed efficacia]. Urologia 2010;77(1):43‐51. - PubMed
Posadzki 2012 {published data only}
    1. Posadzki P, Zhang J, Lee M S, Ernst E. Acupuncture for chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a systematic review. Journal of Andrology 2012;33(1):15‐21. - PubMed
Pushkar' 2006 {published data only}
    1. Pushkar' DIu, Zaitsev AV, Segal AS. Longidase in the treatment of chronic prostatitis. Urologiia 2006;1(6):26‐8. - PubMed
Qin 2016a {published data only}
    1. Qin Z, Wu J, Zhou J, Liu Z. Systematic review of acupuncture for chronic prostatitis/chronic pelvic pain syndrome. Medicine (Baltimore) 2016;95(11):e3095. - PMC - PubMed
Qin 2016b {published data only}
    1. Qin Z, Wu J, Tian J, Zhou J, Liu Y, Liu Z. Network meta‐analysis of the efficacy of acupuncture, alpha‐blockers and antibiotics on chronic prostatitis/chronic pelvic pain syndrome. Scientific Reports 2016;6:35737. - PMC - PubMed
Razumov 2005 {published data only}
    1. Razumov SV, Egorov AA. Validity of using physical therapy in combined treatment of chronic prostatitis. Urologiia 2005;1(2):42‐6. - PubMed
Simmons 1985 {published data only}
    1. Simmons PD, Thin RN. Minocycline in chronic abacterial prostatitis: a double‐blind prospective trial. British Journal of Urology 1985;57(1):43‐5. - PubMed
Stamatiou 2014 {published data only}
    1. Stamatiou KN, Moschouris H. A prospective interventional study in chronic prostatitis with emphasis to clinical features. Urology Journal 2014;11(4):1829‐33. - PubMed
Takahashi 2005 {published data only}
    1. Takahashi K, Ozaki Y, Yoshida T, Fujimoto N, Matsumoto T, Nakashima M, et al. Clinical evaluation of treatment using mainly levofloxacin and cernitin pollen extract for chronic non‐bacterial prostatitis as judged by the National Institutes of Health Chronic Prostatitis Symptom Index. Nishinihon Journal of Urology 2005;67(11):637‐48.
Thakkinstian 2012 {published data only}
    1. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. Alpha‐blockers, antibiotics and anti‐inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU International 2012;110(7):1014‐22. - PubMed
Thin 1983 {published data only}
    1. Thin RN, Simmons PD. Review of results of four regimens for treatment of chronic non‐bacterial prostatitis. British Journal of Urology 1983;55(5):519‐21. - PubMed
Tkachuk 2006 {published data only}
    1. Tkachuk VN, Al'‐Shukri SKh, Lotsan‐Medvedev AK. Vitaprost efficacy in patients with chronic abacterial prostatitis. Urologiia 2006;1(2):71‐2, 74. - PubMed
Tkachuk 2011 {published data only}
    1. Tkachuk VN, Al'‐Shukri SKh, Tkacuk IN, Kornienko VI. Correction of erectile dysfunction in patients with chronic abacterial prostatitis. Urologiia 2011;1(6):29‐31. - PubMed
Wagenlehner 2017 {published data only}
    1. Wagenlehner FME, Till JWO, Houbiers JGA, Martina RV, Cerneus DP, Melis JHJM, et al. Fatty acid amide hydrolase inhibitor treatment in men with chronic prostatitis/chronic pelvic pain syndrome: an adaptive double‐blind, randomized controlled trial. Urology 2017;103:191‐7. [PUBMED: 28254462] - PubMed
Xu 2004 {published data only}
    1. Xu S, Qi G, Tang P, Li Y. Combined therapy for the chronic pelvic pain syndrome. Zhonghua Nan Ke Xue 2004;10(6):429‐30, 433. - PubMed
Yang 2006 {published data only}
    1. Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q. The effect of alpha‐adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta‐analysis of randomized controlled trials. Journal of Andrology 2006;27(6):847‐52. - PubMed
Yang 2008 {published data only}
    1. Yang M, Zhao X, Hou Y. Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta‐analysis of randomized controlled trials (RCTs). Chinese Journal of Andrology 2008;22(4):20‐6.
Zhang 2011b {published data only}
    1. Zhang MJ, Weng JF, Shi YL, Cheng WJ, Ruan XJ, Zhang QY. Effect of aike mixture on the inflammatory infiltration in patients with chronic prostatitis type III A. Chinese Journal of Integrative Medicine 2011;17(1):26‐30. - PubMed
Zhou 2017 {published data only}
    1. Zhou M, Yang M, Chen L, Yu C, Zhang W, Ji J, et al. The effectiveness of long‐needle acupuncture at acupoints BL30 and BL35 for CP/CPPS: a randomized controlled pilot study. BMC Complementary and Alternative Medicine 2017;17:1‐6. - PMC - PubMed

References to studies awaiting assessment

Rochester 2011 {published and unpublished data}
    1. Rochester M, Armitage J, Sanders M, Christmas P. Self management activation randomised trial for prostatitis (SMART‐P): study protocol for a randomised controlled trial. Trials 2011;12:210. [ISRCTN21012555] - PMC - PubMed

References to ongoing studies

ChiCTR‐IPR‐16009262 {published data only}
    1. ChiCTR‐IPR‐16009262. A randomized controlled trial of psychological intervention therapy in patients with category III chronic prostatitis/chronic pelvic pain syndrome. http://www.chictr.org.cn/showprojen.aspx?proj=15638 (accessed 22 January 2018 via http://apps.who.int/trialsearch/ search portal).
NCT01828996 {unpublished data only}
    1. Shocking Therapy for Chronic Pelvic Pain Syndrome (CPPS).. Ongoing study February 2013..
NCT02588274 {published and unpublished data}
    1. Qin Z, Zang Z, Wu J, Zhou J, Liu Z. Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndromes: study protocol for a randomized, sham acupuncture‐controlled trial. BMC Complementary and Alternative Medicine 2016;16(1):440. [PUBMED: 27821109] - PMC - PubMed
NCT03213938 {published data only}
    1. NCT03213938. Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a multicenter randomized controlled trial. clinicaltrials.gov/ct2/show/NCT03213938 Date first registered: 11 July 2017.

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MeSH terms

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