Rawal Medical Journal

Transcription

1 Rawal Medical Journal An official publication of Pakistan Medical Association Rawalpindi Islamabad branch Established 1975 Volume 36 Number 4 October - December 2011 Original Article Role of alpha blockers in the management of chronic prostatitis Firas Azer Khori, Mohanned M Naser, Awad B Kaabneh Prince Hussien Urology Center, Prince Rashid Military Hospital, King Hussien Medical City, Amman, Jordan ABSTRACT Objective To evaluate the role of α-blockers in treatment of chronic prostatitis. Methods A total of 124 patients with chronic prostatitis were followed in urology clinic at Prince Rashid Military Hospital from January 2006 to march Only 98 patients completed the study and were divided into two groups; group A managed with α-blockers and group B with placebo. Results There was same response rate in both groups, with 48.7% decrease of at least 4 points in their total NIH-CPSI score from base line to 6 weeks.

2 Conclusion We found that α-blockers are not helpful in the management of chronic prostatitis. (Rawal Med J 2011;36: ). Key words Prostatitis, alpha blockers, INTRODUCTION Prostatitis is considered to be one of the common causes of visit to urology clinic. It accounts for 3-8% of out patients visit to urology clinics in North America and Europe. 1-3 It is classified into four subtypes according to National Institution of Health (NIH): Type I: acute bacterial prostatitis, Type II: chronic bacterial prostatitis, Type III: chronic prostatitis, chronic pelvic pain syndrome (CP\CPPS), which is the commonest type, and Type IV: asymptomatic inflammatory prostatitis. 4-6 α-blockers have been used to treat the symptoms of chronic prostatitis as well as benign prostate hyperplasia by virtue of their effect on the muscles of prostate and bladder neck. 6 These are one of three commonest prescribed medicines by urologists for chronic prostatitis i.e antibiotics, alpha blockers and anti inflammatory drugs. 7 The aim of this study was to evaluate the role of α-blockers in treatment of chronic prostatitis. PATIENTS AND METHODS A total of 124 patients of chronic prostatitis were followed in urology clinic at Prince Rashid Military Hospital between January 2006 and March Only 98 patients completed the study. We divided the patients into two groups; group A (49 patients) managed with α-blocker

3 Doxazosin 4mg once daily and group B (49 patients) used placebo. The period of the study lasted for 6 weeks. We used the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) 4 to measure the improvement of our patients. NIH-CPSI takes into account pain symptoms, urinary symptoms and impact on quality of life, with a total score of (0-43). We measured the score for our patients before and after treatment. Patients were classified as responders if there was 4 points or more improvement and non responders if less than 4 points were achieved. In both groups, patients ages are symmetrical (27-45years), RESULTS Of 124 patients, 26 patients did not complete with the study, only 98 patients did. The ages of patients range from 27 year to 45 years (mean 39 years). All patients were married. 48.7% men on alpha blocker showed a decrease of at least 4 points in their total NIH-CPSI score at 6 weeks. There was almost same rate of response in patients on placebo. At global response, we did not find any significant difference (p=0.7) or changes over time in the secondary outcome between the two groups, (32.4% vs33.6%). DISCUSSION Chronic prostatitis patients experience a difficult and worse quality of life than patients suffering from benign prostate hyperplasia or even most of patients with prostate cancer. 5 α- Blockers are considered to be an important modality of treatment of chronic prostatitis/chronic pelvic pain syndrome, as several studies have shown that they improve symptoms of chronic prostatitis and decrease the risk of urine retention Cheah et al did a randomized study on 86 patients with

4 chronic prostatitis using α- blockers and placebo, and reported significant response with 50% reduction in the mean symptoms score compared to 37% in placebo. 8 A 65% improvement of symptoms in comparison with only 42% with placebo, 9 and 52% response with α- blockers compared with 33% with placebo have been reported. 10 On the contrary, no significant response with α- blockers in chronic prostatitis was obtained by Alexander et al who did a large multicenter randomized trial of treatment on patients with CP\CPPS in two groups, one with ciprofloxacin and α-blockers, other group with placebo. They found no difference among these drugs, either mono or multi therapy treatment of CP\CPPS. 11 CONCLUSION In our study, our findings did not support use of α-blockers, in treating chronic prostatitis. Correspondence: Awad B Al-kaabneh. awadalkaabneh@gmail.com Received: April 07, 2011 Accepted: September 26, 2011 REFERENCES 1. Nickel JC, Teichman JMH, Gregoire M, Clark J, Downey J. Prevalence,diagnosis,charecterization,and treatement of prostatitis,interstisial cystitis,and epidymitis in outpatient urological practice:the Canadian PIE study. Urology 2005:66: McNaughton-Collins M, Stafford RS, Oleary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998;159:

5 3. Rizzo M, Marchetti F, Travaglini F, Trienchieri A, Nickel JC. Prevalence, diagnosis and treatment of prostatitis in Italy, a prospective urology outpatient practice study. Br J Urol Int 2004:23: Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999:282: Nickel JC. Alpha Blockers for the treatment of prostatitis like syndromes. Rev Urol 2006:8(suppl 4):S26-S Gul O, Eroglu M, Ozok U. Use of terazosine in patients with chronic pelvic pain syndrome and evaluation by prostatitis symptom score index. Int Urol Nephrol 2001:32: Nickel JC. The three A s of chronic prostatitis therapy,antibiotics,alpha blockers, and anti inflamatories.what is the evidence? Br J Urol Int 2004,94: Cheah PY, Liong ML, Yuen KH, Teh CL, Khor T, Yang JR. Terazosin therapy for chronic prostatitis chronic pelvic pain syndrome: a randomized placebo controlled trial. J Urol 2003:169: Mehik A, Alas P, Nickel JC, Sarpola A, Helstrom PJ. Alfuzosin treatement for chronic prostatitis chronic pelvic pain syndrome: a prospective, randomized, double blind, placebo controlled, pilot study. Urology 2003:62: Nickel JC, Narayan P, Mckay J, Dolye C. Treatement of chronic prostatitis chronic pelvic pain syndrome with tamsulosin:a randomized double blind trial. J Urol 2004:171:

6 11. Alexander RB, Propert KI, Schaeffer AJ, Landis JR, Nickel JC, O Leary MP, et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis chronic pelvic pain syndrome: a randomized, double blind trial. Ann Intern Med 2004:141: Propert KJ, Alexander RB, Nickel JC, Kusek JW, Litwin MS, Landis JR, et al. Desgin of a multicenter randomized clinical trial of chronic prostatitis chronic pelvic pain syndrome. Urology 2002:59: Nickel JC, Downey J, Arden D, Clark J, Nickel K. Failure of a monotherapy strategy for difficult of chronic prostatitis/chronic pelvic pain syndrome. J Urol 2004:172: Mc Naughton,CM. The impact of chronic prostatitis/chronic pelvic pain syndrome on patients. World J Urol 20003,21: Kramer G, Mitteregger M, Marberger M. Is benign prostate hyperplasia(bph)an immune inflammatory disease? Eur Urol 2007;51: Propert KJ, Litwin M, Wang Y, Alexander RB, Calhoun E, Nickel JC, et al. Responsiveness of National Institutes of Health- Chronic Prostatitis Symptom Index (NIH-CPSI). Qual life Res 2006,15: Dimitrakov JD, Kaplan SA, Kroenke K, Jackson JL, Freeman MR. Manegemant of chronic prostatitis/chronic pelvic pain syndrome: an evidence- based approach. Urology 2006;67:881-8.

7 Table 1. NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) Pain or Discomfort 1. In the last week, have you experienced any pain or discomfort in the following areas? Yes No a. Area between rectum and 1 0 testicles (perineum) b. Testicles 1 0 c. Tip of the penis (not related to 1 0 urination) d. Below your waist, in your 1 0 pubic or bladder area 2. In the last week, have you experienced: Yes No a. Pain or burning during 1 0 urination? b. Pain or discomfort during or 1 0 after sexual climax (ejaculation)? 3. How often have you had pain or discomfort in any of these areas over the last week? 0 Never 1 Rarely 2 Sometimes 3 Often 4 Usually 5 Always 4. Which number best describes your AVERAGE pain or discomfort on the days that you had it, over the last week? No pain Pain bad as you can imagine Urination 5. How often have you had a sensation of not emptying your bladder completely after you finished urinating, over the last week? 0 Not at all 1 Less than 1 time in 5 2 Less than half the time 3 About half the time 4 More than half the time 5 Almost always 6. How often have you had to urinate again less than two hours after you finished urinating, over the last week? 0 Not at all 1 Less than 1 time in 5 2 Less than half the time 3 About half the time 4 More than half the time 5 Almost always Impact of Symptoms 7. How much have your symptoms kept you from doing the kinds of things you would usually do, over the last week? 0 None 1 Only a little 2 Some 3 A lot 8. How much did you think about your symptoms, over the last week? 0 None 1 Only a little 2 Some 3 A lot Quality of Life 9. If you were to spend the rest of your life with your symptoms just the way they have been during the last week, how would you feel about that? 0 Delighted 1 Pleased 2 Mostly satisfied 3 Mixed (about equally satisfied and dissatisfied) 4 Mostly dissatisfied 5 Unhappy 6 Terrible Scoring the NIH-Chronic Prostatitis Symptom Index Domains Pain: Total of items 1a, 1b, 1c,1d, 2a, 2b, 3, and 4 = Urinary Symptoms: Total of items 5 and 6 = Quality of Life Impact: Total of items 7, 8, and 9

8