The Management of Chronic Prostatitis/Chronic Pelvic Pain ... · label represents a heterogeneous...

The Management of Chronic ProstatitisChronic Pelvic Pain Syndrome

Proposal for a systematic review and network meta-analysis

Thunyarat Anothaisintawee MD

Section for Clinical Epidemiology and Biostatistics Department of Family Medicine Faculty of

Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand

e-mail rattanmahidolacth

John Attia MD PhD FRCPC

Centre for Clinical Epidemiology and Biostatistics School of Medicine and Public Health

University of Newcastle and Hunter Medical Research Institute Newcastle NSW Australia

e-mail johnattianewcastleeduau

J Curtis Nickel MD FRCSC

Department of Urology Queens University Kingston Ontario Canada

e-mail jcnqueensuca

Sangsuree Thammakraisorn MD

Department of Family Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University

Bangkok Thailand

e-mail rasazmahidolacth

Pawin Numthavaj MD

1

Section for Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi Hospital

Mahidol University Bangkok Thailand

E-mail pawinpawingmailcom

Mark McEvoy MSc


University of New Castle NSW Australia

e-mail markmcevoynewcastleeduau

Ammarin Thakkinstian PhD



e-mail raatkmahidolacth

Corresponding author

Ammarin Thakkinstian Section for Clinical Epidemiology and Biostatistics Ramathibodi Hospital

Rama VI Road Rachatevi Bangkok Thailand 10400 Tel 6622011762 Fax 6622011284

Emailraatkmahidolacth

Word counts 1210

2

INTRODUCTION

ldquoProstatitisrdquo is a common condition with an estimated prevalence in the community of about 91

and accounted for nearly 2 million ambulatory care encounters annually in the US2 However this

label represents a heterogeneous mix of conditions including acute prostatitis chronic bacterial

prostatitis and asymptomatic inflammatory prostatitis with 90-95 of cases being chronic

prostatitischronic pelvic pain syndrome (CPCPPS) 34 CPCPPS is a clinical entity defined as

urologic pain or discomfort in the pelvic region associated with urinary symptoms andor sexual

dysfunction lasting for at least 3 of the previous 6 months These symptoms can diminish not only

quality of life but can also impact physical and psychological function 5 It is a diagnosis of

exclusion and patients should not have active urethritis urogenital cancer urinary tract disease

urethral stricture or neurologic disease affecting the bladder

Although many possible mechanisms have been proposed the etiology of CPCPPS is still

uncertain but may include inflammatory or noninflammatory etiologies6-8 An inciting agent may

cause inflammation or neurological damage in or around the prostate and lead to pelvic floor

neuromuscular dysfunction andor neuropathic pain Factors predisposing individuals to prostatitis

may include genetic predisposition infection voiding abnormalities hormonal imbalance intra-

prostatic reflux immunological or allergic triggers or psychological traits As a result a wide

variety of therapies including α-blockers antibiotics anti-inflammatories and other agents (eg

finasteride phytotherapy and gabapentinoids) are routinely employed However the efficacy of

these treatments is controversial 9-15 partly due to the fact that many of these studies were of small

size with low power to detect treatment effects

To date only one systematic review of α-blockers versus placebo has been performed for the

treatment of CPCPPS 6 Therefore we will perform a systematic review and network meta-

3

analysis mapping all treatment regimens with the following aims first to compare means of total

symptom pain voiding and quality of life scores between α-blocker (the most commonly

evaluated therapy for CPCPPS) and other active drugs or placebo groups second to compare the

rates of response to treatment in these groups

METHODS

Search Strategy

Medline and EMBASE databases will be used for identifying relevant studies published in English

from 1949 (for Medline) or 1974 (for EMBASE) until November 16th 2010 Search terms and

strategies for each database will be described in an Appendix Reference lists of included trials and

previous systematic reviews 6 will also be explored

Selection of studies

Identified studies will be first selected based on their title and abstract by two independent authors

(TA and ST) Full papers will be retrieved if a decision cannot be made from the abstracts

Agreement between the two reviewers will be measured using the kappa statistic Disagreement

will be resolved by consensus and discussion with a third party (AT and JCN)

Inclusion criteria

Randomized controlled studies that were published in English will be selected if they meet with

the following criteria

- Participants with IIIA or IIIB (CPCPPS) categories according to the National

Institutes of Health classification4

- Compared any pair of the following interventions α-blockers antibiotics steroidal amp

non-steroidal anti-inflammatory drugs finasteride glycosminoglycans phytotherapy

gabapentinoids or placebo

4

- Had any of the following outcomes of interest pain scores voiding scores quality of

life scores and total symptom scores (ie a summation of pain voiding and quality of

life scores)

- Full paper can be retrieved and has sufficient data for extraction including number of

patients mean and standard deviation of continuous outcomes in each group andor

numbers of patients per group for dichotomous outcomes

Data extraction

Two authors (TA ST) will independently extract data using a standardized extraction form Any

disagreement will be resolved by discussion or consensus with a third party (AT) Relevant

missing information on the trials will be sought by contacting the corresponding authors of the

studies

Risk of bias assessment

Two authors (TA and PN) will independently assessed risk of bias of each study using an

established tool16 Six domains will be assessed ie sequence generation allocation concealment

blinding incomplete outcome data selective outcome reporting and other sources of bias

Disagreement between the two authors will be resolved by consensus and discussion Levels of

agreement for each domain and the overall domains will be assessed using the Kappa statistic

Outcomes

The outcomes of interest are symptom scores (eg total symptom pain voiding and quality of

life scores) and response rates as defined in the original papers using the following tools

5

- NIH chronic prostatitis symptom index (NIH-CPSI) consisting of three domains (ie

pain voiding and quality of life) The overall total scores range from 0 to 4317

- International prostate symptom score (IPSS ) questionnaire18 consisting of three

domains (ie voiding pain and quality of life) with combined total scores which

range from 0 to 51

- Prostatitis symptom score index (PSSI) measuring only pain scores with a total score

range from 0 to 12

- Pain and voiding questionnaires19 which consists of 7 and 5 items respectively grading

each item from 0 to 3

For all of these measurements scores close to 0 reflect more favourable status The minimal

clinical significant difference for all these scales is in the range from 3 to 6 points20-23 For

response to treatment various definitions will be used as in the original studies eg 25 33 or

50 decreases in NIH-CPSI or 4 (clinically perceptible improvement) - 6 (clinically significant

improvement) unit score decreases in NIH-CPSI from baseline

Statistical Analysis

For direct meta-analysis the mean differences of continuous outcomes (ie total score pain

voiding and quality of life scores) between treatment groups will be estimated for each study and

pooled using a standardized mean difference (SMD) if the scale used for measurements is

different otherwise an unstandardized mean difference (USMD) will be applied Heterogeneity of

the mean difference will be assessed using Q and I2 statistics If heterogeneity is present or the

degree of heterogeneity I2 is gt 25 the SMD will be estimated using a random effects model

otherwise a fixed effects model will be applied

6

Relative risk (RR) of response to treatment will be estimated for each study If there is evidence of

heterogeneity a random effects model will be used for pooling otherwise the inverse-variance

method will be used The source of heterogeneity will be explored by fitting co-variables (ie

mean age duration of treatment and baseline total symptom scores) one by one in the meta-

regression Publication bias will be assessed using contour enhanced funnel plots and Eggerrsquos test

24 25

For indirect comparisons network meta-analysis will be applied to assess treatment effects for all

possible treatment arms if summary data is available 26-28 Linear regression models weighted by

inverse variance will be applied to assess treatment effects for continuous outcomes and study

variables will be included as covariates in the model For response to treatment summary data

will be expanded to individual patient level data using the expand command in STATA Treatment

groups will be considered in a mixed effect hierarchical model with a log-link function using the

xtpoisson command26 The pooled RRs and 95 confidence interval (CI) will be estimated by

exponential coefficients of treatments All analyses will be performed using STATA version

11029 P values with two-sided tests lt 005 will be considered statistically significant except for

the heterogeneity test where one-sided p lt010 will be used

References 1 Roberts RO Lieber MM Rhodes T Girman CJ Bostwick DG Jacobsen SJ Prevalence of

a physician-assigned diagnosis of prostatitis the Olmsted County Study of Urinary

Symptoms and Health Status Among Men Urology Apr 199851(4)578-584

7

2 Collins MM Stafford RS OLeary MP Barry MJ How common is prostatitis A national

survey of physician visits J Urol Apr 1998159(4)1224-1228

3 de la Rosette JJ Hubregtse MR Meuleman EJ Stolk-Engelaar MV Debruyne FM

Diagnosis and treatment of 409 patients with prostatitis syndromes Urology Apr

199341(4)301-307

4 Krieger JN Nyberg L Jr Nickel JC NIH consensus definition and classification of

prostatitis JAMA Jul 21 1999282(3)236-237

5 McNaughton Collins M Pontari MA OLeary MP et al Quality of life is impaired in men

with chronic prostatitis the Chronic Prostatitis Collaborative Research Network Journal of

general internal medicine Oct 200116(10)656-662

6 McNaughton Collins M MacDonald R Wilt TJ Diagnosis and treatment of chronic

abacterial prostatitis a systematic review Ann Intern Med Sep 5 2000133(5)367-381

7 Hetrick DC Ciol MA Rothman I Turner JA Frest M Berger RE Musculoskeletal

dysfunction in men with chronic pelvic pain syndrome type III a case-control study J

Urol Sep 2003170(3)828-831

8 Hochreiter WW Nadler RB Koch AE et al Evaluation of the cytokines interleukin 8 and

epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic

secretions Urology Dec 20 200056(6)1025-1029

9 Nickel JC Krieger JN McNaughton-Collins M et al Alfuzosin and symptoms of chronic

prostatitis-chronic pelvic pain syndrome N Engl J Med Dec 18 2008359(25)2663-2673

10 Tugcu V Tasci AI Fazlioglu A et al A Placebo-Controlled Comparison of the Efficiency

of Triple- and Monotherapy in Category III B Chronic Pelvic Pain Syndrome (CPPS)

European Urology 200751(4)1113-1118

8

11 Goldmeier D Madden P McKenna M Tamm N Treatment of category III A prostatitis

with zafirlukast A randomized controlled feasibility study International Journal of STD

and AIDS 200516(3)196-200

12 Nickel JC Pontari M Moon T et al A randomized placebo controlled multicenter study

to evaluate the safety and efficacy of rofecoxib in the treatment of chronic nonbacterial

prostatitis Journal of Urology 2003169(4)1401-1405

13 Elist J Effects of pollen extract preparation ProstatPoltit on lower urinary tract symptoms

in patients with chronic nonbacterial prostatitischronic pelvic pain syndrome a

randomized double-blind placebo-controlled study Urology Jan 200667(1)60-63

14 Shoskes DA Zeitlin SI Shahed A Rajfer J Quercetin in men with category III chronic

prostatitis a preliminary prospective double-blind placebo-controlled trial Urology Dec

199954(6)960-963

15 Wagenlehner FM Schneider H Ludwig M Schnitker J Brahler E Weidner W A pollen

extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain

syndrome a multicentre randomised prospective double-blind placebo-controlled phase

3 study Eur Urol Sep 200956(3)544-551

16 Higgins JPT ADe Assessing risk of bias in included studies Cochrane Handbook for

Systematic Reviews of Interventions [wwwcochrane-handbookorg] 2008 501 2008

17 Litwin MS McNaughton-Collins M Fowler FJ Jr et al The National Institutes of Health

chronic prostatitis symptom index development and validation of a new outcome measure

Chronic Prostatitis Collaborative Research Network J Urol Aug 1999162(2)369-375

18 Cockett ATK KS Aso Y et al The Second International Consultation on Benign Prostatic

Hyperplasia Scientific Communication International Channel Island1994624-635

9

19 Krieger JN Egan KJ Ross SO Jacobs R Berger RE Chronic pelvic pains represent the

most prominent urogenital symptoms of chronic prostatitis Urology Nov

199648(5)715-721 discussion 721-712

20 Alexander RB Propert KJ Schaeffer AJ et al Ciprofloxacin or tamsulosin in men with

chronic prostatitischronic pelvic pain syndrome a randomized double-blind trial Ann

Intern Med Oct 19 2004141(8)581-589

21 Bates SM Hill VA Anderson JB et al A prospective randomized double-blind trial to

evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of

chronic prostatitischronic pelvic pain syndrome BJU International 200799(2)355-359

22 Nickel JC Treatment of chronic prostatitischronic pelvic pain syndrome International

Journal of Antimicrobial Agents 200831(Supplement 1)112-116

23 Nickel JC Narayan P McKay J Doyle C Treatment of chronic prostatitischronic pelvic

pain syndrome with tamsulosin A randomized double blind trial Journal of Urology

2004171(4)1594-1597

24 Moreno SG Sutton AJ Turner EH et al Novel methods to deal with publication biases

secondary analysis of antidepressant trials in the FDA trial registry database and related

journal publications BMJ (Clinical research ed 2009339b2981

25 Nuesch E Trelle S Reichenbach S et al Small study effects in meta-analyses of

osteoarthritis trials meta-epidemiological study BMJ (Clinical research ed341c3515

26 Lu G Ades AE Combination of direct and indirect evidence in mixed treatment

comparisons Stat Med Oct 30 200423(20)3105-3124

27 Song F Altman DG Glenny AM Deeks JJ Validity of indirect comparison for estimating

efficacy of competing interventions empirical evidence from published meta-analyses

BMJ (Clinical research ed Mar 1 2003326(7387)472

10

28 Song F Harvey I Lilford R Adjusted indirect comparison may be less biased than direct

comparison for evaluating new pharmaceutical interventions J Clin Epidemiol May

200861(5)455-463

29 Stata Release 11 Statistical Software [computer program] Version Release 11 College

Station TX StataCorp LP 2009

30 Kaplan SA Volpe MA Te AE A prospective 1-year trial using saw palmetto versus

finasteride in the treatment of category III prostatitischronic pelvic pain syndrome Journal

of Urology 2004171(1)284-288

31 Kulovac B Aganovic D Prcic A Hadziosmanovic O Management of chronic nonbacterial

prostatitischronic pelvic pain syndrome Bosn J Basic Med Sci Aug 20077(3)245-249

32 Cheah PY Liong ML Yuen KH et al Terazosin therapy for chronic prostatitischronic

pelvic pain syndrome A randomized placebo controlled trial Journal of Urology

2003169(2)592-596

33 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 200234(3)351-356

34 Gul O Eroglu M Ozok U Use of terazosine in patients with chronic pelvic pain syndrome

and evaluation by prostatitis symptom score index International Urology and Nephrology

200132(3)433-436

35 Jeong CW Lim DJ Son H Lee SE Jeong H Treatment for chronic prostatitischronic

pelvic pain syndrome Levofloxacin doxazosin and their combination Urologia

Internationalis 200880(2)157-161

36 Leskinen M Lukkarinen O Marttila T Effects of finasteride in patients with inflammatory

chronic pelvic pain syndrome A double-blind placebo-controlled pilot study Urology

199953(3)502-505

11

37 Mehik A Alas P Nickel JC Sarpola A Helstrom PJ Alfuzosin treatment for chronic

prostatitischronic pelvic pain syndrome A prospective randomized double-blind

placebo-controlled pilot study Urology 200362(3)425-429

38 Nickel JC Downey J Clark J et al Levofloxacin for chronic prostatitischronic pelvic pain

syndrome in men A randomized placebo-controlled multicenter trial Urology

200362(4)614-617

39 Nickel JC Downey J Pontari MA Shoskes DA Zeitlin SI A randomized placebo-

controlled multicentre study to evaluate the safety and efficacy of finasteride for male

chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis) BJU

International 200493(7)991-995

40 Nickel JC Forrest JB Tomera K et al Pentosan polysulfate sodium therapy for men with

chronic pelvic pain syndrome a multicenter randomized placebo controlled study J Urol

Apr 2005173(4)1252-1255

41 Ye ZQ Lan RZ Yang WM Yao LF Yu X Tamsulosin treatment of chronic non-bacterial

prostatitis Journal of International Medical Research 200836(2)244-252

42 Zhao WP Zhang ZG Li XD et al Celecoxib reduces symptoms in men with difficult

chronic pelvic pain syndrome (Category IIIA) Brazilian Journal of Medical and Biological

Research 200942(10)963-967

43 Zhou Z Hong L Shen X et al Detection of nanobacteria infection in type III prostatitis

Urology Jun 200871(6)1091-1095

44 Pontari MA Krieger JN Litwin MS et al Pregabalin for the Treatment of Men With

Chronic ProstatitisChronic Pelvic Pain Syndrome A Randomized Controlled Trial Arch

Intern Med September 20101701586-1593

12

45 Shoskes DA Nickel JC Dolinga R Prots D Clinical phenotyping of patients with chronic

prostatitischronic pelvic pain syndrome and correlation with symptom severity Urology

Mar 200973(3)538-542 discussion 542-533

46 Nickel JC Moon T Chronic bacterial prostatitis an evolving clinical enigma Urology Jul

200566(1)2-8

47 Nickel JC Xiang J Clinical significance of nontraditional bacterial uropathogens in the

management of chronic prostatitis J Urol Apr 2008179(4)1391-1395

48 Shoskes DA Nickel JC Kattan MW Phenotypically directed multimodal therapy for

chronic prostatitischronic pelvic pain syndrome a prospective study using UPOINT

Urology Jun 201075(6)1249-1253

49 Galley HF Nelson SJ Dubbels AM Webster NR Effect of ciprofloxacin on the

accumulation of interleukin-6 interleukin-8 and nitrite from a human endothelial cell

model of sepsis Crit Care Med Aug 199725(8)1392-1395

50 Yoshimura T Kurita C Usami E et al Immunomodulatory action of levofloxacin on

cytokine production by human peripheral blood mononuclear cells Chemotherapy Nov-

Dec 199642(6)459-464

51 Katsuno G Takahashi HK Iwagaki H et al The immunosuppressive effects of

ciprofloxacin during human mixed lymphocyte reaction Clin Immunol Apr

2006119(1)110-119

52 Nickel JC Shoskes D Phenotypic Approach to the management of the Chronic

ProstatitisChronic Pelvic Pain Syndrome BJU Int 2010in press

53 Lee SW Liong ML Yuen KH Liong YV Krieger JN Chronic prostatitischronic pelvic

pain syndrome role of alpha blocker therapy Urol Int 200778(2)97-105

54 Murphy AB Macejko A Taylor A Nadler RB Chronic prostatitis management strategies

Drugs 200969(1)71-84

13

55 Yang G Wei Q Li H Yang Y Zhang S Dong Q The effect of alpha-adrenergic

antagonists in chronic prostatitischronic pelvic pain syndrome a meta-analysis of

randomized controlled trials J Androl Nov-Dec 200627(6)847-852

56 Caldwell DM Ades AE Higgins JP Simultaneous comparison of multiple treatments

combining direct and indirect evidence BMJ (Clinical research ed Oct 15 2005

331(7521)897-900

14

Figure legends

Figure 1 Flow chart of selecting studies

Figure 2 Contour enhanced funnel plot

A) Total score between α-blocker and placebo groups

B) Pain

C) Void

D) QoL

A)

15

Table 1 Characteristics of included studies

Author Intervention No of subjects

Duration of treatment (weeks)

Outcome measurement

Mea

α-blocker vs placebo

Nickel JC9 2008 Alfuzosin 138 12 NIH-CPSI 40 Placebo 134 Tugcu V10 2007 Doxazosin 30 24 NIH-CPSI 29 Placebo 30 Alexander RB20 2004 Ciprofloxacin 49 6 NIH-CPSI 44 Placebo 49 Nickel JC23 2004 Tamsulosin 27 6 NIH-CPSI 40 Placebo 30 Cheah PY32 2003 Terazosin 43 14 NIH-CPSI 35 Placebo 43 Evliyaoglu Y33 2002 Doxazosin 30 12 IPSS pain score 3 Placebo 30 Gul O34 2001 Terazosine 39 12 PSSI 3 Placebo 30 Mehik A37 2003 Alfuzosin 19 24 NIH-CPSI 4 Placebo 21 Author Intervention No of

subjects Duration of treatment (weeks)

Outcome measurement

Mea

Antibiotic vs placebo

Alexander RB20 2004 Tamsulosin 49 6 NIH-CPSI 44 Placebo 49 Nickel JC38 2003 Levofloxacin 45 6 NIH-CPSI 56 Placebo 35 Zhou Z43 2008 Tetracycline HCL 24 12 NIH-CPSI Placebo 24 Author Intervention No of

subjects


Outcome measurement

Mea

Finasteride VS placebo

Leskinen M36 1999 Finasteride 31 52 IPSS pain score 46 Placebo 10 Nickel JC39 2004 Finasteride 33 24 NIH-CPSI 44 Placebo 31 Author Intervention No of


Outcome measurement

Mea

Anti-inflammatory vs placebo

Goldmeier D11 2005 Zafirlukast 10 4 NIH-CPSI 35 Placebo 7 Nickel JC12 2003 Rofecoxib 49 6 NIH-CPSI 46 Placebo 59 Bates SM21 2007 Prednisolone 9 4 NIH-CPSI 40

16

Placebo 12 Zhao WP42 2009 Celecoxib 32 6 NIH-CPSI Placebo 32 Author Intervention No of

subjects


Outcome measurement

Mea

Phytotherapy VS placebo

Elist J13 2006 ProstatPoltit 30 24 Questionnaire 35 Placebo 30 Shoskes DA14 1999 Quercetin 15 4 NIH-CPSI 44 Placebo 15 Wagenlehner F15 2009 Cernilton 70 12 NIH-CPSI 39 Placebo 69 Author Intervention No of

subjects


Outcome measurement

Mea

Glycosaminoglycan VS placebo

Nickel JC40 2005 Pentosan polysulfate 51 16 NIH-CPSI 392 Placebo 49 Author Intervention No of

subjects


Outcome measurement

Mea

Pregabalin VS placebo

Potari MA44 2010 Pregabalin 217 6 NIH-CPSI Placebo 104 Author Intervention No of

subjects


Outcome measurement

Mea

Dual VS mono-therapies

Alexander RB20 2004 Ciprofloxacin+tamsulosin 49 6 NIH-CPSI 44 Tamsulosin 49 Ciprofloxacin 49 Placebo 49 Jeong CW35 2008 Doxazosin + levofloxacin 29 6 NIH-CPSI 40 Doxazosin 26 Levofloxacin 26 Ye ZQ41 2008 Tamsulosin +

levofloxacin 42 12 NIH-CPSI

Tamsulosin 42 levofloxacin 21

a Measured at baseline before receiving treatments b range Table 2 Mean symptom scores between α-blockers and placebo groups

Author Outcome measurement

A Total score α-blockers Placebo

Na

Mean SD N Mean SD

Nickel JC9 NIH-CPSI 138 167 149 134 186 141 Tugcu V10 NIH-CPSI 30 107 13 30 219 12 Alexander RB20 NIH-CPSI 45 202 122 45 216 98

17

Cheah PY32 NIH-CPSI 43 108 90 43 170 121 Evliyaoglu Y33 IPSS and pain

questionnaire 30 105 44 30 162 57

SMD 95 CI -17 -28 -06 Antibiotics Placebo N mean SD N Mean SD Alexander RB20 NIH-CPSI 42 180 132 45 216 98 Nickel JC38 NIH-CPSI 45 190 95 35 184 91 Zhou Z43 NIH-CPSI 24 171 28 24 31 25 USMD 95 CI -58 -159 44


B Pain score α-blockers Placebo

N mean SD N Mean SD Nickel JC9 NIH-CPSI 138 78 76 134 85 76 Tugcu V10 NIH-CPSI 30 47 12 30 86 08 Alexander RB20 NIH-CPSI 45 90 71 45 106 58 Cheah PY32 NIH-CPSI 43 52 57 43 78 67 Evliyaoglu Y33 Pain

questionnaire 30 23 11 30 37 13

Gul O34 PSSI 39 63 16 30 88 27 SMD 95 CI -11 -18 -03 Antibiotics Placebo N mean SD N mean SD Alexander RB20 NIH-CPSI 42 87 67 45 106 58 Nickel JC38 NIH-CPSI 45 89 50 35 76 47 Zhou Z43 NIH-CPSI 24 71 10 24 145 20 USMD 95 CI -27 -87 32 Author Outcome

measurement Phytotherapy Placebo

N mean SD N mean SD Elist J13 Pain


Shoskes DA14 NIH-CPSI 15 62 39 13 90 32 Wagenlehner F15 NIH-CPSI 68 55 49 68 73 49 SMD 95 CI -05 -07 -02


C Voiding score α-blockers Placebo

N mean SD N mean SD Nickel JC9 NIH-CPSI 138 33 40 134 39 41 Tugcu V10 NIH-CPSI 30 22 08 30 64 10 Alexander RB20 NIH-CPSI 45 42 40 45 106 58 Cheah PY32 NIH-CPSI 43 20 28 43 36 36 Evliyaoglu Y33 IPSS 30 59 25 30 88 36 SMD 95 CI -14 -23 -05 Antibiotics Placebo N mean SD N mean SD Alexander RB20 NIH-CPSI 42 35 38 45 106 58 Nickel JC38 NIH-CPSI 45 42 30 35 41 28

18

Zhou Z43 NIH-CPSI 24 5 08 24 8 05 USMD 95 CI -32 -61 -03 Author Outcome




Shoskes DA14 NIH-CPSI 15 15 19 13 30 27 Wagenlehner F15 NIH-CPSI 68 18 29 69 26 31 SMD 95 CI -04 -07 -01 Author Outcome

measurement D QoL score

α-blockers Placebo N mean SD N mean SD

Nickel JC9 NIH-CPSI 138 33 25 134 35 23 Tugcu V10 NIH-CPSI 30 38 11 30 69 11 Alexander RB20 NIH-CPSI 45 69 34 45 71 33 Cheah PY32 NIH-CPSI 43 36 34 43 55 39 Evliyaoglu Y33 IPSS 30 23 08 30 37 08 SMD 95 CI -10 -18 -02 Author Outcome

measurement Antibiotics Placebo

N mean SD N mean SD Alexander RB20 NIH-CPSI 42 58 39 45 71 33 Nickel JC38 NIH-CPSI 45 37 18 35 38 17 Zhou Z43 NIH-CPSI 24 55 06 24 85 10 USMD 95 CI -15 -36 06 aNumber of subjects

19

Table 3 Treatment response and treatment effects between α-blockers anti-inflammatory and placebo groups

Author Definitiona α-blockers Placebo RR 95 CI No of

response No of non-

response No of

response No of non-

response Nickel JC9 4 points decrease

in NIH-CPSI 68 70 66 68 10 08 13

Tugcu V10 50 decrease in NIH-CPSI

20 10 10 20 20 14 35

Alexander RB20 4 points decrease in NIH-CPSI

12 33 11 34 11 05 23

Nickel JC23 50 decrease in NIH-CPSI

9 18 5 25 20 08 52

Cheah PY32 50 decrease in NIH-CPSI

24 19 14 29 16 10 26

Mehik A37 33 decrease in NIH-CPSI

13 4 4 16 25 14 45

Pooled RR 16 11 23 Author Definitiona Anti-inflammatory Placebo RR 95 CI

No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26

Bates SM21 6 points decrease in NIH-CPSI

2 4 4 8 10 03 40

Zhao WP42 25 decrease in NIH-CPSI

25 7 10 22 25 15 43

Pooled RR 18 12 26 adefinition of response to treatment

20

Appendix Search strategies

EMBASE

1 antibioticexp OR antibiotic

2 alpha blocker

3 alpha adrenergic receptor blocker

4 alpha adrenergic receptor antagonist

5 alpha adrenergic blocker

6 alpha adrenergic antagonist

7 chronic pelvic pain

8 chronic prostatitis

9 antibacterial

10 quinoloneexp OR quinolone

11 nonsteroidal antiinflammatory

12 cyclooxygenase-2 inhibitorexp OR cyclooxygenase-2 inhibitor

13 corticosteroidexp OR corticosteroid

14 finasterideexp OR finasteride

15 glycosaminoglycanexp OR glycosaminoglycan

21

16 phytotherapyexp OR phytotherapy

17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23

25 randomized controlled trialexp OR randomized controlled trial OR randomised controlled trialexp OR randomised

26 24 AND 25

Medline

((chronic pelvic pain) OR (chronic prostatitis)) AND (((alpha adrenergic AND blocker) OR (alpha adrenergic AND antagonist) OR

(adrenergic alpha antagonist)) OR ((antibiotics) OR (antibacterial) OR (quinolones)) OR (((non-steroidal anti-inflammatory) OR

(nonsteroidal anti-inflammatory) OR (cyclooxygenase-2 inhibitor)) OR (corticosteroid)) OR ((finasteride) OR (glycosaminoglycan)

OR (phytotherapy) OR (pregabalin)))

22

23



E-mail pawinpawingmailcom

Mark McEvoy MSc


University of New Castle NSW Australia

e-mail markmcevoynewcastleeduau

Ammarin Thakkinstian PhD



e-mail raatkmahidolacth

Corresponding author

Ammarin Thakkinstian Section for Clinical Epidemiology and Biostatistics Ramathibodi Hospital

Rama VI Road Rachatevi Bangkok Thailand 10400 Tel 6622011762 Fax 6622011284

Emailraatkmahidolacth

Word counts 1210

2

INTRODUCTION























3





METHODS

Search Strategy










Inclusion criteria








4



life scores)




Data extraction




studies







Outcomes



5





range from 0 to 51


range from 0 to 12
















6






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23

INTRODUCTION























3





METHODS

Search Strategy










Inclusion criteria








4



life scores)




Data extraction




studies







Outcomes



5





range from 0 to 51


range from 0 to 12
















6






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23





METHODS

Search Strategy










Inclusion criteria








4



life scores)




Data extraction




studies







Outcomes



5





range from 0 to 51


range from 0 to 12
















6






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



life scores)




Data extraction




studies







Outcomes



5





range from 0 to 51


range from 0 to 12
















6






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23





range from 0 to 51


range from 0 to 12
















6






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23






24 25














7





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23





199341(4)301-307










Urol Sep 2003170(3)828-831









8



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



and AIDS 200516(3)196-200









199954(6)960-963












9



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



199648(5)715-721 discussion 721-712



Intern Med Oct 19 2004141(8)581-589








2004171(4)1594-1597











10



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



200861(5)455-463





of Urology 2004171(1)284-288





2003169(2)592-596






200132(3)433-436






199953(3)502-505

11






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23






200362(4)614-617







Apr 2005173(4)1252-1255





Research 200942(10)963-967


Urology Jun 200871(6)1091-1095




12



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



Mar 200973(3)538-542 discussion 542-533


200566(1)2-8





Urology Jun 201075(6)1249-1253






Dec 199642(6)459-464



2006119(1)110-119






Drugs 200969(1)71-84

13






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23






331(7521)897-900

14

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23

Figure legends




B) Pain

C) Void

D) QoL

A)

15




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23




Outcome measurement

Mea




Outcome measurement

Mea



subjects


Outcome measurement

Mea




Outcome measurement

Mea



16


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23


subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea



subjects


Outcome measurement

Mea








Na

Mean SD N Mean SD


17


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23


questionnaire 30 105 44 30 162 57














18











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23











19



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23



response No of non-

response No of

response No of non-


in NIH-CPSI 68 70 66 68 10 08 13


20 10 10 20 20 14 35


12 33 11 34 11 05 23


9 18 5 25 20 08 52


24 19 14 29 16 10 26


13 4 4 16 25 14 45


No of response

No of non- response

No of response

No of non- response


31 18 24 35 16 11 26


2 4 4 8 10 03 40


25 7 10 22 25 15 43


20


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23


EMBASE


2 alpha blocker







9 antibacterial







21


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23


17 pregabalin

18 7 OR 8

19 2 OR 3 OR 4 OR 5 OR 6

20 1 OR 9 OR 10

21 11 OR 12 OR 13

22 14 OR 15 OR 16 OR 17

23 19 OR 20 OR 21 OR 22

24 18 AND 23


26 24 AND 25

Medline





22

23

The Management of Chronic Prostatitis/Chronic Pelvic Pain ... · label represents a heterogeneous...

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