Sacral magnetic stimulation in non-inflammatory chronic pelvic pain syndrome.

OBJECTIVES: To prospectively evaluate sacral magnetic high-frequency stimulation as a treatment option for patients with non-inflammatory chronic pelvic pain syndrome (CPPS, category IIIB). PATIENTS AND METHODS: Fourteen men with CPPS IIIB were treated with high-frequency sacral magnetic stimulation, with 10 treatment sessions once a week for 30 min at a frequency of 50 Hz. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and quality-of-life index were determined before and after treatment. RESULTS: All patients tolerated the stimulation well and 12 of 14 reported agreeable sensations during stimulation. There were no complications; only one patient did not complete the treatment course. The mean (range) total NIH-CPSI score did not change with treatment, at 27 (18-38) before and 27 (4-40) after treatment. Moreover, there was no sustained effect on the mean scores for pain, micturition complaints or quality of life. CONCLUSIONS: High-frequency sacral magnetic stimulation in patients with CPPS IIIB only reduces pain during stimulation, with no sustained relief of symptoms. Therefore, intermittent sacral magnetic stimulation cannot be recommended as a treatment option for CPPS IIIB.

[Four-glass or two glass test for chronic prostatitis]. / 4- oder 2-Gläserprobe bei der chronischen Prostatitis?

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases.

[Drug treatment options in prostatic hyperplasia]. / Medikamentöse Behandlungsmöglichkeiten bei Prostatahyperplasie.

The following may be briefly stated about the actually known and clinically used pharmacotherapeutic strategies: Among the choices of treatment regimens for benign prostatic hyperplasia drugs are in general of only limited importance. Only early stages of hyperplasia may be successfully treated with drugs. Before and during treatment, however, prostatic cancer has to be excluded. To this end thorough and strict controls are mandatory, questions about the state of health and filling of recipies alone are by no means sufficient.

Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients.

BACKGROUND: Controversy regarding the relative efficacy of treatments for the relief of the symptoms of benign prostatic hyperplasia (BPH). METHODS: This was a 6-month double-blind randomized equivalence study that compared the effects of a plant extract (320 mg Permixon) with those of a 5 alpha-reductase inhibitor (5 mg finasteride) in 1,098 men with moderate BPH using the International Prostate Symptom Score (IPSS) as the primary end-point. RESULTS: Both Permixon and finasteride decreased the IPSS (-37% and -39%, respectively), improved quality of life (by 38 and 41%), and increased peak urinary flow rate (+25% and +30%, P = 0.035), with no statistical difference in the percent of responders with a 3 ml/sec improvement. Finasteride markedly decreased prostate volume (-18%) and serum PSA levels (-41%); Permixon improved symptoms with little effect on volume (-6%) and no change in PSA levels. Permixon fared better than finasteride in a sexual function questionnaire and gave rise to less complaints of decreased libido and impotence. CONCLUSIONS: Both treatments relieve the symptoms of BPH in about two-thirds of patients but, unlike finasteride, Permixon has little effect on so-called androgen-dependent parameters. This suggests that other pathways might also be involved in the symptomatology of BPH.

[Pharmacotherapy in benign prostatic hyperplasia]. / Pharmakotherapie bei benigner Prostatahyperplasie.

To avoid an operation, there are innumerable pharmaceutics on sale for the treatment of the benign prostatic hyperplasia. For this reason we have to distinguish between pharmaceutics without effect and those with proved action on the hyperplastic metaplasia. The symptoms can often be lessened at the initial stage by way of drugs with ineffective action (phytopharmaceutics); there could not yet be proved any effect on the biology of the prostatic hyperplasia. We make use of this therapeutic at the initial stage. Some of the substances with a real effect (alpha-receptor blockers, alpha-reductase inhibitors) do not necessarily provide an effective result in all cases. In addition to that, these therapeutics of partially serious side effects have to be taken for life. Here immediately arises the question of how it could be managed financially.

Arterially originated erectile disturbances: surgical possibilities and their alternatives--some personal thoughts.

The arterially originated erectile disturbances are the most common form of impotence due to morphological reasons. The concepts of therapy range from the surgical revascularization, to the intracavernous self-injection of vasoactive substances and to the implantation of penis prostheses. The advantages and disadvantages are discussed and weighed against each other.