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1.
PLoS One ; 15(1): e0227695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951599

RESUMO

BACKGROUND: Endometriosis is defined by the presence of endometrial-like tissue (lesions) outside the uterus, commonly on the pelvic peritoneum. It affects 6-10% of women and is associated with debilitating pelvic pain. Current management options are often unsatisfactory. Omega-3 polyunsaturated fatty acids (O-PUFA) have the potential to reduce the painful symptoms associated with endometriosis, reduce lesion size, preserve the patient's ability to conceive, and have minimal side effects. We performed a two-arm, parallel double-blinded randomised controlled trial to inform the planning of a future multicentre randomised controlled trial to evaluate the efficacy of O-PUFA for endometriosis-associated pain. OBJECTIVES: The primary objectives of the trial were to assess recruitment and retention rates. The secondary objectives were to determine the acceptability to women of the proposed methods of recruitment, randomisation, treatments and questionnaires, to estimate the variability in the proposed primary endpoints to inform the sample size calculation and to refine the research methodology for the future definitive trial. METHODS: We recruited women with endometriosis from June 2016 to June 2017 and randomised them to eight weeks of treatment with O-PUFA or olive oil. Pain scores and quality of life questionnaires were collected at baseline and eight weeks. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to eight weeks. Acceptability questionnaires were used to evaluate women's experiences of the trial. RESULTS: The proportion of eligible participants who were randomised was 45.2% (33/73) and 81.8% (27/33) completed the study. The majority of participants described their overall trial experience favourably and there were no adverse events in either group. CONCLUSION: Our pilot trial supports the feasibility of a future larger trial to definitively evaluate the efficacy of O-PUFA for endometriosis-associated pain. TRIAL REGISTRATION: The trial was registered on the ISRCTN registry (registration number ISRCTN44202346).


Assuntos
Endometriose/tratamento farmacológico , Endometriose/fisiopatologia , Ácidos Graxos Ômega-3/uso terapêutico , Dor Pélvica/tratamento farmacológico , Adulto , Método Duplo-Cego , Endometriose/complicações , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Seleção de Pacientes , Dor Pélvica/etiologia , Dor Pélvica/fisiopatologia , Projetos Piloto , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
2.
Prostate ; 80(1): 28-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573117

RESUMO

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a disorder that is characterized by persistent pelvic pain in men of any age. Although several studies suggest that the transient receptor potential vanilloid 1 (TRPV1) channel is involved in various pathways of chronic pain, the TRPV1 channel has not been implicated in chronic pelvic pain associated with CP/CPPS. METHODS: Male C57BL/6J (B6) and TRPV1 knockout (TRPV1 KO) mice (5-7 weeks old) were used to study the development of pelvic allodynia in a murine model of CP/CPPS called experimental autoimmune prostatitis (EAP). The prostate lobes, dorsal root ganglia (DRG), and spinal cord were excised at day 20. The prostate lobes were assessed for inflammation, TRPV1 expression, and mast cell activity. DRG and spinal cord, between the L6-S4 regions, were analyzed to determine the levels of phosphorylated ERK1/2 (p-ERK 1/2). To examine the therapeutic potential of TRPV1, B6 mice with EAP received intraurethral infusion of a TRPV1 antagonist at day 20 (repeated every 2 days) and pelvic pain was evaluated at days 20, 25, 30, and 35. RESULTS: Our data showed that B6 mice with EAP developed pelvic tactile allodynia at days 7, 14, and 20. In contrast, TRPV1 KO mice with EAP do not develop pelvic tactile allodynia at any time point. Although we observed no change in the levels of TRPV1 protein expression in the prostate from B6 mice with EAP, there was evidence of significant inflammation and elevated mast cell activation. Interestingly, the prostate from TRPV1 KO mice with EAP showed a lack of mast cell activation despite evidence of prostate inflammation. Next, we observed a significant increase of p-ERK1/2 in the DRG and spinal cord from B6 mice with EAP; however, p-ERK1/2 expression was unaltered in TRPV1 KO mice with EAP. Finally, we confirmed that intraurethral administration of a TRPV1 antagonist peptide reduced pelvic tactile allodynia in B6 mice with EAP after day 20. CONCLUSIONS: We demonstrated that in a murine model of CP/CPPS, the TRPV1 channel is key to persistent pelvic tactile allodynia and blocking TRPV1 in the prostate may be a promising strategy to quell chronic pelvic pain.


Assuntos
Doenças Autoimunes/metabolismo , Prostatite/metabolismo , Canais de Cátion TRPV/metabolismo , Animais , Arginina/análogos & derivados , Arginina/farmacologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/imunologia , Doenças Autoimunes/patologia , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Gânglios Espinais/metabolismo , Hiperalgesia/tratamento farmacológico , Hiperalgesia/imunologia , Hiperalgesia/metabolismo , Hiperalgesia/patologia , Masculino , Mastócitos/imunologia , Mastócitos/metabolismo , Mastócitos/patologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Oligopeptídeos/farmacologia , Dor Pélvica/tratamento farmacológico , Dor Pélvica/imunologia , Dor Pélvica/metabolismo , Dor Pélvica/patologia , Fosforilação , Prostatite/tratamento farmacológico , Prostatite/imunologia , Prostatite/patologia , Medula Espinal/metabolismo , Canais de Cátion TRPV/antagonistas & inibidores , Canais de Cátion TRPV/deficiência
3.
Nihon Yakurigaku Zasshi ; 154(5): 259-264, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31735755

RESUMO

Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) is commonly diagnosed in men younger than 50 years old. It is characterized by pelvic pain, voiding symptoms and sexual dysfunction. The considerable discomfort or pain experienced has a negative impact on the quality of life of patients and is a huge economic burden because of the high recurrence rate and the low cure rate. Appropriate animal models are essential for the development of new drugs for the treatment of CP/CPPS, and several rodent models induced by different methods and over different time frames have been established. This article reviews studies of three in vivo rodent models of prostatitis, namely, chemical-induced, autoimmune-induced and hormone-associated models reported by us and other investigators. Recent clinical investigation has suggested that tadalafil improves the International Prostatic Symptom Score and the total National Institutes of Health Chronic Prostatitis Symptom Index score of patients with benign prostatic hyperplasia with CP/CPPS, which enables us to investigate the effect of tadalafil on the pelvic-pain-related behavior and prostatic inflammation in two of these prostatitis model types, experimental autoimmune prostatitis (EAP) and hormone/castration-induced prostatitis (HCP). Both models showed the pelvic-pain-related behavior and prostatic inflammation that are characteristic of chronic prostatitis. In EAP, tadalafil suppressed both the pelvic-pain-related behavior and the prostatic inflammation. In HCP, tadalafil suppressed the pelvic-pain-related behavior. These results mimic the clinical findings. Therefore EAP and HCP are suitable for the evaluation of the potency of drugs for the treatment of CP/CPPS.


Assuntos
Dor Crônica/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatite/complicações , Tadalafila/uso terapêutico , Animais , Modelos Animais de Doenças , Humanos , Masculino , Roedores
4.
Pain Physician ; 22(4): E333-E344, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337177

RESUMO

BACKGROUND: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain. OBJECTIVE: The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia. STUDY DESIGN: This study used a retrospective cross-sectional study design. SETTING: The research was conducted at a large academic hospital. METHODS: Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed. INTERVENTION: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale. MEASUREMENT: MRN findings for pudendal neuropathy were compared to the results of the CT-guided pudendal nerve blocks. Injection pain responses were categorized into 3 groups - positive block, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC). RESULTS: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02). LIMITATIONS: Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review. CONCLUSION: Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men. KEY WORDS: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy.


Assuntos
Bloqueio Nervoso/métodos , Neuralgia do Pudendo/diagnóstico , Neuralgia do Pudendo/tratamento farmacológico , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/efeitos dos fármacos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
5.
Eur J Pharmacol ; 857: 172429, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31170381

RESUMO

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a frustrating syndrome. The pathogenesis and state of the art treatment of CP/CPPS are not known. A wide variety of therapies including anti-inflammatories, antibiotics, alpha-blockers, neuropathic pain modulators, and 5α-reductase inhibitors are in practice. These treatment strategies focus on alleviating symptoms in specific domains without treating root-cause and therapeutic outcome is far from satisfactory. We review the literature on current pharmacological treatments for CP/CPPS in detail and suggest future perspectives to modify the treatment strategies. We suggest that introducing novel treatment strategies such as gene editing, and Tregs expressing chimeric receptors may improve the treatment outcomes by inducing immune tolerance and controlling expression of pro-inflammatory cytokines.


Assuntos
Dor Pélvica/terapia , Prostatite/terapia , Doença Crônica , Edição de Genes , Humanos , Masculino , Dor Pélvica/tratamento farmacológico , Dor Pélvica/genética , Prostatite/tratamento farmacológico , Prostatite/genética
6.
Einstein (Sao Paulo) ; 17(2): eAO4583, 2019 May 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31066795

RESUMO

OBJECTIVE: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. METHODS: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. RESULTS: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). CONCLUSION: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.


Assuntos
Anticoncepcionais Orais Combinados/uso terapêutico , Endometriose/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Progestinas/uso terapêutico , Doenças Retais/tratamento farmacológico , Doenças do Colo Sigmoide/tratamento farmacológico , Adulto , Dor Crônica , Dismenorreia/tratamento farmacológico , Dispareunia/tratamento farmacológico , Endometriose/cirurgia , Feminino , Seguimentos , Humanos , Registros Médicos , Medição da Dor , Dor Pélvica/cirurgia , Proteínas Recombinantes de Fusão , Doenças Retais/cirurgia , Estudos Retrospectivos , Doenças do Colo Sigmoide/cirurgia , Resultado do Tratamento
7.
BMC Womens Health ; 19(1): 68, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096979

RESUMO

BACKGROUND: Dienogest has been shown to substantially improve endometriosis-associated symptoms such as debilitating chronic pelvic pain, and in turn, health-related quality of life (HRQoL). To date, there is no data on patient-reported outcomes reflecting the real-world practice in Asia where endometriosis is a relevant health, social and economic burden. This non-interventional, multi-center, prospective study aims to investigate the influence of dienogest on HRQoL. METHODS: Asian women received dienogest (2 mg/daily) and were followed for 24 months. The effectiveness of dienogest to improve HRQoL and endometriosis-associated pelvic pain (EAPP) was assessed by patient-reported outcomes. HRQoL, especially the "pain" domain as primary endpoint, was evaluated with the Endometriosis Health Profile-30 (EHP-30) questionnaire. The numeric rating scale served to determine changes in the severity of EAPP. Within the presented interim analysis (data cut-off: 2017-11-27), the mean changes in EHP-30 and EAPP scores from baseline to 6 months upon availability of the data were evaluated. Treatment-emergent adverse events (TEAEs) and bleeding profiles were documented. RESULTS: Dienogest therapy decreased EHP-30 scores in all assessed domains (score 0-100, lower scores indicate better HRQoL). Primarily, the "pain" domain was improved in 78.4% of patients. EAPP was reduced (score 0-10, lower scores reflect less pain), highlighted by a mean reduction of the pain score by - 4.5 points. Patients with a higher EAPP score at baseline had an increased response to dienogest (- 6.2 points mean change) compared to patients with low baseline EAPP severity (- 1.4 points mean change). Both surgically and clinically diagnosed patients described comparable pain reduction, as well as women with or without prior treatment. Drug-related TEAEs were documented for 31.5% of patients, with amenorrhoea (5.9%) and metrorrhagia (5.1%) being the most common events. The bleeding pattern was changed upon dienogest, characterized by decreased normal bleeding (84.2 to 28.8%) and increased amenorrhea (3.2 to 42.9%) at 6 months. CONCLUSION: The data indicate an amelioration of HRQoL and EAPP upon dienogest therapy. No new safety signals were observed. Therefore, its use as first-line therapy for long-term management of debilitating and chronic endometriosis-associated pain represents an interesting option that remains to be further investigated. TRIAL REGISTRATION: Name of registry: Clinical Trials Clinicaltrials.gov registration number: NCT02425462 Registration date: 2015-04-24. Registration timing: prospective.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Nandrolona/análogos & derivados , Dor Pélvica/tratamento farmacológico , Qualidade de Vida/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Nandrolona/uso terapêutico , Dor Pélvica/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
8.
Gynecol Endocrinol ; 35(9): 782-786, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30957578

RESUMO

Primary dysmenorrhea is a common gynecologic disorder and is one of the main causes for referral to the gynecology clinic. This study aimed to determine the effects of alpha-lipoic acid (ALA) and mefenamic acid and a combination compared with placebo on the girls with primary dysmenorrhea. This double-blind, placebo-controlled clinical trial done on population consisted of female students living in dormitories of Qazvin University of Medical Sciences who had moderate to severe dysmenorrhea using the Visual Analog Scale (VAS) questionnaire. Participants were randomly divided into four groups (n = 100): ALA, mefenamic acid, ALA + mefenamic acid and placebo groups. ALA and mefenamic acid were administrated in 600 mg and 250 mg, respectively. The severity of the pain was measured in the beginning and the end of the study. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, IL). Our final results suggested that, although mefenamic acid significantly decreased the menstrual pain, ALA supplementation, 600 mg, would be more efficient than mefenamic acid in 250 mg. Also, the combination of ALA and mefenamic acid significantly has been far. Considering the ALA supplementation effect on pain relief in patients with primary dysmenorrhea, this antioxidant can be recommended for the healing of symptoms of these patients.


Assuntos
Dismenorreia/tratamento farmacológico , Ácido Mefenâmico/administração & dosagem , Ácido Tióctico/administração & dosagem , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Dismenorreia/complicações , Feminino , Humanos , Irã (Geográfico) , Menstruação/efeitos dos fármacos , Manejo da Dor/métodos , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Placebos , Resultado do Tratamento , Adulto Jovem
9.
Fertil Steril ; 112(2): 298-304.e3, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30992150

RESUMO

OBJECTIVE: To evaluate the efficacy of elagolix, an oral GnRH antagonist, for the reduction of fatigue in women with moderate or severe endometriosis-associated pain. DESIGN: Randomized, double-blind, multicenter, placebo-controlled phase III trial. SETTING: Clinics. PATIENT(S): A total of 860 women treated with elagolix or placebo. INTERVENTION(S): Women received either elagolix at 150 mg daily (QD) orally, elagolix at 200 mg twice daily (BID) orally, or placebo. MAIN OUTCOME MEASURE(S): Change from baseline to month 1, 3, and 6 visits, in Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 6a questionnaire T-scores. RESULTS(S): At baseline, 54%-74% of women with moderate to severe pain associated with endometriosis reported having fatigue-related issues "quite a bit" or "very much," depending on the question asked. Fatigue extent was reduced to 29%-43% and 14%-29% for women treated with elagolix at 150 mg QD and 200 mg BID, respectively, at 6 months, compared with 35%-50% with placebo. The resultant decrease in fatigue T-scores was significant after elagolix treatment compared with placebo at 6 months, with changes of -2.21 and -5.90 with elagolix at 150 mg QD and 200 mg BID, respectively. Significant reduction in fatigue scores were observed among patients reporting clinically meaningful response "reduction" in dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia (-7.31, -6.62, and -4.31, respectively) compared with nonresponders. CONCLUSION(S): In women with moderate to severe endometriosis related pain, elagolix significantly reduces fatigue levels.


Assuntos
Endometriose/tratamento farmacológico , Fadiga/tratamento farmacológico , Hidrocarbonetos Fluorados/uso terapêutico , Dor Pélvica/tratamento farmacológico , Pirimidinas/uso terapêutico , Doenças Uterinas/tratamento farmacológico , Adolescente , Adulto , Método Duplo-Cego , Endometriose/complicações , Fadiga/etiologia , Feminino , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Antagonistas de Hormônios/uso terapêutico , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/etiologia , Dor Pélvica/patologia , Placebos , Índice de Gravidade de Doença , Resultado do Tratamento , Doenças Uterinas/complicações , Adulto Jovem
10.
Arch Ital Urol Androl ; 91(1): 16-21, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932424

RESUMO

OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common problem and severely impairs the quality of life (QoL). We aimed to investigate the effects of different treatment options on voiding symptoms and QoL in patients with urinary phenotype according to the UPOINT system. Matherial and methods: Ninety-six patients with NIH category II,III CP/CPPS were included in the study prospectively. After the diagnosis, the questionnaires including NIH Chronic prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), Overactive Bladder Screening Questionnaire (OAB-V8), and Beck depression inventory were filled by the patients. The patients with urinary phenotype were treated by alpha-blocker, antimuscarinic or both therapy modalities (combined) considering the specific therapy recommendations by UPOINT. The questionnaires applied on the first visit were reapplied after one month and treatment success was evaluated. RESULTS: Seventy-three patients were included in 'Urinary phenotype' group (76%) and 23 were included in 'other phenotypes' (24%) group of the patients according to the UPOINT classification. Significant improvements of symptoms were observed with the all treatment modalities when the NIH-CPSI, IPSS and OAB-V8 scores were compared before and after treatment in the 'Urinary phenotype' group. Significant differences in the percentage of change in values were obtained in the anticholinergic group for pain subdomain of NIH-CPSI and IPSS scores. CONCLUSION: U-POINT clasification is useful for deciding on the treatment modality in CP/CPSS patients. We showed anticholinergic therapy might be effective option. Addition to the symptomatic recovery, there is need more further studies about effectivity cholinergic system in the prostate tissue.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Prostatite/tratamento farmacológico , Antagonistas Adrenérgicos alfa/administração & dosagem , Adulto , Antagonistas Colinérgicos/administração & dosagem , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/uso terapêutico , Fenótipo , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Síndrome , Resultado do Tratamento
11.
Urol Int ; 102(4): 482-486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30840961

RESUMO

INTRODUCTION: Alpha-adrenergic blockers are now the cornerstone medication in management of lower urinary tract symptom (LUTS); however, the associated treatment-related abnormal ejaculation could be a bothersome event. This is a comparative study among different methods of tamsulosin administration in terms of efficacy, recoverability of ejaculatory function, and quality of life (QoL) in men with tamsulosin-related abnormal ejaculation. PATIENTS AND METHODS: Sexually active men receiving tamsulosin for LUTS who were bothered by treatment-related abnormal ejaculation following initiation of tamsulosin were randomized into 3 groups; group A received intermittent-full-standard-dose, group B received low-dose-tamsulosin, and group C received full-standard-dose tamsulosin The status of ejaculatory function, IPSS, QoL score, and Q-Max were measured at baseline and 3 months later. RESULTS: A total of 93 men with mean age of 53.1 years were included in the study, 3-months after randomization, statistically significant improvements in IPSS, QoL index, and Q-Max in comparison to pre-treatment levels were noted. Restoration of normal ejaculation was reported by 74.1 and 90.3% of patients in group A and B, respectively, versus none in group C. The QoL score was significant when comparing group A to the other groups; finally, the Q-Max was significant when comparing group C to the other groups. CONCLUSION: For patients bothered by tamsulosin-related abnormal ejaculation, a significant improvement in the QoL, without deviation from the therapeutic purpose of treatment, can be achieved by administration of 0.4 mg tamsulosin every other day.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Ejaculação/efeitos dos fármacos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Qualidade de Vida , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Tansulosina/administração & dosagem , Tansulosina/efeitos adversos , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Idoso , Esquema de Medicação , Humanos , Sintomas do Trato Urinário Inferior/complicações , Masculino , Pessoa de Meia-Idade , Dor Pélvica/tratamento farmacológico , Estudos Prospectivos , Prostatite/tratamento farmacológico , Disfunções Sexuais Fisiológicas/psicologia , Resultado do Tratamento
12.
Tech Coloproctol ; 23(3): 239-244, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30778784

RESUMO

BACKGROUND: Anorectal pain is a symptom which may have both structural and functional causes, and can, sometimes, develop into a chronic pain syndrome. Functional causes in particular are challenging to treat when conservative treatment measures fail. Botulinum toxin A (BTX-A) can be applied to relax the anal sphincter and/or levator ani muscle to break the vicious circle of pain and contraction. In our tertiary referral proctology clinic, we evaluated the outcome of patients treated with BTX-A for chronic functional anorectal pain. METHODS: Our electronic database was searched for patients who had BTX-A treatment for chronic functional anorectal pain from 2011 to 2016. All medical data concerning history, treatments, and clinical outcome were retrieved. The clinical outcome (resolution of pain) was scored as good, temporary, or poor. RESULTS: A total of 113 patients [47 (42%) males; age 51years, SD 13 years, range 18-88 years] with chronic functional anorectal pain were included. The outcome of BTX-A treatment was good in 53 (47%), temporary in 23 (20%), and poor in 37 (33%). To achieve this outcome, 29 (45%) patients needed a single treatment, 11 (44%) a second treatment, and 13 (54%) ≥ 3 treatments. CONCLUSIONS: Chronic functional anorectal pain can be treated successfully with BTX-A in 47% of patients who fail conservative management. Repeated injections may be needed to ensure complete cure in a subgroup of patients.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Dor Crônica/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Dor Pélvica/tratamento farmacológico , Doenças Retais/tratamento farmacológico , Adolescente , Adulto , Canal Anal/efeitos dos fármacos , Canal Anal/fisiopatologia , Dor Crônica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/fisiopatologia , Doenças Retais/fisiopatologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
13.
Eur J Contracept Reprod Health Care ; 24(1): 61-70, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30664383

RESUMO

OBJECTIVE: A systematic review was carried out of studies of women with endometriosis, to examine the evidence for efficacy of the use of hormonal contraception to improve disease-related pain and decrease postoperative risk of disease recurrence. METHODS: A search of the Medline/PubMed and Embase databases was performed to identify all published English language studies on hormonal contraceptive therapies (combined hormonal contraceptives [CHCs], combined oral contraceptives [COCs], progestin-only pills [POPs] and progestin-only contraceptives [POCs]) in women with a validated endometriosis diagnosis, in comparison with placebo, comparator therapies or other hormonal therapies. Main outcome measures were endometriosis-related pain (dysmenorrhoea, pelvic pain and dyspareunia), quality of life (QoL) and postoperative rate of disease recurrence during treatment. RESULTS: CHC and POC treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in non-cyclical pelvic pain and dyspareunia and an improvement in QoL. Only two COC preparations (ethinylestradiol [EE]/norethisterone acetate [NETA] and a flexible EE/drospirenone regimen) demonstrated significantly increased efficacy compared with placebo. Only three studies found that the postoperative use of COCs (EE/NETA, EE/desogestrel and EE/gestodene) reduced the risk of disease recurrence. There was no evidence that POCs reduced the risk of disease recurrence. CONCLUSIONS: CHCs and POCs are effective for the relief of endometriosis-related dysmenorrhoea, pelvic pain and dyspareunia, and improve QoL. Some COCs decreased the risk of disease recurrence after conservative surgery, but POCs did not. There is insufficient evidence, however, to reach definitive conclusions about the overall superiority of any particular hormonal contraceptive.


Assuntos
Anticoncepção/métodos , Anticoncepcionais Orais Combinados/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Endometriose/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Adulto , Androstenos/uso terapêutico , Desogestrel/uso terapêutico , Combinação de Medicamentos , Endometriose/complicações , Etinilestradiol/uso terapêutico , Feminino , Humanos , Noretindrona/uso terapêutico , Dor Pélvica/etiologia , Progestinas/uso terapêutico , Resultado do Tratamento
14.
Arch Ital Urol Androl ; 90(4): 260-264, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30655636

RESUMO

INTRODUCTION: Chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) represents a challenge for the urologist, since the therapeutic efficacy does not always result in a satisfactory quality of life for the patients. Often the side effects of the medications used (antiinflammatories, antibiotics, alpha blockers) far outweighs the benefits gained with their admission. The choice of nutraceutical medications is preferred for their effectiveness, that has been accepted and proven by the scientific community, and for the low incidence of side effects. The objective of this study to compare the therapeutic efficacy of the flower pollen extracts (Deprox®) versus Bioflavonoids in terms of reduction of symptoms, and in the average waiting time of the variation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and to evaluate the quality of life improvement of the patients affected by CP/CPPS. METHODS: Among the 68 patients presented with prostatic symptoms to the Hospital "Umberto I" in Rome, Italy between March 2016 and June 2016, 54 patients met the clinical diagnosis of CP/CPPS (class IIIa or IIIb according to the NIH classification). The patients were assigned to either treatment with Deprox® or quercetin based on a randomization scheme previously determined.The NIH- CPSI, IPSS, QoL questionnaires were administered. Every patient underwent bacterial cultures and trans-rectal ultrasound. RESULTS: There was a statistically significant improvement of the NIH-CPSI score and QoL in the Deprox® group (p = < 0.0001 and p = 0.003 respectively). The average waiting time of the variation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was statistically significant (p = 0.0019). In the absence of efficacy of the "conventional" medications, which also carries significant side effects, the dietary supplements may represent a valid alternative. CONCLUSIONS: DEPROX® has demonstrated a significant improvement of the symptoms and quality of life of patients diagnosed with by CP/CPPS. Furthermore, there was a statistical difference in the average waiting time of the variation of the NIH-CPSI) score without side effects as compared to the bioflavonoids complex with quercetin.


Assuntos
Flavonoides/uso terapêutico , Dor Pélvica/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Prostatite/tratamento farmacológico , Adulto , Doença Crônica , Suplementos Nutricionais , Flores , Humanos , Itália , Masculino , Pólen/química , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Síndrome , Resultado do Tratamento
15.
Clin Obstet Gynecol ; 62(1): 22-36, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30383545

RESUMO

Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.


Assuntos
Ansiedade/complicações , Catastrofização/complicações , Dor Crônica/psicologia , Depressão/complicações , Dor Pélvica/psicologia , Antidepressivos Tricíclicos/farmacologia , Dor Crônica/complicações , Dor Crônica/tratamento farmacológico , Dor Crônica/terapia , Terapia Cognitivo-Comportamental , Feminino , Gabapentina/farmacologia , Gabapentina/uso terapêutico , Humanos , Uso Off-Label , Dor Pélvica/complicações , Dor Pélvica/tratamento farmacológico , Dor Pélvica/terapia , Prevalência , Inibidores da Recaptação de Serotonina e Norepinefrina/farmacologia , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Estudos em Gêmeos como Assunto
16.
Prostate ; 79(5): 446-453, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30549073

RESUMO

BACKGROUND: Experimental autoimmune prostatitis (EAP) and prostatitis induced by 17ß-estradiol treatment combined with castration (hormone/castration-induced prostatitis; HCP) are the most commonly used rodent models of nonbacterial prostatitis. We studied the effect of the phosphodiesterase 5 inhibitor tadalafil on chronic pelvic pain in two such models in rats. METHODS: EAP was induced by intradermal injection of rat prostate antigen and complete Freund's adjuvant on Days 0 and 28. HCP was induced by castration followed by daily subcutaneous injection of 17ß-estradiol for 30 days. On Day 42 after antigen injection in the EAP model and Day 30 after castration in the HCP model, we investigated voiding behavior, pelvic pain (measured by applying von Frey filaments to the lower abdomen), and inflammatory changes, including changes in histopathology and IL-1ß, CCL2, and CCL3 mRNA levels. We investigated the effect of repeated administration of tadalafil on chronic pelvic pain in both models. RESULTS: In the EAP model, we observed inflammation in the ventral prostate, while in the HCP model, we observed inflammation in the lateral lobe of the prostate. Neither model showed any change in voiding behavior. As well as in the EAP model, in which chronic pelvic pain was observed, we found for the first time that HCP led to a significant increase in chronic pelvic pain. Repeated treatment with tadalafil attenuated the chronic pelvic pain in both models. CONCLUSIONS: Chronic pelvic pain was induced in both EAP and HCP models. Tadalafil significantly attenuated the chronic pelvic pain in both models.


Assuntos
Dor Crônica/tratamento farmacológico , Modelos Animais de Doenças , Dor Pélvica/tratamento farmacológico , Prostatite/tratamento farmacológico , Prostatite/fisiopatologia , Tadalafila/administração & dosagem , Animais , Doenças Autoimunes , Dor Crônica/etiologia , Masculino , Orquiectomia , Dor Pélvica/etiologia , Inibidores da Fosfodiesterase 5 , Prostatite/etiologia , Ratos , Ratos Wistar , Micção/efeitos dos fármacos , Micção/fisiologia
17.
Explore (NY) ; 15(2): 142-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30309790

RESUMO

OBJECTIVE: The objective of our study is to report our experience of treatment of a patient with endometrioma who was diagnosed with blood deficiency and blood stasis. METHODS: A 36-years-old Korean woman diagnosed with endometrioma of the right ovary complained of pelvic pain around the menstrual periods, vaginal discharge, and swelling and itching of the pudenda. The patient was administered the modified Gyejibokryeong-hwan (GBH) and the Bogol-gongjin-dan (BGD) for 6 months. RESULTS: After treatment, the size of the endometrioma in the right ovary was reduced to 17 × 11 × 10  mm from 25 × 21 × 17  mm before treatment. The level of CA 125 decreased from 47.2 U/ml at baseline to 34.3 U/ml after treatment. The level of CA 125 after treatment was within normal range. After treatment, the pelvic pain around the menstrual periods (VAS 7→1), vaginal discharge (VAS 4→1), and swelling and itching of the pudenda (VAS 5→2) decreased from the baseline values. CONCLUSION: Herbal medicine is a potential alternative therapy for patients with endometrioma of the ovary. Further studies, including case-control studies and RCTs based on an international standard and higher methodological quality, are needed.


Assuntos
Endometriose/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Adulto , Antígeno Ca-125/sangue , Feminino , Genitália Feminina/patologia , Humanos , Ovário/patologia , Dor Pélvica/tratamento farmacológico , Extratos Vegetais/efeitos adversos , Plantas Medicinais , Prurido/tratamento farmacológico , Descarga Vaginal/tratamento farmacológico
18.
Fundam Clin Pharmacol ; 33(3): 267-276, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30471234

RESUMO

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex disease of unclear etiology. Precise treatment of CP/CPPS is not available due to lack of specific cause; however, autoimmunity is the most valid theory. We develop a new treatment strategy that involves synthesis and coupling of biodegradable nanoparticles to antigenic T2 peptide to induce immune tolerance in CP/CPPS mice models. A total of 50 male C57BL/6 mice were randomized into five groups, that is, naïve, Model, PLGA-PEMA, PLGA-PEMA-OVA323-339 , and PLGA-PEMA-T2 group. All groups except naïve were injected subcutaneously on day 0 with 0.2 mL of T2 peptide with CFA to generate valid CP/CPPS models. After successful induction of CP/CPPS, Model group, PLGA-PEMA, PLGA-PEMA-OVA, and PLGA-PEMA-T2 groups were treated with 0.15 mL of normal saline, 0.2 mg of PLGA-PEMA and PLG-PEMA-T2 and 0.3 mg PLGA-PEMA-OVA nanoparticles, respectively, on day 28. Hematoxylin and eosin staining, and ELISA were used to evaluate the variation in CP/CPPS manifestations and seral level of IL-10 in each group. Pain threshold and voiding behavior were also recorded for every group. Mice treated with PLGA-PEMA-T2 exhibited enhanced pain threshold, reduced urine frequency, and prostate pathology. Furthermore, serum level of inflammatory mediators (TNF-α and CRP) were reduced and anti-inflammatory IL-10 was enhanced in PLGA-PEMA-T2 group as compared to other groups. Our results demonstrate that PLGA-PEMA-T2 nanoparticle ameliorates disease manifestations in CP/CPPS mice models and upregulates IL-10 which is essential for tolerance induction. This strategy highlights the new therapeutic approach utilizing biodegradable nanoparticles for the treatment of CP/CPPS.


Assuntos
Nanopartículas , Dor Pélvica/tratamento farmacológico , Peptídeos/administração & dosagem , Prostatite/tratamento farmacológico , Animais , Doença Crônica , Dor Crônica/tratamento farmacológico , Dor Crônica/imunologia , Modelos Animais de Doenças , Portadores de Fármacos/química , Ensaio de Imunoadsorção Enzimática , Tolerância Imunológica/efeitos dos fármacos , Mediadores da Inflamação/imunologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ovalbumina/imunologia , Dor Pélvica/imunologia , Peptídeos/imunologia , Peptídeos/farmacologia , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Prostatite/imunologia , Distribuição Aleatória
19.
Clin Obstet Gynecol ; 62(1): 48-58, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30475236

RESUMO

Chronic pelvic pain is a commonly encountered clinical entity, and many women with this chronic pain condition will be treated at some point in time with opioids for management of their pain. Clinicians in women's health are frequently asked and expected to participate in the care of women with chronic pelvic pain, as well as other gynecologic pain conditions, and should be familiar with the role of opioid therapy for these conditions. The goal of this article is to help determine which patients may be appropriate candidates for the initiation or continuation of opioid therapy for gynecologic pain. In addition, this article will help the clinician to establish treatment goals, select appropriate medications, monitor the efficacy of treatment, and to determine when discontinuation of medications is appropriate.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Seleção de Pacientes , Dor Pélvica/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Técnicas de Apoio para a Decisão , Feminino , Humanos , Medição de Risco , Inquéritos e Questionários
20.
Female Pelvic Med Reconstr Surg ; 25(1): 76-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29280763

RESUMO

OBJECTIVES: Pelvic floor hypertonic disorder is characterized by an involuntary spasm of the levator ani muscles and is associated with several clinical syndromes. Several treatment options have been described; however, treatment efficacy data are limited. The objective of this study was to determine the efficacy of intravaginal diazepam for the treatment of pelvic pain secondary to levator ani muscle spasm in comparison to placebo. METHODS: Adult women with complaints of pelvic pain, who were noted to have levator ani muscle spasm on physical examination, were approached for enrollment in a double-blind, placebo-controlled, randomized clinical trial. Eligible participants were randomized to receive 10-mg diazepam capsules or identical-appearing placebo capsules. The primary outcome was the change in pain scores measured by a 100-mm visual analog scale at 4 weeks. Several validated questionnaires were similarly assessed as secondary outcomes. RESULTS: In total, 49 women were randomized (25 in the diazepam arm and 24 in the placebo arm). At 4 weeks, 35 women returned for follow-up and had complete data available analysis. There was no difference in visual analog scale scores between the treatment groups after 4 weeks (50 vs 39 mm, for diazepam and placebo, respectively; P = 0.36). There were also no differences noted in the questionnaire scores. CONCLUSIONS: It is unlikely that self-administered intravaginal diazepam suppositories promote an improvement in the 100-mm visual analog scale of 20 mm or more or other substantial symptom improvement in women with pelvic floor hypertonic disorder.


Assuntos
Diazepam/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Distúrbios do Assoalho Pélvico/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Administração Intravaginal , Adulto , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Falha de Tratamento
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