A pilot study of botulinum toxin for interstitial cystitis/painful bladder syndrome.

OBJECTIVES: Preliminary studies using botulinum toxin (BTX) have demonstrated some benefits in treating interstitial cystitis (IC)/painful bladder syndrome (PBS) pain. The purpose of this study was to investigate the efficacy of a periurethral injection of BTX to block urethral visceral and somatic afferent fibers, for the treatment of IC/PBS. METHODS: Twenty adult women with IC/PBS were identified from the Female Urology Clinic at our hospital. Symptom evaluation was performed using a female modification of the Chronic Prostatitis Symptom Index (CPSI), AUA Symptom Index, Graded Chronic Pain Scale, Perceived Stress Scale, and symptom improvement Visual Analog Scale (VAS). All patients were randomized to receive either botulinum toxin A (BTX-A) or placebo (normal saline). Patients randomized to BTX-A received 50 U diluted in 2 cm(3) normal saline injected periurethrally. The physician and patient were blinded to the treatment. RESULTS: BTX was administered to nine women. There were no complications or side effects reported. There was no improvement between placebo and BTX-A groups in the CPSI score at 3-month follow-up (P=0.97). Additionally, there were no improvements in the other symptom indices. At follow-up, the mean VAS for the BTX group was -0.3, indicating the subjects' symptoms were the same as at the start of the study. CONCLUSIONS: Periurethral injection of botulinum toxin in women did not effectively treat the pain of IC/PBS. While the results from this study are negative, there is still a valid rationale for further investigations of novel injection protocols given the dearth of current effective treatments.

A pilot study of botulinum toxin A for male chronic pelvic pain syndrome.

OBJECTIVE: Male chronic pelvic pain syndrome (CPPS) has been the subject of numerous clinical trials, but so far, no uniformly effective treatment has been identified. A commonly reported tender spot in men with CPPS is the bulbospongiosus muscle. A randomized placebo controlled pilot trial of botulinum toxin A (BTX-A) injection into the perineal skeletal musculature for the treatment CPPS was conducted. MATERIAL AND METHODS: Twenty-nine men with CPPS were identified from a urology clinic. Symptom evaluation was performed using a Global Response Assessment (GRA) and the Chronic Prostatitis Symptom Index (CPSI). All subjects were randomized to receive either BTX-A 100 U or normal saline injected into the perineal body and bulbospongiosus muscle. RESULTS: BTX-A injection was administered in 13 men. At the 1 month follow-up there was a 30% response rate for BTX-A treatment compared with 13% for placebo (p = 0.0002), based on GRA results. Total CPSI score did not reach significance in the BTX-A-treated group, compared with controls. The CPSI pain subdomain score reached statistical significance in the BTX-A patients compared with controls (p = 0.05). The injections were well tolerated. There were no complications from the injections and no patients reported side-effects. CONCLUSIONS: BTX-A injection into the perineal body and bulbospongiosus muscle results in a modest response rate on the GRA compared with placebo for overall symptoms associated with CPPS. The treatment is well tolerated and safe. BTX-A use may enhance polytherapeutic pain management.

A review of botulinum toxin use for chronic pelvic pain syndrome.

The inability of urologists to consistently and effectively treat men with chronic pelvic pain syndrome (CPPS), also known as chronic abacterial prostatitis, is a source of great frustration. Botulinum toxin (BTX), a potent neurotoxin, can act on most of the peripheral nerves of the pelvis through a variety of mechanisms. BTX injection therapy for CPPS treatment has shown modest improvements. BTX is ideal for integration into a multimodal treatment plan, which may help achieve pain relief in men with chronic pelvic pain.

Comparing Sildenafil alone vs. Sildenafil plus brief couple sex therapy on erectile dysfunction and couples' sexual and marital quality of life: a pilot study.

Treatment options for managing erectile dysfunction (ED) include medical and psychological interventions. The present study examined the effectiveness of a drug-only vs. combined treatment approach on erectile function as well as other domains of sexual function and cognition, couple intimacy and adaptation, and treatment satisfaction. Couples with ED were randomly assigned to either Viagra-only (VO) or Viagra plus sex therapy (VST). Sexual and relationship variables were measured at specific time points. Despite limitations, study findings extend previous conclusions and provide empirical support for the effectiveness and satisfaction with the combined treatment approach for treating men with ED of mixed etiology.

The association between sexual function, pain, and psychological adaptation of men diagnosed with chronic pelvic pain syndrome type III.

INTRODUCTION: Prostatitis/chronic pelvic pain syndrome (CPPS) is known to have a negative impact on quality of life, especially on intimate relationships and sexual function. Information is, however, missing on the contribution of demographic and psychological variables to sexual variables. AIM. We compared the sexual function of men with CPPS to men without pain, and examined the relationship between the sexual, demographic, and psychological measures in men with CPPS. MAIN OUTCOME MEASURES: Self-report questionnaires assessing demographic, pain, sexual function, and psychological adaptation. METHODS: The sample consisted of 72 men diagnosed with CPPS and 98 men without any pain condition. Self-report questionnaires measuring demographic, pain, and sexual function were completed once at the eligibility visit by all subjects. CPPS subjects completed additional questionnaires related to pain and psychological adaptation. RESULTS: CPPS subjects differed from controls by reporting significantly less frequent sexual desire or thoughts, less frequent sexual activities, less arousal/erectile function, less orgasm function, and higher frequencies of genital pain during/after intercourse. When we adjusted for age and marital status, the difference between groups remained for thoughts/desire, frequency of sexual activity, and arousal/erectile function. Analysis of factors related to sexual function in CPPS subjects included pain status and psychological adaptation. Results showed that frequency of sexual activity decreased with increasing depression, whereas arousal/erectile function decreased with increasing pain symptoms and stress appraisal. Orgasm function decreased with increasing depression and pleasure/satisfaction decreased with increasing pain symptoms, stress appraisal, and decreasing belief of a relationship between emotions and pain. CONCLUSIONS: We found a differential sexual profile for men with CPPS when compared to men without pain. The results suggest that interventions addressing psychological factors affecting sexual responses should be further studied in prospective clinical trials as one possible way to improve sexual function and satisfaction in men with CPPS.

Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS.

BACKGROUND: We wished to determine if there were differences in pelvic and non-pelvic tenderness between men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) Type III and men without pelvic pain. METHODS: We performed the Manual Tender Point Survey (MTPS) as described by the American College of Rheumatology on 62 men with CP/CPPS Type IIIA and IIIB and 98 men without pelvic pain. We also assessed tenderness of 10 external pelvic tender points (EPTP) and of 7 internal pelvic tender points (IPTP). All study participants completed the National Institutes of Health Chronic Prostatitis Symptom Inventory (NIH CPSI). RESULTS: We found that men with CPPS were significantly more tender in the MTPS, the EPTPS and the IPTPS. CPSI scores correlated with EPTP scale but not with IPTP scale or prostate tenderness. Prostatic tenderness was present in 75% of men with CPPS and in 50% of men without CPPS. Expressed prostatic fluid leukocytosis was not associated with prostatic tenderness. CONCLUSION: Men with CP/CPPS have more tenderness compared to men without CPPS. Tenderness in men with CPPS is distributed throughout the pelvis and not specific to the prostate.