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Year : 2009  |  Volume : 25  |  Issue : 3  |  Page : 423
 

Alfuzosin for chronic pelvic pain syndrome: Another placebo?


Department of Urology, Christian Medical College, Vellore, India

Date of Web Publication1-Oct-2009

Correspondence Address:
J C Singh
Department of Urology, Christian Medical College, Vellore
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Nirmal T J, Singh J C. Alfuzosin for chronic pelvic pain syndrome: Another placebo?. Indian J Urol 2009;25:423

How to cite this URL:
Nirmal T J, Singh J C. Alfuzosin for chronic pelvic pain syndrome: Another placebo?. Indian J Urol [serial online] 2009 [cited 2019 Nov 21];25:423. Available from: http://www.indianjurol.com/text.asp?2009/25/3/423/56199

Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, et al. Alfuzosin and symptoms of chronic prostatitis - chronic pelvic pain syndrome. Chronic Prostatitis Collaborative Research Network. N Engl J Med. 2008 Dec 18;359(25):2663-73.


The most common urologic diagnosis made in men younger than 50 years is prostatitis. [2] Till date, a multitude of studies involving various therapeutic agents have been conducted. [2] Lack of a clear etiology is an important limitation in identifying an appropriate treatment strategy. Though the efficacy of the alpha-adrenergic blocker alfuzosin in treating the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been studied before, results have not been consistent. [3],[4] Most of the other trials that demonstrated a favorable outcome were underpowered. The results of a meta-analysis of alpha-adrenergic antagonists in men with CP/CPPS were that there was a significant reduction in total NIH-CPSI score and IPSS. But the authors had emphasized that the duration of treatment needs to be at least three months to see the effect. [5] This trial [1] and that of Alexander et al. [4] were adequately powered but both concluded that alfuzosin is not beneficial in CP/CPPS. One of the reasons attributed to the lack of benefit in the trial by Alexander et al. [4] was that patients were not alpha-blocker naive. But, though only those who had never been treated with alpha-blockers were included in this study, [1] alfuzosin was found to be ineffective. The impact of alpha-blockers on men with concomitant outlet obstruction was not studied separately in this trial. Furthermore, as the duration of treatment was only six weeks the possibility of benefit with longer duration in alpha-blocker naive patients remains to be studied. One of the known adverse effects of alpha-blockers is retrograde ejaculation. Though the incidence is lesser with alfuzosin compared to tamsulosin, the finding that there was significant improvement in scores for ejaculation following therapy with alfuzosin in this trial comes as a surprise. Whether the improvement was actually in the pain during ejaculation or ejaculation per se is not clear. Other therapeutic options being explored for CP/CPPS include tricyclics, anticonvulsants, physical therapy, and myofascial or trigger point release. [2] The results in favor of these interventions have not been consistent. By this trial, we know that short-term alpha-blocker monotherapy is not useful for alpha-blocker naive patients. But multimodal therapy needs to be explored addressing various aspects of CP/CPPS, including adequate pain relief, improvement in voiding symptoms, and quality-of-life issues.

 
   References Top

1.Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, et al. Alfuzosin and symptoms of chronic prostatitis - chronic pelvic pain syndrome. Chronic Prostatitis Collaborative Research Network. N Engl J Med 2008;359:2663-73.  Back to cited text no. 1      
2.Pontari MA. Chronic prostatitis/chronic pelvic pain syndrome. Urol Clin North Am 2008;35:81-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Nickel JC. The three As of chronic prostatitis therapy: antibiotics, alpha-blockers, and anti-inflammatories: what is the evidence? BJU Int 2004;94:1230-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP, et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med 2004;141:581-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q. The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials. J Androl 2006;27:847-52.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  



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