α-Blockers For Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review Of Efficacy And Adverse Effects

Purpose: To examine the evidence for the effectiveness and adverse effects ofα-blockers in men with CP/CPPS.Materials and Methods: The trials were identified from an electronic database search (Pubmed, Embase, the Cochrane Library, the Prostatic and Urologic Cancers Cochrane Review Group, Cochrane Database of Systematic Reviews, etc), CBM, CNKI, plus manual searching of published and unpublished randomized controlled trials in any language comparingα-blockers with placebo or other interventions for CP/CPPS, then extracted and evaluated independently by two authors (using a data collection tool); and reviewed in a meta-analysis. Men who met the National Institutes of Health (NIH) criteria for CP/CPPS were eligible for inclusion in this review. Exclusion criteria included non RCTs studies, no blinded studies, previous treatment with alpha-blockers; evidence of bacterial prostatitis or urinary tract infection; trials with treatment duration less than 2 weeks, and a total patients number less than 10 patients. The primary outcome in this review was NIH-CPSI score, while the secondary outcomes were I-PSS; PSSI total score; and adverse effects.Main results: We identified 82 papers including 14 randomized placebo-controlled trials, and only 10 (involving 911 men) of them met our inclusion criteria. The meta-analysis was taken using Stata version 9.2, and results were expressed as standardized mean difference (SMD and 95%CI) for continuous data, and RR with 95% CI for dichotomous data.Meta-analysis results of this systematic review of randomized controlled trials showed a statistically significant difference in favor of alpha-blockers in post-treatment total score; quality of life score; and pain score domains, while did show only a weak statistically difference in urinary symptoms score domain, and didn't at all in the change of NIH-CPSI score. For overall side effect, there was a statistically significant effect in favor of placebo compared with alpha-blockers.Conclusions: Available evidences show that for a period of time≥3 monthsα-blockers are effective (with moderate adverse effects) for reducing post-treatment total score, pain symptoms, urinary symptoms, and improving quality of life of patients with CP/CPPS. However, additional well designed treatment trials (if possible multi-center trials) of alpha-blockers are required to further confirm the efficacy ofα-adrenergic antagonists in the management of patients with CP/CPPS.