INTRODUCTION: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common condition that often requires multimodal therapy.
CPPS patients have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy (PFPT), however this is a specialized skill. We wished to compare outcomes of PFPT as part of multimodal therapy in CPPS patients between those treated at our institution and elsewhere.
METHODS: We identified patients seen between 2010 and 2014 from our CPPS registry with pelvic floor spasm with >1 visit. Patient phenotype was assessed with the UPOINT system and symptom severity with the National Institute of Health Chronic Prostatitis Symptom Index (CPSI). A 6-point drop in CPSI defined patient improvement.
RESULTS: 82 patients fit criteria with mean age of 41.6 years (range 19 to 75) and median symptom duration 24 months (3 to 240). Mean CPSI was 26.8 (10-41), median number of positive UPOINT domains was 3 (1-6) and 27 (32.9%) were local. At follow up 9 patients had refused PFPT, 24 had PFPT outside our institution and 48 had PFPT locally (CCF). Mean change in CPSI was refused 1.11 +/-4.1, outside -3.46 +/-6.7 and CCF -11.3 +/-7.0 (p< 0.0001). Individual improvement was seen in 1 (11%) refused patient, 10 (42%) outside patients and 38 (79.2%) CCF patients (p< 0.0001). By multivariable analysis, only CCF PT (OR 4.23, p=0.002) and symptom duration (OR 0.52, p=0.03) predicted improvement.
CONCLUSIONS: PFPT can be effective for CPPS with pelvic floor spasm but outcome depends on specialty training/experience of therapists.
Written by:
Polackwich AS, Li J, Shoskes DA. Are you the author?
Clinical Fellow, Male Infertility and Microsurgery, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Q10, Cleveland, OH 44195; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Q10, Cleveland, OH 44195. ; ;
Reference: J Urol. 2015 Apr 22. pii: S0022-5347(15)03859-8.
doi: 10.1016/j.juro.2015.03.130
PubMed Abstract
PMID: 25912491