Department of Urology, University of Washington, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195-6510, USA.
World J Urol. 2013 Aug;31(4):767-72. doi: 10.1007/s00345-013-1066-7. Epub 2013 Apr 26.
This review explores the treatment of male chronic pelvic pain syndrome (CPPS) (i.e., chronic prostatitis) through the use of neuromodulation, which is the electrical stimulation of the nervous system. Neuromodulation has been used for the treatment of chronic pain for decades, and this review will examine the theory and use of neuromodulation and the various techniques available for the treatment of CPPS.
Existing literature on the use of neuromodulation of the pelvic nerves for the treatment of chronic urogenital pelvic pain was reviewed. Because of limited published research, much of the data are not explicitly for male CPPS.
Neuromodulation techniques used for chronic pelvic pain conditions include SNS, PTNS and pudendal nerve stimulation. Only SNS and PTNS are currently approved by the US Food and Drug Administration for the treatment of urinary symptoms, and none of these methods are acknowledged as standard therapies for treating chronic pelvic pain syndromes. The improvement of urinary symptoms is more clearly defined than improvements in pain, but at least a subset of patients in most of the published studies and case series derive some benefit in the short term and limited evidence suggests that long-term improvement of symptoms is possible. However, explantation rates are high in all long-term series of patients receiving implantable neuromodulation devices.
Neuromodulation appears to provide benefits for patients with CPPS. However, because of the paucity of data and the limitations of small studies, the conclusions of the existing literature must be carefully considered. Because we are still becoming familiar with the pathophysiology of the pain syndromes and the mechanism of neuromodulation on urinary and pain symptoms, we cannot yet predict a particular individual's response to neuromodulation. To determine the long-term efficacy of this therapy, more clinical study is needed to explore the use of neuromodulation in the treatment of male CPPS.
本综述探讨了通过神经调节（即神经系统的电刺激）治疗男性慢性盆腔疼痛综合征（CPPS）（即慢性前列腺炎）的方法。神经调节已被用于治疗慢性疼痛数十年，本综述将检查神经调节的理论和用途以及治疗 CPPS 的各种可用技术。
综述了使用盆腔神经的神经调节治疗慢性泌尿生殖系统盆腔疼痛的现有文献。由于发表的研究有限，大部分数据并非专门针对男性 CPPS。
用于慢性盆腔疼痛病症的神经调节技术包括 SNS、PTNS 和阴部神经刺激。只有 SNS 和 PTNS 目前被美国食品和药物管理局批准用于治疗尿症状，而且这些方法都没有被承认为治疗慢性盆腔疼痛综合征的标准疗法。与疼痛改善相比，尿症状的改善更为明确，但在大多数已发表的研究和病例系列中，至少有一部分患者在短期内获得了一些益处，并且有限的证据表明长期症状改善是可能的。然而，在接受植入式神经调节装置的所有长期患者系列中，取出率都很高。
神经调节似乎为 CPPS 患者提供了益处。然而，由于数据匮乏和小型研究的局限性，必须仔细考虑现有文献的结论。由于我们仍在熟悉疼痛综合征的病理生理学和神经调节对尿和疼痛症状的作用机制，我们还无法预测特定个体对神经调节的反应。为了确定这种治疗的长期疗效，需要更多的临床研究来探索神经调节在男性 CPPS 治疗中的应用。
