Rabal Conesa Carlos, Cao Avellaneda Enrique, López Cubillana Pedro, Prieto Merino David, Khalus Plish Alexander, Martínez Franco Antonio, López Abad Alicia
Physiotherapy, Universidad Católica de Murcia, Murcia, ESP.
Urology, University Hospital Virgen de la Arrixaca, Murcia, ESP.
Cureus. 2022 Apr 25;14(4):e24481. doi: 10.7759/cureus.24481. eCollection 2022 Apr.
Purpose Chronic pelvic pain syndrome (CPPS) is permanent pelvic pain of unknown etiology. Current theories suggest a multifactorial origin for CPPS, including urinary pathologies, psychosocial factors, prostate inflammation, infection, central sensitization of the nervous system, and muscular contractures or fibrosis. As there are no defined treatment protocols for CPPS, a multimodal approach is recommended. The objective of this study was to evaluate the impact of a manual therapy treatment protocol on pain, urinary symptoms, and overall quality of life. Materials and Methods Twenty-three men aged 47.36 ± 10.11 years were recruited consecutively by urologists practicing at two hospitals. All men presented prostatic tenderness with no other positive clinical history, urine cultures, or echography studies. Patients underwent six manual therapy sessions (three during the first week and three every two weeks after that) performed by a single osteopath or physiotherapist. The intervention protocol addressed the treatment of muscle structures, fascial mechanics, vascularization, innervation, emotional factors, and the need for information. The questionnaires used to evaluate outcomes included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptoms Score (IPSS), and a Visual Analog Scale (VAS) for pain, and the Hospital Anxiety and Depression Scale (HADS). Data were evaluated using Chi-squared or paired difference tests by an external researcher. Results The mean NIH-CPSI scores recorded for our study cohort decreased by 7.69 points (30.92%; <0.0005; 95% CI 4.02-10.52). IPSS measurements decreased by 3.20 points (22.18%; =0.009; 95% CI 1.00-6.09), although the item addressing quality of life decreased by 1.67 points only (31.99%; <0.0005; 95% CI 0.94-2.33). The VAS score also decreased by 2.20 points (38.6%; <0.0005; 95% CI 1.45-2.73). Changes in HADS scores were not statistically significant. Conclusions Based on patient responses, this case series revealed that manual therapy improved urinary symptoms, pain, and quality of life.
目的 慢性盆腔疼痛综合征（CPPS）是病因不明的持续性盆腔疼痛。目前的理论认为CPPS有多种因素起源，包括泌尿系统疾病、心理社会因素、前列腺炎症、感染、神经系统中枢敏化以及肌肉挛缩或纤维化。由于CPPS没有明确的治疗方案，建议采用多模式方法。本研究的目的是评估一种手法治疗方案对疼痛、泌尿系统症状和总体生活质量的影响。
材料与方法 两家医院的泌尿科医生连续招募了23名年龄在47.36±10.11岁的男性。所有男性均有前列腺压痛，无其他阳性临床病史、尿培养或超声检查结果。患者接受了由一名整骨疗法医生或物理治疗师进行的六次手法治疗（第一周进行三次，之后每两周进行三次）。干预方案涉及肌肉结构、筋膜力学、血管化、神经支配、情绪因素以及信息需求的治疗。用于评估结果的问卷包括美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）、国际前列腺症状评分（IPSS）、疼痛视觉模拟量表（VAS）以及医院焦虑抑郁量表（HADS）。数据由外部研究人员使用卡方检验或配对差异检验进行评估。
结果 我们研究队列记录的平均NIH-CPSI评分下降了7.69分（30.92%；<0.0005；95%置信区间4.02-10.52）。IPSS测量值下降了3.20分（22.18%；=0.009；95%置信区间1.00-6.09），尽管涉及生活质量的项目仅下降了1.67分（31.99%；<0.0005；95%置信区间0.94-2.33）。VAS评分也下降了2.20分（38.6%；<0.0005；95%置信区间1.45-2.73）。HADS评分的变化无统计学意义。
结论 根据患者的反应，该病例系列表明手法治疗改善了泌尿系统症状、疼痛和生活质量。
