Laparoscopic Prostate Removal
for Severe, Treatment-Resistant
Chronic Prostatitis


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Physical Therapy and Pelvic Trigger Point Release

This page deals with physical manipulation of muscles, which is not the same as prostate massage. You can also read about aerobic exercise and flexibility exercise for prostatitis.

Men with prostatitis sometimes exhibit specific points of tenderness in their muscles, which, when pressed, can elicit twitching. Such "trigger points" can affect the skeletal muscles of the back, buttocks, and legs and the somatic muscles of the pelvic floor. Moreover, specific points of tenderness in the intra-pelvic muscles can, when pressed, reproduce the symptoms of chronic prostatitis

The precise relationship of muscle tenderness to prostatitis is not known: They could in theory be a cause of the symptoms of prostatitis or the result of prostatitis or neither. Mechanical trigger point release, also known as myofascial release, is practiced as a treatment for chronic pelvic pain syndrome in both genders, including in men with type III prostatitis. However, there few data and no randomized trials of trigger point release as a treatment for chronic prostatitis. Research about the relative merits of trigger point release would be somewhat difficult to carry out because of methodological challenges, e.g. trigger point identification and release technique could be hard to standardize.

report in the 2011 Journal of Urology details outcomes after a 6-day intensive course of treatment with myofascial (trigger point) release and paradoxical relaxation training. The study group was 200 men, of whom 84 (42%) were lost to followup.

The remaining 116 (58%) volunteers had the following characteristics:

  • Median age of 48 years (range 19 to 80)
  • Median symptom duration of 4.8 years (range  1 to 30)
  • Visual analogue pain scale score of 4 (range 1 to 8)
  • Median CPSI score of 26 (range 10 to 38)

At a median followup of 6 months:

  • 70 had a 6-point decrease in CPSI score
  • The median CPSI score dropped 7 points to 19 (range 13 to 25)

The report raises questions, including:

  • What is the effect of the data censorship caused by the loss to followup of 84 (42%) of the patients entering the study?
  • What is the clinical meaning of a CPSI score of 19? Are patients accepting of such symptoms?
  • What is the clinical meaning of a 7-point change in CPSI? Are patients satisfied with this?
  • What happened to the 84 patients who were lost to followup? Did their symptoms resolve?
  • What happened next with the 46 patients who did not get a 6-point decrease in CPSI?

Patients considering trigger point release should keep in mind that pelvic trigger point release has not been extensively studied and that:

  • Trigger point identification is subjective
  • Release technique may vary
  • Optimal protocols have not been defined
  • The durability of therapeutic effect is not well defined

They should also keep in mind as they consider treatment choice that many treatments (e.g. finasteride, global therapeutic massage, quercetin, pollen extract) and even placebo have been associated with an approximate CPSI change of 7 points. As they select a treatment, patients may want to ask: What might be the advantage of myofascial release with paradoxical training over other seemingly equally effective but perhaps less costly or unpleasant options and/or placebo?

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