Aims
of study
Chronic
pelvic pain
syndrome
is defined
as a disease
with chronic
pelvic pain
or voiding
symptoms
without
any evidence
of prostatitis
or urinary
tract infection. Pharmacotherapy for this syndrome often comes
out to be
unsuccessful.
Recently,
we reported
that the
majority
of men with
chronic
pelvic pain
showed intrapelvic
venous congestion
and postulated
that it
might be
one of the
causes of
choronic
pelvic pain
syndrome1.
The
aim of this
study was
to reveal
the clinical
therapeutic
effects
of acupuncture
as a treatment
option for
chronic
pelvic pain
syndrome
with intrapelvic
venous congestion.
Methods
A
total of
14 patients
with chronic
pelvic pain
syndrome
with intrapelvic
venous congestion
were treated
by acupuncture.
Their
ages ranged
from 18
to 50 years
(mean 33).
All
patients
had pelvic
pain and/or
voiding
symptoms;
perineal
pain or
discomfort
in 8, lower
abdominal
pain in
5, inguinal
pain in
2, pain
during ejaculation
in 1, pollakisuria
in 5 and
dysuria
in 2. Although all of the 14 patients had undergone pharmacotherapy, 4
showed no
improvement
in symptom
and 10 failed
to get satisfactory
relief. Acupuncture was performed using a disposable
stainless
needle (0.3mm
in diameter,
60mm in
length)
with a patient
in the prone
position.
An acupuncture
needle was
inserted
into bilateral
BL-33 (Zhongliao),
as standardized
by WHO on
the skin
of the third
posterior
sacral foramina.
The needle
was inserted
toward the
cranium
so deeply
that its
tip was
close to
the sacral
periosteum
(50 to 60
mm), then
rotated
manually
for 10 minutes
reciprocally.
All
patients
underwent
this procedure
once a week
during 5
weeks. They underwent transrectal sonography before and after the treatment. The prostatic capsular vein observed on sonogram
(sonolucent
zone) was
measured
in its maximum
width as
the diagnostic
index for
intrapelvic
venous congestion.
Symptoms
were evaluated
using AUA
symptom
index2
as well
as NIH chronic
prostatits
symptom
index3
before and
after the
treatment.
Values
were expressed
as the mean
plus or
minus standard
deviation.
A
paired-t
test was
used for
statistical
analysis. A p-value less than 0.05 was defined as statistically
significant.
Results
In
all of the
14 patients,
the AUA
symptom
index improved
from 8.3}9.3
to 5.1}8.0
(statistically
not significant).
NIH chronic
prostatits
symptom
index decreased
significantly
from 20.4}8.0
to 13.1}9.8
(p < 0.01).
@In particular,
pelvic pain
index and
quality
of life
index improved
significantly
from 10.7}4.9
to 7.4}5.0
(p < 0.05)
and from
8.8}2.3
to 4.9}4.0
(p < 0.01),
respectively.
The maximum
width of
sonolucent
zone was
more than
3.0 mm before
treatment
in all of
the patients,
and it also
decreased
significantly
from 4.9}0.6
to 3.3}1.2
(p < 0.0001)
after treatment.
No side
effects
were recognized.
Conclusions
Acupunture
on the third
posterior
sacral foramina
could improve
both pelvic
pain and
diagnostic
index for
intrapelvic
venous congestion,
simultaneously.
It was suggested
that therapeutic
effects
of acupuncture
in men with
chronic
pelvic pain
with intrapelvic
venous congestion
might be
obtained
through
the improvement
of intrapelvic
venous circulation.
Although
this study
was preliminary
one on the
small number
of subjects
and further
studies
are needed,
acupuncture
could be
alternative
option for
chronic
pelvic pain
syndrome.
References
1. Eur.Urol., 27: 280-285,1995.
2. J. Urol., 148: 1549-1557, 1992.
3. J. Urol., 162: 369-375, 1999.
