Table 1.
Study ID | Intervention(s) (route, frequency, total dose/day) | Intervention(s) appropriate as applied in a clinical practice setting (description) | Intervention(s) duration | Comparator(s) (route, frequency, total dose/day) | Comparator(s) appropriate as applied in a clinical practice setting (description) | Comparator(s) duration |
Neimark 2016 | Breathing exercises using 'Karbonik' apparatus (hypercapnic hypoxia) 10‐20 min daily + medical therapy (see comparison). | No information regarding dose‐scaling or contraindications. | 10 days. | Levofloxacin 500 mg/day, tamsulosin 0.4 mg/day, Samprost daily suppository, Serenoa repens fructuum extract 1 capsule/day for 10 days, nimesulide 1‐2 tablets/day for 5‐7 days. | No information regarding dose‐scaling or contraindications. | 10 days. |
Pajovic 2016 | ESWT + medical therapy: each session had 12‐min duration and 3000 impulses with total energy flow 0.25 mJ/mm2 3 Hz, weekly in supine position without anaesthesia. |
No information regarding dose‐scaling or contraindications. | 12 weeks. | Medical therapy with doxazosin 4 mg daily, ibuprofen 400 mg daily and tiocolchicoside 12 mg daily. | Ranitidine was allowed for gastric complaints. No information regarding dose‐scaling or contraindications. |
12 weeks. |
Kucuk 2015 | Acupuncture group: UB28 bladder meridian GB41 gallbladder meridian LIV3 liver 3 meridian LI4 large intestine 4 meridian SP6 spleen 6 meridian SP8 spleen 8 meridian Stimulation using disposable acupuncture needles (Hua Long, 25 40 mm Sterile Acupuncture Needles, China) and electrical pulse generator (Agistim Duo, 4 4 mA rms max/ 99 Hz max, France). |
No information regarding dose‐scaling. "Localized skin infections concerning the acupoints, bleeding diathesis and use of anticoagulation" were contraindications. |
7 weeks. | Medical therapy levofloxacin 500 mg daily and ibuprofen 200 mg. | Orally administrated twice daily for 7 weeks. No information regarding dose‐scaling or contraindications. |
7 weeks. |
Sahin 2015 | Acupuncture, using 2 disposable stainless steel needles (0.3 mm diameter, 60 mm length, Suzhou, Jiangsu, China) that were inserted to a depth of maximum 2.5‐3 cm in 7 acupoints bilaterally: BL33 Zhongliao BL34 Xialiao BL54 Zhibian CV1 Huiyin CV4 Guanyuan SP6 Sanyinjiao SP9 Yinlingquan. Duration: 20 min (with rotation). | Applied weekly for 6 weeks without other treatment modalities. No information regarding dose‐scaling or contraindications. |
6 weeks. | Punctures in sham group performed 1 cm left of each selected acupoint, with same type of needles, of the same duration and frequency. | Applied weekly for 6 weeks. No information regarding dose‐scaling or contraindications. |
6 weeks. |
Zhao 2015 | Medical therapy (4 weeks of ciprofloxacin 500 mg bid, 3 months of ibuprofen 400 mg/day, 3 months of tamsulosin 0.4 mg/day) and scheduled for surgery during the same period in each of the sites by study clinicians; given written instructions about postoperative wound care. | No information regarding dose‐scaling or contraindications. | 3 months. | Same medications (4 weeks of ciprofloxacin 500 mg bid, 3 months of ibuprofen 400 mg/day, 3 months of tamsulosin 0.4 mg/day) and remain uncircumcised until end of 3‐month study participation, when they were scheduled to undergo circumcision. | No information regarding dose‐scaling or contraindications. | 3 months. |
Gallo 2014 | Individually discussed risk factors detected at history by the completed questionnaire, informed that such risk factors were potential causes of their disease symptoms and it was strongly recommended to avoid them, distributed a vademecum with 13 rules relating to diet, sexual habits and lifestyle. | No information regarding dose‐scaling or contraindications. | 3 months. | Followed same diet, sexual behaviours and lifestyle as those of the previous months. | No information regarding dose‐scaling or contraindications. | 3 months. |
Kessler 2014 | Sono‐electromagnetic therapy at home using Sonodyn Device: intensity 100 mW/cm2 with ultrasonic power of 12 mW and frequency 1.9 MHz, electric field force 0.3 V/m and magnetic field force 0.4 A/m; for 10 min, twice daily. | Participants could not see settings or perceive the device. No information regarding dose‐scaling or contraindications. | 12 weeks. | Similar placebo device. Participants applied same procedure, but device was not active during session. | Participants could not see settings or perceive device. No information regarding dose‐scaling or contraindications. | 12 weeks. |
Kaikai 2014 | Non‐intrusive ultrasound. Output frequency 1.79 MHz; output power: 3.15 W/cm2. Duration: 20 min, administered every 3 days (total of 7 times) + integrated Chinese‐Western medications. |
No information regarding dose‐scaling or contraindications. | ‐ | Integrated Chinese‐Western medications alone; QianLieShuTong Capsule, orally 3 times daily, 3 capsules each time, tamsulosin delayed‐release capsule, 0.2 mg, orally 4 times daily. | No information regarding dose‐scaling or contraindications. | 1 month. |
Vahdatpour 2013 | ESWT (DUOLITH SD1, Storz Medical, Tägerwilen, Switzerland) once weekly for 4 weeks. Each time 3000 impulses, with 0.25 mJ/mm2 and 3 Hz of frequency were delivered, although 0.5 mJ/mm2 was added in each week (0.3 mJ/mm2 in week 2, 0.35 mJ/mm2 in week 3 and 0.4 mJ/mm2 in week 4). After each 500 pulses, probe position was corrected, using transperineal ultrasound. | No information regarding dose‐scaling or contraindications. | 4 weeks. | In sham group, same protocol applied but with probe being turned off. | No information regarding dose‐scaling or contraindications. | 4 weeks. |
Fitzgerald 2013 | 10 × 1‐hour sessions of myofascial physical therapy involved connective tissue manipulation of the abdominal wall, back, buttocks and thighs with connective tissue abnormalities in prone and supine position; double voiding and squatting (as home exercises); transrectal manipulation. | No information regarding dose‐scaling. "The presence of painful scars on lower abdominal wall that according to the health care personnel were unlikely to respond to physical therapy" was used as an exclusion criterion. |
‐ | 10 × 1‐hour sessions of global therapeutic Western massage, including effleurage, petrissage, friction, tapotement, vibration and kneading, in upper and lower limbs, trunk, buttocks, abdomen, head and neck each for prescribed time periods; participants not provided with home exercise programme. | No information regarding dose‐scaling or contraindications. | ‐ |
Zeng 2012 | 20,000 ESWT (HB‐ESWT‐01, Haibin Medical Equipment Co. Ltd., China) impulses in 10 sessions, applied directly to perineal area in which pain was localised (from anus to scrotum); starting energy density was 0.06 mJ/mm2 and frequency of 2 Hz was used for all treatments. | Energy density gradually increased until it reached the maximum possible tolerable pain level reported by participant (recorded and used in all subsequent sessions). No information regarding contraindications. |
2 weeks. | Sham ESWT, which was conducted by setting the energy level to 0 (no shockwave energy transmission), under conditions identical to active treatment group. | No information regarding dose‐scaling or contraindications. | 2 weeks. |
Gao 2012 | 60‐min treatment with TRFH (ZRL‐II‐A cavity intervention treatment instrument provided by Shanghai Songhang Industry, Co. Ltd. (Shanghai, China), temperature 40‐43 °C) every day. | No information regarding dose‐scaling or contraindications. | 5 days. | Tamsulosin 0.2 mg once daily + clarithromycin 0.25 g bid. | No information regarding dose‐scaling or contraindications. | 6 weeks. |
TRFH + tamsulosin + clarithromycin (6 weeks). | ||||||
Yang 2011 | Biofeedback group, participant displayed the electromyography of pelvic floor muscle and was instructed to contract and relax the anus according to instructions on display (20‐min sessions, 5 times weekly for 2 weeks). | No information regarding dose‐scaling or contraindications. All participants received interventions in comparison group. |
2 weeks. | All participants, including those in the "usual care group" instructed to avoid alcohol and spicy food, sitting too long and holding urine, catching a cold. Advised to be physically active and do exercise, have sex regularly, have warm sitz baths. | They were instructed to discontinue antibiotics, alpha‐blockers and other medications during the trial. No information regarding dose‐scaling or contraindications. |
‐ |
Electrical stimulation group, anal electrodes using intensity of 6˜23 mA, for 10˜20 s and relaxation for 10˜20 s, (20‐min sessions; 5 times each week for 2 weeks). | ||||||
Biofeedback + electrical stimulation (factorial design). | ||||||
Zhang 2011a | Taijiquan (Tai Chi) exercises for 20‐40 min every day. All participants received herbal therapy (no further specifications available) for 1 month after. | No information regarding dose‐scaling or contraindications. | 1 month. | All participants received herbal therapy (no further specifications available) for 1 month after. | No information regarding dose‐scaling or contraindications. | 1 month. |
Samhan 2011 | TENS daily for mean of 20 min in painful area, mean frequency 100 Hz, pulse width 100 μs and intensity 25 mA daily, 5 times weekly. | No information regarding dose‐scaling or contraindications. | 1 month. | Same as active treatment group but with machine turned off. | No information regarding dose‐scaling or contraindications. | 1 month. |
Lee 2009 | Advice of hot sitz baths and exercise and 12 × 20‐min sessions of electroacupuncture in 6 weeks: 6 acupoints at bilateral: BL32 zhongliao BL33 ciliao GB30 huantiao; preparation alcohol pads and disposable stainless steel needles (40 0.25 mm, Dongbang Acupuncture, Chungnam, Republic of Korea); at GB30, disposable stainless steel needles (70 0.30 mm, Dongbang Acupuncture) were inserted deeply to reach the myofascial trigger point of piriformis muscle. |
No information regarding dose‐scaling or contraindications. | 6 weeks. | Advice and exercise and 12 sessions of sham electroacupuncture, which included the same number and type of needle, duration and frequency of sessions as for the advice and exercise treatment, but treatment was delivered superficially at non‐acupoints 15 mm to the lateral of each corresponding acupoint; points were not stimulated electrically, but sound of pulse generator was heard by the participants. | No information regarding dose‐scaling or contraindications. | 6 weeks. |
Chen 2009 | Acupuncture + warm needle moxibustion. Acupuncture at acupoints: BI18 GanYu BI23 ShenYu BI54 ZhiBian BI26 GuanYuan Ren3 ZhongJi SP9 YinLingQuan SP6 SanYinJiao For 5 s each; needles were removed afterwards; once daily for 1 month. |
For those treated with moxibustion: needles were left afterwards and the tails of which were then covered with 2 cm moxa sticks. Moxa sticks were then ignited. Repeated moxibustion twice more for each acupoint. No information regarding dose‐scaling or contraindications. |
1 month. | Prostat tablet orally twice daily: pollen extract. Course of treatment; 1 month. |
No information regarding dose‐scaling or contraindications. | 1 month. |
Acupuncture procedures same as acupuncture + warm needle moxibustion. Moxibustion not performed. Treated once daily. Course of treatment: 1 month. | ||||||
Zimmermann 2009 | Perineally applied ESWT weekly (3000 pulses each; maximum total energy flow density: 0.25 mJ/mm2; frequency: 3 Hz); position of transducer was changed after every 500 pulses to scan prostatic and pelvic floor region (Duolith SD1, Storz Medical, Tägerwilen, Switzerland); penetration depth 35‐65 mm. | No information regarding dose‐scaling or contraindications. | 4 weeks. | Placebo treatment performed with same therapy head, which was also fitted with a placebo stand‐off. Stand‐off contained shock wave‐absorbing material, layer of air and air‐filled microspheres. | No information regarding dose‐scaling or contraindications. | 4 weeks. |
Marx 2009 | Osteopathic theory of structural dysfunction using direct and indirect techniques of manipulation; including rectal manipulation of the prostate and coccyx; 45‐min sessions for 5 weeks. | No information regarding dose‐scaling or contraindications. | 5 weeks. | Sham exercise program including a warm‐up, stretching, limb, breathing and pelvic floor muscle exercises; 30 min sessions in 5 weeks. | No information regarding dose‐scaling or contraindications. | 5 weeks. |
Oh 2009 | 'Radiofrequency.' | (abstract only) | ‐ | "Placebo therapy." | (abstract only) | ‐ |
Kabay 2009 | PTNS applied unilaterally with 26‐gauge stainless steel needles inserted 5 cm cephalad from medial malleolus and posterior to edge of tibia with a ground neutral electrode placed on same leg near arch of foot; both connected to a stimulator at 200 µs with pulse rate 20 Hz (Medtronic Key Point Net, Medtronic), for 30 min. | No information regarding dose‐scaling or contraindications. | 12 weeks. | Same electrode procedure for PTNS; however, stimulator not connected. | No information regarding dose‐scaling or contraindications. | 12 weeks. |
Yoo 2009 | TRMT alone for 12 weeks; using a Uro‐DR Device (Somang Medical; Kangreung, Korea), at intrarectal temperature of 43 °C for 30 min, at a medium heating rate. | No information regarding dose‐scaling or contraindications. | 12 weeks. | Medical therapy: ciprofloxacin 500 mg bid and NSAIDs C: TRMT + medical therapy. |
No information regarding dose‐scaling or contraindications. | 12 weeks. |
Lee 2008 | 4 acupoints prepared, then sterile, disposable stainless steel needles (Suzhou Huan‐Qiu Acupuncture Medical Supplies, Suzhou, China) placed perpendicularly in 30‐min sessions twice weekly in acupoints: CV1 Guan Yuan CV4 Huiyin SP6 Sanyinjiao SP9 Yinlingquan. |
No information regarding dose‐scaling or contraindications. | 10 weeks. | Sham acupuncture included same number, duration and frequency of sessions as acupuncture group at non‐acupoints (15 mm to left). | No information regarding dose‐scaling or contraindications. | 10 weeks. |
Sikiru 2008 | Antibiotics plus TENS; with high TENS over painful area, daily for mean of 20 min, mean frequency 100 Hz, pulse width 100 μs and intensity 25 mA, 5 times weekly. | Contraindications: loss of skin sensation at and around painful area, cardiac pace maker, previous exposure to TENS and other electroanalgesia. | 4 weeks. | Ofloxacin 300 mg 3 times daily + placebo tablets. | No information regarding dose‐scaling or contraindication. | 4 weeks. |
Giubilei 2007 | Aerobic exercise group, which included an 18‐week walking programme, 3 times weekly; with a warm up and cool‐down regimen, postural muscle and isometric strengthening exercises, 40 min of fast‐paced walking on 'in‐outdoor' track (achieving 70/80% of predicted maximum heart rate for their age). | Participants with a 'lack of interest,' 'lack of time' and 'lack of confidence' to engage physical activity excluded from study. No information regarding dose‐scaling. |
18 weeks. | Placebo/flexibility and motion exercise programme; with same period and with same frequency of aerobic exercise group, maintaining their heart rate under 100 beats per min. | Participants with a 'lack of interest,' 'lack of time' and 'lack of confidence' to engage physical activity were excluded from the study. No information regarding dose‐scaling. |
18 weeks. |
Paick 2006 | Extracorporeal magnetic innervation using Neoconrol system (Neotonus Inc., Marietta, GA, USA) that generates a magnetic field directed in the seat of chair and concentrated in region of pelvic muscles; 2 sessions weekly lasting 20 min each. | 1st 10 min used 10 Hz field, 2 min rest and then 10 min of 50 Hz field. No information regarding contraindications. |
6 weeks. | Medical therapy with terazosin 4 mg daily. | They started 2 mg daily for 1st 7 days, and continued to receive 4 mg daily for the following 5 weeks. No information regarding contraindications. |
6 weeks. |
Ateya 2006 | Participants received antibiotics empirically and prostatic massage (3 times weekly for 4 weeks). Prostate massaged from above and lateral to gland, 6 times on each side, by gentle and firm pressure of finger directed downwards and inwards, followed by a few strokes in middle from above downwards. | No information regarding dose‐scaling or contraindications. | ‐ | Empirical antibiotic therapy alone without prostatic massage. | 'In the 44 participants with negative cultures, antibiotic selection included quinolones (28 participants), clindamycin/metronidazole (11 participants), ampicillin/ clavulanic acid (2 participants), and azithromycin (1 participant). All participants continued the 1 month of treatment.' | ‐ |
Shen 2006 | Medical therapy with modified BiXieFenQing Drink in morning and evening, 200 mL each + prostate massage once weekly. | No information regarding dose‐scaling or contraindications. | ‐ | Medical therapy alone. | No information regarding dose‐scaling or contraindications. | ‐ |
Rowe 2005 | Participant seated in a Neotonus Electromagnetic Chair (Neotonus Inc., Marietta, GA, USA), for 2 consecutive 15‐min periods; 2 sessions weekly. | 1st period 10 Hz, 2nd period 50 Hz. No information regarding contraindications. |
4 weeks. | Participants seated in chair, ventilation mechanism activated, but no active stimulation applied. | No information regarding dose‐scaling or contraindications. | 4 weeks. |
Fang 2005 | He‐Ne laser directed to prostate. Optic fibre was inserted from urethra and located at prostatic urethra; 10 mW output at 18 J each time. | 1 course of treatment: 10 doses of radiation (2 sessions weekly). Participants discontinued all other treatments, except for some of the participants, short‐term sulfa‐drugs were administered temporarily to prevent infection. |
‐ | 'Routine care' for prostatitis including antibiotics, pollen extract, Chinese medicine, physical therapy and lifestyle interventions. | Sulfamethoxazole tablets, 2 tablets, orally bid, 60 days of fluoroquinolones such as levofloxacin 0.2 g, bid, 14 days of pollen drugs such as Prostat; Chinese patent drugs such as salvianolic acid B and saponins of panax notoginseng mixture (SalB/PNS); hot water bath and advise on lifestyle. | ‐ |
Kastner 2004 | Transurethral microwave thermotherapy through catheter connected to a Targis System estimated peak intraprostatic temperatures of 55 °C. | No information regarding dose‐scaling or contraindications. | ‐ | Transurethral microwave thermotherapy through catheter connected to a Targis System estimated peak intraprostatic temperatures of 70 °C. | No information regarding dose‐scaling or contraindications. | ‐ |
Wang 2002 | External radiofrequency hyperthermia. | Applied externally: 2 electrodes placed at hip and lower abdomen, 5˜7 cm away from skin, with pubic symphysis as centre (42.5˜43.5 °C), 1˜2 hours each time, course of treatment: 2˜3 times, interval: 1˜2 weeks. No information regarding dose‐scaling or contraindications. |
1˜2 weeks. | Same external radiofrequency hyperthermia + terazosin 2 mg. | Daily for 2 days and then dose was increased to 2 mg bid for 12 weeks. No information regarding contraindications for terazosin. |
12 weeks. |
Leskinen 2002 | TUNA using 465‐kHz radiofrequency energy and formal needle insertion technique as described by Issa 1996; treatment applied on 2 planes on both lateral lobes of prostate in all participants so target temperature of 50 °C at needle tip was achieved for ≥ 1 min; under spinal analgesia and antibiotic prophylaxis. | No information regarding dose‐scaling or contraindications. | ‐ | 3 sham urethroscopy performed so it was seemingly identical to TUNA in participant's opinion; under spinal analgesia and antibiotic prophylaxis. | No information regarding dose‐scaling or contraindications. | ‐ |
Vassily 1999 | TRMT, 6 sessions over 2 weeks each. | No information regarding dose‐scaling or contraindications. | ‐ | Sham procedure. | No information regarding dose‐scaling or contraindications. | ‐ |
Nickel 1996 | Transurethral microwave thermotherapy consisted of 1 × 1‐hour treatment with computer‐driven device that elevated prostate interstitial temperatures to 45‐60 °C, a range that does not cause significant necrosis of normal prostatic tissue. | No information regarding dose‐scaling or contraindications. | Single session. | Sham therapy consisted of 1 × 1‐hour session with same device using sham software. | No information regarding dose‐scaling or contraindications. | Single session. |
Muraro 1995 | Seaprose S (Flaminase, Formenti) 30 mg 3 times daily in combination with local hyperthermia, total of 7 sessions on alternate days of 60‐min duration, reaching local temperature of 42.5‐43.5 °C. | No information regarding dose‐scaling. Contraindication to those with hypersensitivity to the drug. |
‐ | 7 sessions of local hyperthermia alone. | No information regarding dose‐scaling or contraindications. | ‐ |
Montorsi 1993 | I1: 1 session of transrectal hyperthermia weekly for 4 weeks. I2: 1 session of transrectal hyperthermia weekly for 6 weeks. I3: 2 sessions of transrectal hyperthermia weekly for 3 weeks. Prostathermer 99D system (Biodan Ltd, Rehovot, Israel), target temperature reached within 1st 10 min of treatment, microwaves at 915 MHz, thermosensors for monitoring rectal temperature, cooling system for anterior rectal wall, thermosensors for urethra temperatures, outpatient basis, required local anaesthesia, with 2% xylocaine jelly before insertion of the catheter. |
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Shah 1993 | TRMT, 4 × 1‐hour treatment over 2 or 3 weeks. Temperature raised to 43.8 °C with input of 40 W. | No information regarding dose‐scaling or contraindications. (abstract only) |
2˜3 weeks | Sham group with temperature < 37 °C. | No information regarding dose‐scaling or contraindications. (abstract only) |
‐ |
‐ denotes not reported.
bid: twice daily; C: comparator; ESWT: extracorporeal shockwave therapy; I: intervention; min: minute; NSAID: non‐steroidal anti‐inflammatory drug; PTNS: posterior tibial nerve stimulation; s: second; TENS: transcutaneous electrical nerve stimulation; TRFH: transrectal radiofrequency hyperthermia; TRMT: transrectal microwave thermotherapy; TUNA: transurethral needle ablation.