title: Neuromodulation in male chronic pelvic pain syndrome: rationale and practice.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, University of Washington, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195-6510, USA. cyang@u.washington.edu
authors.forename: Claire C
authors.initials: CC
authors.lastname: Yang
mesh_terms: D004599:Electric Stimulation Therapy; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology; D008297:Male; D011472:Prostatitis / Q000503:physiopathology / Q000628:therapy*; D060525:Pudendal Nerve / Q000502:physiology; D013979:Tibial Nerve / Q000502:physiology; D016896:Treatment Outcome