Use of Adjuvant Rectal Diazepam with Oral Tadalafil for Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Abstract Studies show oral Tadalafil and Diazepam suppositories each independently improve chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), leading providers to use medications simultaneously in the same patients. Our objective was to explore the efficacy of Tadalafil in CP/CPPS symptom management and whether co-administration of rectal Diazepam enhances potential benefit. A single-institution, retrospective chart review was performed on 63 adult males with CP/CPPS. NIH-Chronic Prostatitis Symptom Index (CPSI) questionnaires were collected before and after at least 45 days of treatment with either Tadalafil alone (n = 40) or Tadalafil with adjunctive Diazepam suppositories (n = 23). Both groups had similar baseline pain and urinary CPSI sub-scores, yet patients treated with Diazepam had significantly worse median quality of life sub-scores on both the initial (8.5 vs. 11, P = 0.01) and final (4 vs. 8.5 P = 0.02) surveys. For both groups, CPSI aggregated scores and pain, urinary, and quality of life sub-scores were significantly reduced compared to scores before treatment ( P < 0.0001-0.02). However, the reduction in symptom scores was not significantly different with the addition of Diazepam suppositories ( P = 0.47–0.94). Tadalafil, both with and without Diazepam, improved CP/CPPS symptom scores across all domains of the CPSI questionnaire. However, Diazepam suppositories do not confer additional benefit compared to Tadalafil therapy alone for CP/CPPS.