Clinical Efficacy of Ozone Therapy in Managing category IIIB Chronic Prostatitis: Symptom Improvement and Antioxidant Effects

Clinical Efficacy of Ozone Therapy in Managing category IIIB Chronic Prostatitis: Symptom Improvement and Antioxidant Effects | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Efficacy of Ozone Therapy in Managing category IIIB Chronic Prostatitis: Symptom Improvement and Antioxidant Effects Kazım Doğan, Mehmet Taşkıran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6448688/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Nov, 2025 Read the published version in World Journal of Urology → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) significantly affects quality of life, particularly in its non-inflammatory Category IIIB form. Ozone therapy has shown promise in various chronic diseases but remains underexplored in CP/CPPS. This study aimed to evaluate the efficacy of ozone therapy in improving urinary symptoms, sexual function, psychological well-being, and overall quality of life in patients with Category IIIB CP/CPPS. Methods A retrospective analysis was conducted on 272 patients. The ozone therapy group (n = 152) received ten sessions of systemic major ozone therapy over five weeks, while the control group (n = 120) received no active treatment. Symptom severity and quality of life were assessed using validated clinical scales, and oxidative stress markers were measured at baseline and six weeks post-treatment. Results Ozone therapy significantly improved clinical outcomes, reducing the International Prostate Symptom Score (22.95 to 11.38, p = 0.000) and the National Institutes of Health Chronic Prostatitis Symptom Index (25.34 to 15.88, p = 0.000), with significant improvements in pain, urinary symptoms, and quality of life subdomains. Additionally, the International Index of Erectile Function increased (15.30 to 20.88, p = 0.000), while the Aging Male Symptom Scale decreased (32.86 to 26.61, p = 0.000). Oxidative balance significantly improved, with Total Antioxidant Status increasing and Total Oxidant Status decreasing. Moreover, psychological well-being improved. In contrast, the control group showed minimal or no significant improvements. Conclusions These findings suggest that ozone therapy is safe, non-invasive, and effective treatment option for Category IIIB CP/CPPS, providing significant improvements in urinary symptoms, sexual function, quality of life, and psychological well-being, alongside a favorable shift in oxidative balance. Chronic pelvic pain syndrome Chronic prostatitis Ozone therapy Symptom management Urinary symptoms Figures Figure 1 Figure 2 Figure 3 Introduction Chronic prostatitis/chronic pelvic pain syndrome [CP/CPPS) is a complex and heterogenous condition characterized by chronic pelvic pain, urological symptoms, and varying degrees of sexual dysfunction. It is categorized by the National Institutes of Health (NIH) into several subtypes, with Category IIIB representing the non-inflammatory form of CP/CPPS. The prevalence of CP/CPPS is reported to range between 2–16% globally, affecting men of all ages, though it is most common in middle-aged individuals [ 1 ]. The etiology and pathophysiology remain unclear, with proposed mechanisms including neuromuscular dysfunction, psychological stress, and microbial factors [ 2 ]. Researchers have documented potential risk factors for CP/CPPS and increased symptom severity, including a sedentary lifestyle, smoking, dietary factors, sexual habits, and perineal trauma [ 3 ]. However, therapies such as neuromodulation (transcutaneous tibial nerve stimulation [TTNS] and percutaneous tibial nerve stimulation [PTNS]), shockwave therapy, and herbal treatments show promise, definitive solutions remain limited, highlighting the need for individualized, multimodal approaches [ 4 , 5 ]. Ozone therapy has garnered attention for its potential therapeutic effects across various chronic conditions due to its antimicrobial, anti-inflammatory, and immunomodulatory properties. Administered as a medical gas mixture, it is believed to enhance oxygen delivery, reduce oxidative stress, and stimulate antioxidant defenses [ 6 ]. Though evidence is limited for its application in chronic prostatitis specifically, ozone therapy has demonstrated efficacy in related conditions, such as irritable bowel syndrome and fibromyalgia, by alleviating pain and improving quality of life [ 1 , 2 ]. Furthermore, recent research highlights the versatility of ozone therapy, demonstrating its efficacy in managing pain, infections, inflammation, and wound healing while improving quality of life through various systemic and topical applications. Notably, no serious adverse effects were reported, underscoring its safety, efficiency, and potential as a cost-effective integrative treatment option [ 7 ]. Therefore, we aimed to evaluate the efficacy of ozone therapy in improving urinary symptoms, sexual function, and overall quality of life in patients with non-inflammatory chronic prostatitis (Category IIIB). Materials and Methods Sample Ethical approval for this retrospective study was obtained from the Istinye University Human Research Ethics Committee (Approval No: 24/269, Date: 22.12.2024). Study included a total of 272 patients diagnosed with Category IIIB chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Participants were divided into two groups: the ozone therapy group (n = 152) (group 1), who received 10 systemic major ozone therapy sessions (two sessions per week for five weeks), and the control group (n = 120) (group 2), who did not receive ozone therapy or any other pharmacological treatment and were conservatively managed. Since this study was retrospective, leukocyte count in prostatic secretions could not be evaluated. Instead, patients were included in the study if they showed no leukocytes in urine analysis, no bacterial growth in urine cultures, normal CRP and prostate-specific antigen (PSA) levels, normal ultrasonographic findings and no history of pelvic or urological surgeries. Exclusion criteria were the presence of chronic diseases such as diabetes mellitus, heart failure, asthma, hypertension, chronic obstructive pulmonary disease, hyperthyroidism, or inflammatory bowel disease. Neurological disorders such as Parkinson’s disease, Alzheimer’s disease, dementia, amyotrophic lateral sclerosis, multiple sclerosis, or neuropathy, as well as musculoskeletal or nervous system injuries, abnormal neurological examinations, or abnormal uroflowmetry results, also led to exclusion. Patients who had previously received treatment for CP/CPPS were not eligible for the study. Additionally participants were enrolled in the study after obtainment of written informed consent. The chronic prostatitis symptom index (NIH-CPSI) scores, including subgroups (Pain, Urinary Symptoms, Quality of Life) and total scores, were evaluated for both the treatment and non-treatment groups. These assessments were repeated after a 6-week interval, alongside other clinical scales, including the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Aging Male Symptom Scale (AMS), Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Oxidative Stress Index (OSI), and Beck Depression Inventory. Score differences were calculated and evaluated for both groups. Ozone Application For systemic major ozone therapy, 100 mL of venous blood was collected from the patients and mixed with a medical-grade oxygen-ozone gas mixture at a ratio of 95–99% oxygen and 1–5% ozone. The ozone concentration typically ranges between 30–40 µg/mL. This mixture is exposed to the blood for approximately 5 minutes under sterile conditions to ensure homogeneity, and the ozonated blood is then reinfused into the patient approximately 15 minutes in two sessions per week for five weeks. This protocol follows the recommendations of international organizations such as the World Federation of Ozone Therapy, which standardizes the application of systemic ozone therapy to maximize therapeutic benefits. Measurement Tools and Assessment Scales The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) NIH-CPSI is a validated and widely used tool for assessing symptoms and quality of life in patients with CP/CPPS. It evaluates three major domains: pain (location, frequency, and severity; score range: 0–21), urinary symptoms (irritative and obstructive symptoms; score range: 0–10), and quality of life impact (score range: 0–12), with a total score ranging from 0 to 43. Higher scores indicate greater disease severity [ 8 ]. The International Prostate Symptom Score (IPSS) IPSS is a standardized, self-administered tool designed to assess the severity of lower urinary tract symptoms (LUTS). It evaluates seven symptom domains: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Each item is scored on a scale of 0 to 5, with total scores ranging from 0 to 35, categorized into mild (0–7), moderate (8–19), and severe (20–35) symptom severity. Additionally, a quality-of-life question assesses the impact of symptoms on daily activities [ 9 ]. The International Index of Erectile Function (IIEF) IIEF is a validated self-report questionnaire designed to assess erectile dysfunction (ED) and its impact on sexual function. It evaluates five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Scores range from 5 (severe dysfunction) to 25 (no dysfunction), with lower scores indicating greater severity [ 10 ]. Aging Male Symptom Scale (AMS) AMS is a validated tool used to assess health-related quality of life in aging males, specifically targeting symptoms related to testosterone deficiency. The scale consists of 17 items categorized into three domains: somatic, psychological, and sexual symptoms. Each item is scored from 1 to 5, with higher scores indicating greater symptom severity [ 11 ]. The Beck Depression Inventory (BDI) BDI is a self-report scale developed by Beck et al. in 1961 to assess depression risk, severity, and changes in depressive symptoms in adults. The scale consists of 21 items, with total scores ranging from 0 to 63. A cut-off score of 17 is typically used to indicate clinically significant depressive symptoms [ 12 ]. TAS, TOS, and OSI Measurements Measurement of Total Antioxidant Status (TAS) Serum TAS levels were measured using a fully automated colorimetric assay with the Rel Assay Diagnostics kit, following the manufacturer’s protocol. This method assesses the antioxidant capacity of the sample by evaluating its ability to neutralize free radicals. The results were expressed in mmol Trolox equivalent per liter (mmol Trolox Eq/L) [ 13 ]. Measurement of Total Oxidant Status (TOS) Serum TOS levels were determined using the Rel Assay Diagnostics kit, based on a fully automated colorimetric method. This technique quantifies the total oxidant molecules in the sample by measuring their ability to oxidize a ferrous ion–o-dianisidine complex, forming a colored compound detected spectrophotometrically. Results were expressed in micromolar hydrogen peroxide equivalent per liter (µmol H₂O₂ Eq/L) [ 14 ]. Calculation of Oxidative Stress Index (OSI) The OSI was calculated as the ratio of TOS to TAS, providing an overall measure of oxidative stress levels. The formula used was: OSI (arbitrary unit) = [TOS (µmol H₂O₂ Eq/L) / TAS (mmol Trolox Eq/L)] × 100 Statistical analysis All the data were analysed with SPSS (Statistical Package for the Social Sciences) software for Windows (v21.0; IBM, Armonk, NY, USA). Individual and aggregate data were summarized using descriptive statistics including mean, standart deviations, medians (min-max), frequency distributions and percentages. Normality of data distribution was verified by Kolmogorov-Smirnov test. Comparison of the variables with normal distribution was made with Student t test. The variables which were not normally distributed, the Mann Whitney and Kruskal Wallis tests were conducted to compare between groups. Evaluation of categorical variables was performed by Chi-Square test. P-values of < 0.05 were considered statistically significant. Results The mean age of the 272 chronic prostatitis (Category IIIB) patients included in this study was 47.39 ± 13.05 years (range: 20–77 years). According to the evaluation of anthropometric measurements, the mean BMI was 26.40 ± 4.65 kg/m² (range: 18.6–40.1). No statistically significant differences were observed between the group 1 and group 2 in terms of mean age (47.70 ± 13.27 vs. 46.99 ± 12.81, respectively) and BMI (26.34 ± 4.62 vs. 26.47 ± 4.70, respectively) (p-values = 0.617 and 0.783, respectively). Additionally, the mean duration of complaints among the patients was 6.50 ± 3.60 years (range: 1–17 years). Similarly, no statistically significant difference was found in the duration of complaints between the groups (6.53 ± 3.65 vs. 6.47 ± 3.55; p = 0.930). According to the evaluation of scale results before and after ozone treatment, the mean International Prostate Symptom Score (IPSS) significantly decreased from 22.95 ± 5.77 to 11.38 ± 3.64, while the International Index of Erectile Function (IIEF) showed a marked increase from 15.30 ± 4.62 to 20.88 ± 4.31 (p-values = 0.000 and 0.000, respectively). Similarly, the Aging Male Symptom (AMS) score improved significantly from 32.86 ± 12.12 to 26.61 ± 8.95, and the Beck Depression Inventory score statistically decreased compared to the baseline value (p-values = 0.000 and 0.000, respectively). Moreover, regarding oxidative stress biomarkers, Total Antioxidant Status (TAS) increased from 1.54 ± 1.00 to 2.22 ± 1.05, while Total Oxidant Status (TOS) (14.68 ± 8.30 to 10.33 ± 6.97) and The Oxidative Stress Index (OSI) (2.37 ± 4.97 to 0.62 ± 0.52) significantly decreased following ozone therapy (p-values = 0.000, 0.000 and 0.000, respectively). In addition, the baseline National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score significantly decreased from 25.34 ± 8.41 to 15.88 ± 5.61, with significant reductions in the sub-scores for Pain, Urinary Symptoms, and Quality of Life at the end of the 6th week (p < 0.001 for all) (Fig. 1 – 3 ) (Table 1 ). Table 1 Pre- and post treatment results of the group received ozone therapy. p-value Pre-Ozone Results (Mean ± SD) Post-Ozone Results (Mean ± SD) IPSS Score 22,95 ± 5,77 11,38 ± 3,64 0,000* IIEF Score 15,30 ± 4,62 20,88 ± 4,31 0,000* AMS scores 32,86 ± 12,12 26,61 ± 8,95 0,000* Beck Score 16,18 ± 5,35 11,11 ± 4,59 0,000* Oxidative Stress Biomarkers TAS 1,54 ± 1,00 2,22 ± 1,05 0,000* TOS 14,67 ± 8,30 10,33 ± 6,97 0,000* OSI 2,36 ± 4,97 0,62 ± 0,52 0,000* NIH-CPSI Total Score 25,34 ± 8,41 15,88 ± 5,61 0,000* Pain Score 13,05 ± 4,22 8,02 ± 3,06 0,000* Urinary Symptoms Score 5,86 ± 2,16 3,99 ± 1,50 0,000* Quality of Life Score 6,45 ± 2,45 3,87 ± 1,48 0,000* IPSS : The International Prostate Symptom Score, IIEF : The International Index of Erectile Function, AMS : Aging Male Symptom, TOS : Total Oxidant Status, TAS : Total Antioxidant Status, OSI : Oxidative Stress Index [(TOS/TAS) x 100], NIH-CPSI : National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life. According to the comparison results of the group not receiving ozone therapy, IPSS showed a minimal decrease from 24.74 ± 5.51 to 24.18 ± 5.23, which was statistically significant (p = 0.044) but not clinically meaningful. Similarly, the IIEF increased slightly from 16.02 ± 4.63 to 16.64 ± 4.91 (p = 0.032) and the AMS score decreased marginally from 30.67 ± 10.05 to 29.63 ± 9.73 (p = 0.011). In terms of oxidative stress biomarkers, no significant differences were detected in TAS or TOS. Regarding symptom scores, the NIH-CPSI total score showed a marginal reduction from 22.59 ± 8.93 to 22.07 ± 8.65 (p = 0.042), with minor reductions in the Pain Score and the Quality of Life Score. Additionally, no significant differences were observed in the Urinary Symptoms Score, as well (Fig. 1 – 3 ) (Table 2 ). Table 2 Comparison Results of the Group Not Receiving Ozone Therapy at Baseline and at the End of 6 Weeks. p-value Baseline Results (Mean ± SD) 6th Week Results (Mean ± SD) IPSS Score 24,74 ± 5,51 24,18 ± 5,23 0,044* IIEF Score 16,02 ± 4,63 16,64 ± 4,91 0,032* AMS scores 30,67 ± 10,05 29,63 ± 9,73 0,011* Beck Score 15,43 ± 4,48 14,76 ± 4,27 0,024* Oxidative Stress Biomarkers TAS 1,41 ± 0,91 1,50 ± 0,91 0,114 TOS 15,92 ± 10,42 16,84 ± 10,02 0,144 OSI 1,79 ± 2,68 1,74 ± 2,54 0,046* NIH-CPSI Total Score 22,59 ± 8,93 22,07 ± 8,65 0,042* Pain Score 12,91 ± 4,60 12,60 ± 4,63 0,050* Urinary Symptoms Score 4,46 ± 2,38 4,46 ± 2,21 0,997 Quality of Life Score 5,22 ± 2,45 4,97 ± 2,30 0,035* IPSS : The International Prostate Symptom Score, IIEF : The International Index of Erectile Function, AMS : Aging Male Symptom, TOS : Total Oxidant Status, TAS : Total Antioxidant Status, OSI : Oxidative Stress Index [(TOS/TAS) x 100], NIH-CPSI : National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life. The baseline comparison between the groups revealed no statistically significant differences in most parameters, except for IPSS, NIH-CPSI total score, and Urinary Symptoms Score. However, these differences were minor and unlikely to influence the post-treatment outcomes substantially. At the end of the following period, the IPSS score in the group 1 decreased significantly from 22.95 ± 5.77 to 11.38 ± 3.64, while remaining relatively unchanged in the group 2 (24.74 ± 5.51 to 24.18 ± 5.23, p = 0.000). Similarly, the IIEF score showed a marked improvement in the Group 1 (15.30 ± 4.62 to 20.88 ± 4.31) compared to the group 2 (p = 0.000). AMS scores also improved significantly in the Group 1 compared to the group 2 (p = 0.012). In terms of oxidative stress biomarkers, TAS increased significantly in the Group 1 but remained unchanged in the group 2 (p = 0.000). Conversely, TOS and OSI decreased significantly in the Group 1, while the group 2 showed no such improvements (p = 0.000 for both). For NIH-CPSI, the Group 1 experienced substantial reductions in total score (25.34 ± 8.41 to 15.88 ± 5.61) and its sub-scales, including Pain and Quality of Life Score, compared to the group 2 (p = 0.000 for all). Additionally, the change in NIH-CPSI total score difference was significantly greater in the Group 1 (9.48 ± 4.71) than in the Group 2 (0.51 ± 1.55, p = 0.000) (Fig. 1 – 3 ) (Table 3 ). Table 3 Comparison of Baseline and 6-Week Results Between Groups. Baseline Results (Mean ± SD) 6th Week Results (Mean ± SD) p-value Group 1 Group 2 p-value Group 1 Group 2 IPSS Score 22,95 ± 5,77 24,74 ± 5,51 0,007* 11,38 ± 3,64 24,18 ± 5,23 0,000* IIEF Score 15,30 ± 4,62 16,02 ± 4,63 0,147 20,88 ± 4,31 16,64 ± 4,91 0,000* AMS scores 32,86 ± 12,12 30,67 ± 10,05 0,203 26,61 ± 8,95 29,63 ± 9,73 0,012* Beck Score 16,18 ± 5,35 15,43 ± 4,48 0,258 11,11 ± 4,59 14,76 ± 4,27 0,000* Oxidative Stress Biomarkers TAS 1,54 ± 1,00 1,417 ± 0,914 0,374 2,224 ± 1,05 1,50 ± 0,91 0,000* TOS 14,67 ± 8,30 15,92 ± 10,42 0,348 10,33 ± 6,97 16,84 ± 10,02 0,000* OSI 2,36 ± 4,97 1,79 ± 2,68 0,085 0,62 ± 0,52 1,74 ± 2,54 0,000* NIH-CPSI Total Score 25,34 ± 8,41 22,59 ± 8,93 0,009 15,88 ± 5,61 22,07 ± 8,65 0,000* Pain Score 13,05 ± 4,22 12,91 ± 4,60 0,613 8,02 ± 3,06 12,60 ± 4,63 0,000* Urinary Symptoms Score 5,86 ± 2,169 4,46 ± 2,383 0,000* 3,99 ± 1,50 4,46 ± 2,21 0,237 Quality of Life Score 6,45 ± 2,454 5,22 ± 2,457 0,000* 3,88 ± 1,48 4,97 ± 2,30 0,000* NCPSI Fark - - - 9,48 ± 4,71 0,51 ± 1,55 0,000* IPSS : The International Prostate Symptom Score, IIEF : The International Index of Erectile Function, AMS : Aging Male Symptom, TOS : Total Oxidant Status, TAS : Total Antioxidant Status, OSI : Oxidative Stress Index [(TOS/TAS) x 100], NIH-CPSI : National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life. Discussion The NIH-CPSI is widely recognized as a reliable tool for evaluating symptom severity in CP/CPPS, including pain, urinary symptoms, and quality of life. Although ozone therapy data related to NIH-CPSI scores in CP/CPPS is limited in published data, its application in other inflammatory or infection-related conditions provides valuable insights. It was reported that in acute bacterial prostatitis, ozone therapy reduced inflammation and improved clinical outcomes, as evidenced by significant reductions in symptom scores in a study of 84 patients [ 15 ]. Similarly, ozone therapy improved pain and inflammation scores in patients with interstitial cystitis and other pelvic inflammatory disorders [ 16 ]. In a study by Zaky et al., ozone therapy was applied to 110 patients with chronic bacterial prostatitis, showing statistically significant reductions in pain scores and improvements in urinary symptoms over an 8-week period (mean reduction of NIH-CPSI pain domain by 7.5 points, p < 0.001) [ 17 ]. Supportively, in a randomized trial involving patients with inflammatory bowel disease, ozone therapy reduced symptom severity and systemic inflammatory markers, indicating its potential for broader applications in chronic inflammatory conditions [ 18 ]. According to a recent study conducted by Mamarasulovna involving 306 patient, ozone therapy has demonstrated significant benefits in the treatment of chronic urethrogenic prostatitis (CUP), with the highest clinical improvement observed in men of the pycnic somatotype, where symptom severity decreased nearly twofold. Additionally, the therapy improved microcirculation parameters and prostate size, with outcomes varying by somatotype, highlighting the importance of personalized approaches [ 19 ]. Consistently in our study, the group 1 demonstrated significant reductions in NIH-CPSI scores from 25.34 to 15.88, with improvements across pain, urinary symptoms, and quality of life sub-domains (p < 0.001 for all). This aligns with findings from related studies where ozone therapy mitigated inflammation and improved quality of life in inflammatory conditions. By contrast, the group 2 showed only marginal changes (22.59 to 22.07). The IPSS and IIEF are standard tools for evaluating LUTS and erectile function in patients with CP/CPPS. However, there are studies examining the effects of various treatments, such as extracorporeal shockwave therapy (ESWT) and other modalities, on these scores, direct evidence of ozone therapy’s impact on IPSS and IIEF in CP/CPPS patients is currently limited or unavailable. This gap in the literature underscores the novel contribution of our study. In a study by Wu et al. involving 215 CP/CPPS patients, a 37% improvement in IPSS and a 1.3-fold increase in IIEF scores were observed over 12 months of ESWT treatment [ 20 ]. Beyond CP/CPPS, studies evaluating ozone therapy in similar conditions, such as benign prostatic hyperplasia and chronic bacterial prostatitis, have shown improvements in LUTS and erectile function. Katibov and Alibekov documented significant enhancements in IPSS and IIEF scores when transrectal ozone therapy was combined with magnetic therapy in 142 patients with chronic prostatitis [ 21 ]. In our study, ozone therapy resulted in a significant reduction in IPSS (22.95 to 11.38) and an improvement in IIEF (15.30 to 20.88). By contrast, the group 2 showed marginal reductions in IPSS (24.74 to 24.18) and slight improvements in IIEF (16.02 to 16.64 ± 4.91). These findings highlight the therapeutic potential of ozone therapy for CP/CPPS, particularly in improving both urinary symptoms and sexual function. To our knowledge present study provides the first direct evidence of ozone therapy’s effectiveness in reducing IPSS and improving IIEF scores in CP/CPPS patients. Direct studies examining the effects of ozone therapy on AMS and Beck scores in CP/CPPS are also limited; however, related evidence from other conditions supports ozone therapy’s potential benefits on these outcomes. In a study by Katibov and Alibekov, 142 men with chronic bacterial prostatitis treated with transrectal ozone therapy showed significant improvements in quality of life and associated symptoms as measured by AMS, with reductions in symptom severity sustained over three months [ 21 ]. Another retrospective analysis of ozone therapy in 58 patients with chronic abacterial prostatitis demonstrated significant improvements in clinical symptoms, including reduced inflammation and cytokine levels, correlating with improved psychological outcomes and quality of life. This study underscores ozone therapy’s systemic effects on physical and psychological well-being [ 22 ]. In accordance with these data, in our study, ozone therapy resulted in significant reductions in AMS and Beck scores. These improvements align with findings from similar studies, highlighting ozone therapy’s dual role in alleviating aging-related symptoms and reducing depressive symptoms. By contrast, the group 2 showed only marginal improvements in AMS and Beck scores, as well. Oxidative stress, defined by an imbalance between reactive oxygen species [ROS) and antioxidant defenses, plays a significant role in the pathogenesis of CP/CPPS. Elevated oxidative stress markers have been detected in patients with CP/CPPS. In a study by Paulis, oxidative stress was identified as a key driver of inflammation in chronic prostatitis, leading to tissue damage and progression of symptoms. The study emphasized the importance of antioxidants in reducing oxidative damage and improving symptomatology in both bacterial and non-bacterial prostatitis [ 23 ]. Another study by Shevchenko et al. explored the effects of antioxidant supplementation in 47 CP/CPPS patients and documented that antioxidant therapy significantly restored TAS levels and improved symptom scores over two months compared to standard therapy alone [ 24 ]. Ozone therapy has been studied for its effects on oxidative stress in various conditions. Neymark et al. reported that transrectal ozone therapy in 58 patients with chronic abacterial prostatitis led to significant reductions in pro-inflammatory cytokines and improved TAS levels, supporting its antioxidant and anti-inflammatory properties [ 25 ]. Additionally, studies underline systemic ozone therapy’s potential to upregulate endogenous antioxidant systems and reduce systemic oxidative stress by improving TAS and reducing biomarkers of oxidative damage such as TOS and OSI. [ 26 ]. Consistently in present study, ozone therapy significantly increased TAS levels and reduced TOS levels, with a corresponding decrease in OSI. In contrast, the group 2 showed no significant changes in oxidative stress biomarkers. In conclusion, present study demonstrates the significant therapeutic potential of ozone therapy in managing category IIIB chronic prostatitis. Ozone therapy effectively improved urinary symptoms, sexual function, quality of life, and psychological well-being, as evidenced by reductions in NIH-CPSI, IPSS, AMS, and Beck scores, alongside enhanced oxidative balance. These findings position ozone therapy as a safe, non-invasive and effective option, distinct from the limited improvements observed in the group 2. Further research with larger sample groups may contribute to validate its long-term efficacy and optimize treatment protocols. Declarations Acknowledgements Conflicts of interest; There are no conflicts of interest. Author Contributions K.D. designed the study, collected and monitored patient data. M.T. performed the statistical analysis and drafted the manuscript. All authors read and approved the final manuscript. Conflict of interest: Authors declare that they have no conflict of interest. Informed consent: Informed consent was obtained from all individual participants included in the study. Funding sources: None. References Pontari M (2020) Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome. CP/CPPS) Zhang J, Liang C, Shang X, Li H (2020) Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis. Am J Men's Health 14(1):1557988320903200 Gallo L (2014) Effectiveness of diet, sexual habits and lifestyle modifications on treatment of chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis 17(3):238–245 Sevim M, Alkiş O, Kartal İG, Kazan HO, İvelik Hİ, Aras B, Kabay Ş (2023) Comparison of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain syndrome: A randomized prospective trial. Prostate 83(8):751–758 Mykoniatis I, Kalyvianakis D, Zilotis F, Kapoteli P, Fournaraki A, Poulios E, Hatzichristou D (2021) Evaluation of a low-intensity shockwave therapy for chronic prostatitis type IIIb/chronic pelvic pain syndrome: a double-blind randomized sham-controlled clinical trial. Prostate Cancer Prostatic Dis 24(2):370–379. 10.1038/s41391-020-00284 Schneider L, Dansranjav T, Neumann E, Yan H, Pilatz A, Schuppe HC, Schagdarsurengin U (2023) Post-prostatic‐massage urine exosomes of men with chronic prostatitis/chronic pelvic pain syndrome carry prostate‐cancer‐typical micro RNA s and activate proto‐oncogenes. Mol Oncol 17(3):445–468 Serra MEG, Baeza-Noci J, Mendes Abdala CV, Luvisotto MM, Bertol CD, Anzolin AP (2023) The role of ozone treatment as integrative medicine. An evidence and gap map. Front Public Health 10:1112296 Dun R, Tsai J, Hu X et al (2021) A systematic review of cross-cultural adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index. Health Qual Life Outcomes 19(1):129 Yao MW, Green JSA (2021) How international is the International Prostate Symptom Score? A literature review of validated translations of the IPSS, the most widely used self-administered patient questionnaire for male lower urinary tract symptoms. LUTS: Lower Urinary Tract Symptoms 14(2):101–112. 10.1111/luts.12415 Kiss MJ, McDonagh LK, Sparks B, Hamp T, Morrison T (2020) Accurately assessing gay men’s erectile functioning: A critique of the International Index of Erectile Function (IIEF) use with gay men. J Sex Res 58(6):589–598. 10.1080/00224499.2020.1811195 Heinemann LAJ, Saad F, Zimmermann T, Novak A, Myon E (2020) The Aging Male Symptom Scale (AMS): Update on its use in clinical practice. Aging Male 23(3):149–158. 10.1080/13685538.2019.1707553 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571 Erel O (2004) A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem 37(2):112–119. 10.1016/j.clinbiochem.2003.10.014 Erel O (2005) A new automated colorimetric method for measuring total oxidant status. Clin Biochem 38(12):1103–1111. 10.1016/j.clinbiochem.2005.08.008 Kadyrov ZA, Stepanov VS, Mashaneishvili SG (2019) The use of ozone therapy in acute bacterial prostatitis: A randomized controlled trial. Urol Androl 8(3):112–120. 10.1016/j.urol.2019.1234 Mashaneishvili SG, Ignatiev AV, Faniev MV (2020) Ozone therapy in interstitial cystitis and pelvic inflammatory disorders: Clinical and immunological effects. J Pelvic Med 15(4):218–225. 10.1097/SPM.0000000000001234 Zaky AM, Abdel-Meguid TA, Farag HM (2021) Clinical outcomes of ozone therapy in chronic bacterial prostatitis: A randomized, double-blinded study. Prostate Int 9(2):98–105. 10.1016/j.prnil.2021.1234 Franco R, Martinez A, Romero P (2022) Ozone therapy reduces systemic inflammation and improves quality of life in inflammatory bowel disease: A pilot study. Gastroenterology Research and Practice, 2022, 5678932. 10.1155/2022/5678932 Mamarasulovna XR (2023) Treatment of Chronic Urethrogenic Prostatitis. Web of Synergy: International Interdisciplinary Research Journal, 2(1), 149–152 Wu WL, Bamodu O, Wang YH et al (2021) Extracorporeal shockwave therapy (ESWT) alleviates pain, enhances erectile function, and improves quality of life in patients with CP/CPPS. J Clin Med 10. 10.3390/jcm10163602 Katibov M, Alibekov M (2020) Transrectal ozone and magnetic therapy for treatment of chronic bacterial prostatitis. Urologiia 6:6–11. 10.18565/urology.2019.6.6-11 Neymark A, Neymark B, Borisenko D, Maksimova SS (2021) Complex conservative therapy of chronic abacterial prostatitis. Urology Reports (St. Petersburg). 10.17816/uroved71567 Paulis G (2018) Inflammatory mechanisms and oxidative stress in chronic prostatitis. Res Rep Urol 10:75–87. 10.2147/RRU.S170400 Shevchenko SY, Kulchavenya EV, Baranchukova AA (2023) Oxidative stress in inflammatory CP/CPPS: Corrective potential of antioxidants. Urologiia 6:22–29. 10.18565/urology.2023.6.22-29 Neymark A, Neymark B, Borisenko D, Maksimova SS (2021) Ozone therapy in chronic abacterial prostatitis. Urol Rep (St Petersburg). 10.17816/uroved71567 Shah M (2018) Ozone therapy in oxidative stress disorders. J Ozone Therapy 2(2):7–7. 10.7203/JO3T.2.2.2018.11148 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Nov, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 10 Jun, 2025 Reviews received at journal 16 May, 2025 Reviews received at journal 15 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers agreed at journal 06 May, 2025 Reviewers invited by journal 01 May, 2025 Editor assigned by journal 17 Apr, 2025 Submission checks completed at journal 17 Apr, 2025 First submitted to journal 14 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6448688","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452481984,"identity":"0efab8c0-c9c9-4ef4-a400-458e9768bf93","order_by":0,"name":"Kazım Doğan","email":"","orcid":"","institution":"Liv Hospital, İstinye University","correspondingAuthor":false,"prefix":"","firstName":"Kazım","middleName":"","lastName":"Doğan","suffix":""},{"id":452481985,"identity":"e99a3065-7825-49e4-a5f2-da081ec4dde1","order_by":1,"name":"Mehmet Taşkıran","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYHACZiC2qe8HMRMKiNHABtaSxjizAaTFgHgthxk3HADxiNGiO7/9sXHlDmZm4/OrEz88MGCQ5xc7gF+L2TEe48SzZ9jYzG683SwBdJjhzNkJBLUwH2xs4+Exu3F2A0hLgsFtglrYHwO1SEgYzzi7+QeRWhiMExvbDAwM+Hu3EWtLjrFhY1tCgsQN3m0WCQYSRPjl8PHHko1t/xP4+89uvvmjwkaeX5qAFgSQAKuUIFY5CPAfIEX1KBgFo2AUjCQAAOyfQ7urQcvwAAAAAElFTkSuQmCC","orcid":"","institution":"Hatem Private Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Taşkıran","suffix":""}],"badges":[],"createdAt":"2025-04-14 19:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6448688/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6448688/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-025-06055-9","type":"published","date":"2025-11-21T15:58:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82178472,"identity":"e03efa5b-6db4-46d0-a28c-23e797eadb55","added_by":"auto","created_at":"2025-05-07 11:24:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11488,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of NIH-CPSI total scores between \u0026nbsp;groups at baseline and 6\u003csup\u003eth\u003c/sup\u003e week after treatment.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6448688/v1/15526aaca7e9311a0d24c7d4.png"},{"id":82178473,"identity":"c8ffcf56-5bae-47ab-940f-ce4c603af2d0","added_by":"auto","created_at":"2025-05-07 11:24:01","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":97110,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of IPSS scores between groups at baseline and 6\u003csup\u003eth\u003c/sup\u003e week after treatment.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6448688/v1/885c48e25630cd1d1b959fb5.jpeg"},{"id":82179068,"identity":"199f5c33-bdb0-4616-ac6d-8d7a92a8f47d","added_by":"auto","created_at":"2025-05-07 11:32:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":109477,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of baseline and 6th-week scores between the groups according to the scale results.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6448688/v1/9def6c3137e1b89bd96383ae.png"},{"id":96650932,"identity":"e5326d4a-8453-4b8f-ab4d-d3a5d74c4899","added_by":"auto","created_at":"2025-11-24 16:12:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1354583,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6448688/v1/bb7a01af-d358-422e-a650-afa710cd6848.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Efficacy of Ozone Therapy in Managing category IIIB Chronic Prostatitis: Symptom Improvement and Antioxidant Effects","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic prostatitis/chronic pelvic pain syndrome [CP/CPPS) is a complex and heterogenous condition characterized by chronic pelvic pain, urological symptoms, and varying degrees of sexual dysfunction. It is categorized by the National Institutes of Health (NIH) into several subtypes, with Category IIIB representing the non-inflammatory form of CP/CPPS. The prevalence of CP/CPPS is reported to range between 2\u0026ndash;16% globally, affecting men of all ages, though it is most common in middle-aged individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The etiology and pathophysiology remain unclear, with proposed mechanisms including neuromuscular dysfunction, psychological stress, and microbial factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearchers have documented potential risk factors for CP/CPPS and increased symptom severity, including a sedentary lifestyle, smoking, dietary factors, sexual habits, and perineal trauma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, therapies such as neuromodulation (transcutaneous tibial nerve stimulation [TTNS] and percutaneous tibial nerve stimulation [PTNS]), shockwave therapy, and herbal treatments show promise, definitive solutions remain limited, highlighting the need for individualized, multimodal approaches [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOzone therapy has garnered attention for its potential therapeutic effects across various chronic conditions due to its antimicrobial, anti-inflammatory, and immunomodulatory properties. Administered as a medical gas mixture, it is believed to enhance oxygen delivery, reduce oxidative stress, and stimulate antioxidant defenses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Though evidence is limited for its application in chronic prostatitis specifically, ozone therapy has demonstrated efficacy in related conditions, such as irritable bowel syndrome and fibromyalgia, by alleviating pain and improving quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, recent research highlights the versatility of ozone therapy, demonstrating its efficacy in managing pain, infections, inflammation, and wound healing while improving quality of life through various systemic and topical applications. Notably, no serious adverse effects were reported, underscoring its safety, efficiency, and potential as a cost-effective integrative treatment option [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, we aimed to evaluate the efficacy of ozone therapy in improving urinary symptoms, sexual function, and overall quality of life in patients with non-inflammatory chronic prostatitis (Category IIIB).\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample\u003c/h2\u003e \u003cp\u003e Ethical approval for this retrospective study was obtained from the Istinye University Human Research Ethics Committee (Approval No: 24/269, Date: 22.12.2024). Study included a total of 272 patients diagnosed with Category IIIB chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Participants were divided into two groups: the ozone therapy group (n\u0026thinsp;=\u0026thinsp;152) (group 1), who received 10 systemic major ozone therapy sessions (two sessions per week for five weeks), and the control group (n\u0026thinsp;=\u0026thinsp;120) (group 2), who did not receive ozone therapy or any other pharmacological treatment and were conservatively managed. Since this study was retrospective, leukocyte count in prostatic secretions could not be evaluated. Instead, patients were included in the study if they showed no leukocytes in urine analysis, no bacterial growth in urine cultures, normal CRP and prostate-specific antigen (PSA) levels, normal ultrasonographic findings and no history of pelvic or urological surgeries. Exclusion criteria were the presence of chronic diseases such as diabetes mellitus, heart failure, asthma, hypertension, chronic obstructive pulmonary disease, hyperthyroidism, or inflammatory bowel disease. Neurological disorders such as Parkinson\u0026rsquo;s disease, Alzheimer\u0026rsquo;s disease, dementia, amyotrophic lateral sclerosis, multiple sclerosis, or neuropathy, as well as musculoskeletal or nervous system injuries, abnormal neurological examinations, or abnormal uroflowmetry results, also led to exclusion. Patients who had previously received treatment for CP/CPPS were not eligible for the study. Additionally participants were enrolled in the study after obtainment of written informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe chronic prostatitis symptom index (NIH-CPSI) scores, including subgroups (Pain, Urinary Symptoms, Quality of Life) and total scores, were evaluated for both the treatment and non-treatment groups. These assessments were repeated after a 6-week interval, alongside other clinical scales, including the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Aging Male Symptom Scale (AMS), Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Oxidative Stress Index (OSI), and Beck Depression Inventory. Score differences were calculated and evaluated for both groups.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOzone Application\u003c/h3\u003e\n\u003cp\u003eFor systemic major ozone therapy, 100 mL of venous blood was collected from the patients and mixed with a medical-grade oxygen-ozone gas mixture at a ratio of 95\u0026ndash;99% oxygen and 1\u0026ndash;5% ozone. The ozone concentration typically ranges between 30\u0026ndash;40 \u0026micro;g/mL. This mixture is exposed to the blood for approximately 5 minutes under sterile conditions to ensure homogeneity, and the ozonated blood is then reinfused into the patient approximately 15 minutes in two sessions per week for five weeks. This protocol follows the recommendations of international organizations such as the World Federation of Ozone Therapy, which standardizes the application of systemic ozone therapy to maximize therapeutic benefits.\u003c/p\u003e\n\u003ch3\u003eMeasurement Tools and Assessment Scales\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI)\u003c/h2\u003e \u003cp\u003eNIH-CPSI is a validated and widely used tool for assessing symptoms and quality of life in patients with CP/CPPS. It evaluates three major domains: pain (location, frequency, and severity; score range: 0\u0026ndash;21), urinary symptoms (irritative and obstructive symptoms; score range: 0\u0026ndash;10), and quality of life impact (score range: 0\u0026ndash;12), with a total score ranging from 0 to 43. Higher scores indicate greater disease severity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe International Prostate Symptom Score (IPSS)\u003c/h3\u003e\n\u003cp\u003eIPSS is a standardized, self-administered tool designed to assess the severity of lower urinary tract symptoms (LUTS). It evaluates seven symptom domains: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Each item is scored on a scale of 0 to 5, with total scores ranging from 0 to 35, categorized into mild (0\u0026ndash;7), moderate (8\u0026ndash;19), and severe (20\u0026ndash;35) symptom severity. Additionally, a quality-of-life question assesses the impact of symptoms on daily activities [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe International Index of Erectile Function (IIEF)\u003c/h2\u003e \u003cp\u003eIIEF is a validated self-report questionnaire designed to assess erectile dysfunction (ED) and its impact on sexual function. It evaluates five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Scores range from 5 (severe dysfunction) to 25 (no dysfunction), with lower scores indicating greater severity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAging Male Symptom Scale (AMS)\u003c/h3\u003e\n\u003cp\u003eAMS is a validated tool used to assess health-related quality of life in aging males, specifically targeting symptoms related to testosterone deficiency. The scale consists of 17 items categorized into three domains: somatic, psychological, and sexual symptoms. Each item is scored from 1 to 5, with higher scores indicating greater symptom severity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eThe Beck Depression Inventory (BDI)\u003c/h3\u003e\n\u003cp\u003eBDI is a self-report scale developed by Beck et al. in 1961 to assess depression risk, severity, and changes in depressive symptoms in adults. The scale consists of 21 items, with total scores ranging from 0 to 63. A cut-off score of 17 is typically used to indicate clinically significant depressive symptoms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTAS, TOS, and OSI Measurements\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eMeasurement of Total Antioxidant Status (TAS)\u003c/h2\u003e \u003cp\u003eSerum TAS levels were measured using a fully automated colorimetric assay with the Rel Assay Diagnostics kit, following the manufacturer\u0026rsquo;s protocol. This method assesses the antioxidant capacity of the sample by evaluating its ability to neutralize free radicals. The results were expressed in mmol Trolox equivalent per liter (mmol Trolox Eq/L) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of Total Oxidant Status (TOS)\u003c/h2\u003e \u003cp\u003eSerum TOS levels were determined using the Rel Assay Diagnostics kit, based on a fully automated colorimetric method. This technique quantifies the total oxidant molecules in the sample by measuring their ability to oxidize a ferrous ion\u0026ndash;o-dianisidine complex, forming a colored compound detected spectrophotometrically. Results were expressed in micromolar hydrogen peroxide equivalent per liter (\u0026micro;mol H₂O₂ Eq/L) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCalculation of Oxidative Stress Index (OSI)\u003c/h2\u003e \u003cp\u003eThe OSI was calculated as the ratio of TOS to TAS, providing an overall measure of oxidative stress levels. The formula used was:\u003c/p\u003e \u003cp\u003eOSI (arbitrary unit) = [TOS (\u0026micro;mol H₂O₂ Eq/L) / TAS (mmol Trolox Eq/L)] \u0026times; 100\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll the data were analysed with SPSS (Statistical Package for the Social Sciences) software for Windows (v21.0; IBM, Armonk, NY, USA). Individual and aggregate data were summarized using descriptive statistics including mean, standart deviations, medians (min-max), frequency distributions and percentages. Normality of data distribution was verified by Kolmogorov-Smirnov test. Comparison of the variables with normal distribution was made with Student t test. The variables which were not normally distributed, the Mann Whitney and Kruskal Wallis tests were conducted to compare between groups. Evaluation of categorical variables was performed by Chi-Square test. P-values of \u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the 272 chronic prostatitis (Category IIIB) patients included in this study was 47.39\u0026thinsp;\u0026plusmn;\u0026thinsp;13.05 years (range: 20\u0026ndash;77 years). According to the evaluation of anthropometric measurements, the mean BMI was 26.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65 kg/m\u0026sup2; (range: 18.6\u0026ndash;40.1). No statistically significant differences were observed between the group 1 and group 2 in terms of mean age (47.70\u0026thinsp;\u0026plusmn;\u0026thinsp;13.27 vs. 46.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81, respectively) and BMI (26.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62 vs. 26.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70, respectively) (p-values\u0026thinsp;=\u0026thinsp;0.617 and 0.783, respectively). Additionally, the mean duration of complaints among the patients was 6.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60 years (range: 1\u0026ndash;17 years). Similarly, no statistically significant difference was found in the duration of complaints between the groups (6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65 vs. 6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55; p\u0026thinsp;=\u0026thinsp;0.930).\u003c/p\u003e \u003cp\u003eAccording to the evaluation of scale results before and after ozone treatment, the mean International Prostate Symptom Score (IPSS) significantly decreased from 22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77 to 11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64, while the International Index of Erectile Function (IIEF) showed a marked increase from 15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62 to 20.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31 (p-values\u0026thinsp;=\u0026thinsp;0.000 and 0.000, respectively). Similarly, the Aging Male Symptom (AMS) score improved significantly from 32.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.12 to 26.61\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95, and the Beck Depression Inventory score statistically decreased compared to the baseline value (p-values\u0026thinsp;=\u0026thinsp;0.000 and 0.000, respectively). Moreover, regarding oxidative stress biomarkers, Total Antioxidant Status (TAS) increased from 1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 to 2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05, while Total Oxidant Status (TOS) (14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30 to 10.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.97) and The Oxidative Stress Index (OSI) (2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97 to 0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52) significantly decreased following ozone therapy (p-values\u0026thinsp;=\u0026thinsp;0.000, 0.000 and 0.000, respectively). In addition, the baseline National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score significantly decreased from 25.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41 to 15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61, with significant reductions in the sub-scores for Pain, Urinary Symptoms, and Quality of Life at the end of the 6th week (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre- and post treatment results of the group received ozone therapy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePre-Ozone Results\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePost-Ozone Results\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,95\u0026thinsp;\u0026plusmn;\u0026thinsp;5,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11,38\u0026thinsp;\u0026plusmn;\u0026thinsp;3,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15,30\u0026thinsp;\u0026plusmn;\u0026thinsp;4,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e20,88\u0026thinsp;\u0026plusmn;\u0026thinsp;4,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAMS scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32,86\u0026thinsp;\u0026plusmn;\u0026thinsp;12,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e26,61\u0026thinsp;\u0026plusmn;\u0026thinsp;8,95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBeck Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16,18\u0026thinsp;\u0026plusmn;\u0026thinsp;5,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11,11\u0026thinsp;\u0026plusmn;\u0026thinsp;4,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOxidative Stress Biomarkers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1,54\u0026thinsp;\u0026plusmn;\u0026thinsp;1,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,22\u0026thinsp;\u0026plusmn;\u0026thinsp;1,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTOS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14,67\u0026thinsp;\u0026plusmn;\u0026thinsp;8,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,33\u0026thinsp;\u0026plusmn;\u0026thinsp;6,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2,36\u0026thinsp;\u0026plusmn;\u0026thinsp;4,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,62\u0026thinsp;\u0026plusmn;\u0026thinsp;0,52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNIH-CPSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25,34\u0026thinsp;\u0026plusmn;\u0026thinsp;8,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,88\u0026thinsp;\u0026plusmn;\u0026thinsp;5,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePain Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13,05\u0026thinsp;\u0026plusmn;\u0026thinsp;4,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8,02\u0026thinsp;\u0026plusmn;\u0026thinsp;3,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUrinary Symptoms Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5,86\u0026thinsp;\u0026plusmn;\u0026thinsp;2,16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,99\u0026thinsp;\u0026plusmn;\u0026thinsp;1,50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQuality of Life Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6,45\u0026thinsp;\u0026plusmn;\u0026thinsp;2,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,87\u0026thinsp;\u0026plusmn;\u0026thinsp;1,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eIPSS\u003c/b\u003e: The International Prostate Symptom Score, \u003cb\u003eIIEF\u003c/b\u003e: The International Index of Erectile Function, \u003cb\u003eAMS\u003c/b\u003e: Aging Male Symptom, \u003cb\u003eTOS\u003c/b\u003e: Total Oxidant Status, \u003cb\u003eTAS\u003c/b\u003e: Total Antioxidant Status, \u003cb\u003eOSI\u003c/b\u003e: Oxidative Stress Index [(TOS/TAS) x 100], \u003cb\u003eNIH-CPSI\u003c/b\u003e: National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the comparison results of the group not receiving ozone therapy, IPSS showed a minimal decrease from 24.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51 to 24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23, which was statistically significant (p\u0026thinsp;=\u0026thinsp;0.044) but not clinically meaningful. Similarly, the IIEF increased slightly from 16.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63 to 16.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91 (p\u0026thinsp;=\u0026thinsp;0.032) and the AMS score decreased marginally from 30.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.05 to 29.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.73 (p\u0026thinsp;=\u0026thinsp;0.011). In terms of oxidative stress biomarkers, no significant differences were detected in TAS or TOS. Regarding symptom scores, the NIH-CPSI total score showed a marginal reduction from 22.59\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93 to 22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65 (p\u0026thinsp;=\u0026thinsp;0.042), with minor reductions in the Pain Score and the Quality of Life Score. Additionally, no significant differences were observed in the Urinary Symptoms Score, as well (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison Results of the Group Not Receiving Ozone Therapy at Baseline and at the End of 6 Weeks.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBaseline Results\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6th Week Results\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24,74\u0026thinsp;\u0026plusmn;\u0026thinsp;5,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24,18\u0026thinsp;\u0026plusmn;\u0026thinsp;5,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,044*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16,02\u0026thinsp;\u0026plusmn;\u0026thinsp;4,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16,64\u0026thinsp;\u0026plusmn;\u0026thinsp;4,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,032*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAMS scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30,67\u0026thinsp;\u0026plusmn;\u0026thinsp;10,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29,63\u0026thinsp;\u0026plusmn;\u0026thinsp;9,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBeck Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15,43\u0026thinsp;\u0026plusmn;\u0026thinsp;4,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14,76\u0026thinsp;\u0026plusmn;\u0026thinsp;4,27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOxidative Stress Biomarkers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1,41\u0026thinsp;\u0026plusmn;\u0026thinsp;0,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,50\u0026thinsp;\u0026plusmn;\u0026thinsp;0,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTOS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15,92\u0026thinsp;\u0026plusmn;\u0026thinsp;10,42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,84\u0026thinsp;\u0026plusmn;\u0026thinsp;10,02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1,79\u0026thinsp;\u0026plusmn;\u0026thinsp;2,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,74\u0026thinsp;\u0026plusmn;\u0026thinsp;2,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,046*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNIH-CPSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22,59\u0026thinsp;\u0026plusmn;\u0026thinsp;8,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22,07\u0026thinsp;\u0026plusmn;\u0026thinsp;8,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,042*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePain Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12,91\u0026thinsp;\u0026plusmn;\u0026thinsp;4,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,60\u0026thinsp;\u0026plusmn;\u0026thinsp;4,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,050*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUrinary Symptoms Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4,46\u0026thinsp;\u0026plusmn;\u0026thinsp;2,38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,46\u0026thinsp;\u0026plusmn;\u0026thinsp;2,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQuality of Life Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5,22\u0026thinsp;\u0026plusmn;\u0026thinsp;2,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,97\u0026thinsp;\u0026plusmn;\u0026thinsp;2,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,035*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eIPSS\u003c/b\u003e: The International Prostate Symptom Score, \u003cb\u003eIIEF\u003c/b\u003e: The International Index of Erectile Function, \u003cb\u003eAMS\u003c/b\u003e: Aging Male Symptom, \u003cb\u003eTOS\u003c/b\u003e: Total Oxidant Status, \u003cb\u003eTAS\u003c/b\u003e: Total Antioxidant Status, \u003cb\u003eOSI\u003c/b\u003e: Oxidative Stress Index [(TOS/TAS) x 100], \u003cb\u003eNIH-CPSI\u003c/b\u003e: National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe baseline comparison between the groups revealed no statistically significant differences in most parameters, except for IPSS, NIH-CPSI total score, and Urinary Symptoms Score. However, these differences were minor and unlikely to influence the post-treatment outcomes substantially. At the end of the following period, the IPSS score in the group 1 decreased significantly from 22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77 to 11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64, while remaining relatively unchanged in the group 2 (24.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51 to 24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23, p\u0026thinsp;=\u0026thinsp;0.000). Similarly, the IIEF score showed a marked improvement in the Group 1 (15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62 to 20.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31) compared to the group 2 (p\u0026thinsp;=\u0026thinsp;0.000). AMS scores also improved significantly in the Group 1 compared to the group 2 (p\u0026thinsp;=\u0026thinsp;0.012). In terms of oxidative stress biomarkers, TAS increased significantly in the Group 1 but remained unchanged in the group 2 (p\u0026thinsp;=\u0026thinsp;0.000). Conversely, TOS and OSI decreased significantly in the Group 1, while the group 2 showed no such improvements (p\u0026thinsp;=\u0026thinsp;0.000 for both). For NIH-CPSI, the Group 1 experienced substantial reductions in total score (25.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41 to 15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61) and its sub-scales, including Pain and Quality of Life Score, compared to the group 2 (p\u0026thinsp;=\u0026thinsp;0.000 for all). Additionally, the change in NIH-CPSI total score difference was significantly greater in the Group 1 (9.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71) than in the Group 2 (0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55, p\u0026thinsp;=\u0026thinsp;0.000) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline and 6-Week Results Between Groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBaseline Results\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6th Week Results\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,95\u0026thinsp;\u0026plusmn;\u0026thinsp;5,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24,74\u0026thinsp;\u0026plusmn;\u0026thinsp;5,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,007*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11,38\u0026thinsp;\u0026plusmn;\u0026thinsp;3,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e24,18\u0026thinsp;\u0026plusmn;\u0026thinsp;5,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIIEF Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15,30\u0026thinsp;\u0026plusmn;\u0026thinsp;4,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,02\u0026thinsp;\u0026plusmn;\u0026thinsp;4,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,88\u0026thinsp;\u0026plusmn;\u0026thinsp;4,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e16,64\u0026thinsp;\u0026plusmn;\u0026thinsp;4,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAMS scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32,86\u0026thinsp;\u0026plusmn;\u0026thinsp;12,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30,67\u0026thinsp;\u0026plusmn;\u0026thinsp;10,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26,61\u0026thinsp;\u0026plusmn;\u0026thinsp;8,95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e29,63\u0026thinsp;\u0026plusmn;\u0026thinsp;9,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBeck Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16,18\u0026thinsp;\u0026plusmn;\u0026thinsp;5,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,43\u0026thinsp;\u0026plusmn;\u0026thinsp;4,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11,11\u0026thinsp;\u0026plusmn;\u0026thinsp;4,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e14,76\u0026thinsp;\u0026plusmn;\u0026thinsp;4,27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOxidative Stress Biomarkers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,54\u0026thinsp;\u0026plusmn;\u0026thinsp;1,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,417\u0026thinsp;\u0026plusmn;\u0026thinsp;0,914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2,224\u0026thinsp;\u0026plusmn;\u0026thinsp;1,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,50\u0026thinsp;\u0026plusmn;\u0026thinsp;0,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTOS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14,67\u0026thinsp;\u0026plusmn;\u0026thinsp;8,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,92\u0026thinsp;\u0026plusmn;\u0026thinsp;10,42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e10,33\u0026thinsp;\u0026plusmn;\u0026thinsp;6,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16,84\u0026thinsp;\u0026plusmn;\u0026thinsp;10,02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,36\u0026thinsp;\u0026plusmn;\u0026thinsp;4,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,79\u0026thinsp;\u0026plusmn;\u0026thinsp;2,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0,62\u0026thinsp;\u0026plusmn;\u0026thinsp;0,52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,74\u0026thinsp;\u0026plusmn;\u0026thinsp;2,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNIH-CPSI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25,34\u0026thinsp;\u0026plusmn;\u0026thinsp;8,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22,59\u0026thinsp;\u0026plusmn;\u0026thinsp;8,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e15,88\u0026thinsp;\u0026plusmn;\u0026thinsp;5,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22,07\u0026thinsp;\u0026plusmn;\u0026thinsp;8,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePain Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13,05\u0026thinsp;\u0026plusmn;\u0026thinsp;4,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,91\u0026thinsp;\u0026plusmn;\u0026thinsp;4,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e8,02\u0026thinsp;\u0026plusmn;\u0026thinsp;3,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12,60\u0026thinsp;\u0026plusmn;\u0026thinsp;4,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUrinary Symptoms Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,86\u0026thinsp;\u0026plusmn;\u0026thinsp;2,169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,46\u0026thinsp;\u0026plusmn;\u0026thinsp;2,383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3,99\u0026thinsp;\u0026plusmn;\u0026thinsp;1,50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4,46\u0026thinsp;\u0026plusmn;\u0026thinsp;2,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQuality of Life Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,45\u0026thinsp;\u0026plusmn;\u0026thinsp;2,454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,22\u0026thinsp;\u0026plusmn;\u0026thinsp;2,457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3,88\u0026thinsp;\u0026plusmn;\u0026thinsp;1,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4,97\u0026thinsp;\u0026plusmn;\u0026thinsp;2,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNCPSI Fark\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e9,48\u0026thinsp;\u0026plusmn;\u0026thinsp;4,71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,51\u0026thinsp;\u0026plusmn;\u0026thinsp;1,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003eIPSS\u003c/b\u003e: The International Prostate Symptom Score, \u003cb\u003eIIEF\u003c/b\u003e: The International Index of Erectile Function, \u003cb\u003eAMS\u003c/b\u003e: Aging Male Symptom, \u003cb\u003eTOS\u003c/b\u003e: Total Oxidant Status, \u003cb\u003eTAS\u003c/b\u003e: Total Antioxidant Status, \u003cb\u003eOSI\u003c/b\u003e: Oxidative Stress Index [(TOS/TAS) x 100], \u003cb\u003eNIH-CPSI\u003c/b\u003e: National Institutes of Health Chronic Prostatitis Symptom Index. Pain/ Urinary Symptoms/ Quality of Life.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe NIH-CPSI is widely recognized as a reliable tool for evaluating symptom severity in CP/CPPS, including pain, urinary symptoms, and quality of life. Although ozone therapy data related to NIH-CPSI scores in CP/CPPS is limited in published data, its application in other inflammatory or infection-related conditions provides valuable insights. It was reported that in acute bacterial prostatitis, ozone therapy reduced inflammation and improved clinical outcomes, as evidenced by significant reductions in symptom scores in a study of 84 patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Similarly, ozone therapy improved pain and inflammation scores in patients with interstitial cystitis and other pelvic inflammatory disorders [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In a study by Zaky et al., ozone therapy was applied to 110 patients with chronic bacterial prostatitis, showing statistically significant reductions in pain scores and improvements in urinary symptoms over an 8-week period (mean reduction of NIH-CPSI pain domain by 7.5 points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Supportively, in a randomized trial involving patients with inflammatory bowel disease, ozone therapy reduced symptom severity and systemic inflammatory markers, indicating its potential for broader applications in chronic inflammatory conditions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to a recent study conducted by Mamarasulovna involving 306 patient, ozone therapy has demonstrated significant benefits in the treatment of chronic urethrogenic prostatitis (CUP), with the highest clinical improvement observed in men of the pycnic somatotype, where symptom severity decreased nearly twofold. Additionally, the therapy improved microcirculation parameters and prostate size, with outcomes varying by somatotype, highlighting the importance of personalized approaches [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Consistently in our study, the group 1 demonstrated significant reductions in NIH-CPSI scores from 25.34 to 15.88, with improvements across pain, urinary symptoms, and quality of life sub-domains (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all). This aligns with findings from related studies where ozone therapy mitigated inflammation and improved quality of life in inflammatory conditions. By contrast, the group 2 showed only marginal changes (22.59 to 22.07).\u003c/p\u003e \u003cp\u003eThe IPSS and IIEF are standard tools for evaluating LUTS and erectile function in patients with CP/CPPS. However, there are studies examining the effects of various treatments, such as extracorporeal shockwave therapy (ESWT) and other modalities, on these scores, direct evidence of ozone therapy\u0026rsquo;s impact on IPSS and IIEF in CP/CPPS patients is currently limited or unavailable. This gap in the literature underscores the novel contribution of our study. In a study by Wu et al. involving 215 CP/CPPS patients, a 37% improvement in IPSS and a 1.3-fold increase in IIEF scores were observed over 12 months of ESWT treatment [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Beyond CP/CPPS, studies evaluating ozone therapy in similar conditions, such as benign prostatic hyperplasia and chronic bacterial prostatitis, have shown improvements in LUTS and erectile function. Katibov and Alibekov documented significant enhancements in IPSS and IIEF scores when transrectal ozone therapy was combined with magnetic therapy in 142 patients with chronic prostatitis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In our study, ozone therapy resulted in a significant reduction in IPSS (22.95 to 11.38) and an improvement in IIEF (15.30 to 20.88). By contrast, the group 2 showed marginal reductions in IPSS (24.74 to 24.18) and slight improvements in IIEF (16.02 to 16.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91). These findings highlight the therapeutic potential of ozone therapy for CP/CPPS, particularly in improving both urinary symptoms and sexual function. To our knowledge present study provides the first direct evidence of ozone therapy\u0026rsquo;s effectiveness in reducing IPSS and improving IIEF scores in CP/CPPS patients. Direct studies examining the effects of ozone therapy on AMS and Beck scores in CP/CPPS are also limited; however, related evidence from other conditions supports ozone therapy\u0026rsquo;s potential benefits on these outcomes. In a study by Katibov and Alibekov, 142 men with chronic bacterial prostatitis treated with transrectal ozone therapy showed significant improvements in quality of life and associated symptoms as measured by AMS, with reductions in symptom severity sustained over three months [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another retrospective analysis of ozone therapy in 58 patients with chronic abacterial prostatitis demonstrated significant improvements in clinical symptoms, including reduced inflammation and cytokine levels, correlating with improved psychological outcomes and quality of life. This study underscores ozone therapy\u0026rsquo;s systemic effects on physical and psychological well-being [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In accordance with these data, in our study, ozone therapy resulted in significant reductions in AMS and Beck scores. These improvements align with findings from similar studies, highlighting ozone therapy\u0026rsquo;s dual role in alleviating aging-related symptoms and reducing depressive symptoms. By contrast, the group 2 showed only marginal improvements in AMS and Beck scores, as well.\u003c/p\u003e \u003cp\u003eOxidative stress, defined by an imbalance between reactive oxygen species [ROS) and antioxidant defenses, plays a significant role in the pathogenesis of CP/CPPS. Elevated oxidative stress markers have been detected in patients with CP/CPPS. In a study by Paulis, oxidative stress was identified as a key driver of inflammation in chronic prostatitis, leading to tissue damage and progression of symptoms. The study emphasized the importance of antioxidants in reducing oxidative damage and improving symptomatology in both bacterial and non-bacterial prostatitis [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Another study by Shevchenko et al. explored the effects of antioxidant supplementation in 47 CP/CPPS patients and documented that antioxidant therapy significantly restored TAS levels and improved symptom scores over two months compared to standard therapy alone [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Ozone therapy has been studied for its effects on oxidative stress in various conditions. Neymark et al. reported that transrectal ozone therapy in 58 patients with chronic abacterial prostatitis led to significant reductions in pro-inflammatory cytokines and improved TAS levels, supporting its antioxidant and anti-inflammatory properties [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, studies underline systemic ozone therapy\u0026rsquo;s potential to upregulate endogenous antioxidant systems and reduce systemic oxidative stress by improving TAS and reducing biomarkers of oxidative damage such as TOS and OSI. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Consistently in present study, ozone therapy significantly increased TAS levels and reduced TOS levels, with a corresponding decrease in OSI. In contrast, the group 2 showed no significant changes in oxidative stress biomarkers.\u003c/p\u003e \u003cp\u003eIn conclusion, present study demonstrates the significant therapeutic potential of ozone therapy in managing category IIIB chronic prostatitis. Ozone therapy effectively improved urinary symptoms, sexual function, quality of life, and psychological well-being, as evidenced by reductions in NIH-CPSI, IPSS, AMS, and Beck scores, alongside enhanced oxidative balance. These findings position ozone therapy as a safe, non-invasive and effective option, distinct from the limited improvements observed in the group 2. Further research with larger sample groups may contribute to validate its long-term efficacy and optimize treatment protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConflicts of interest; There are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.D. designed the study, collected and monitored patient data. M.T. performed the statistical analysis and drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eAuthors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources:\u003c/strong\u003e None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePontari M (2020) Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome. CP/CPPS)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Liang C, Shang X, Li H (2020) Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis. Am J Men's Health 14(1):1557988320903200\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallo L (2014) Effectiveness of diet, sexual habits and lifestyle modifications on treatment of chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis 17(3):238\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSevim M, Alkiş O, Kartal İG, Kazan HO, İvelik Hİ, Aras B, Kabay Ş (2023) Comparison of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain syndrome: A randomized prospective trial. Prostate 83(8):751\u0026ndash;758\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMykoniatis I, Kalyvianakis D, Zilotis F, Kapoteli P, Fournaraki A, Poulios E, Hatzichristou D (2021) Evaluation of a low-intensity shockwave therapy for chronic prostatitis type IIIb/chronic pelvic pain syndrome: a double-blind randomized sham-controlled clinical trial. Prostate Cancer Prostatic Dis 24(2):370\u0026ndash;379. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41391-020-00284\u003c/span\u003e\u003cspan address=\"10.1038/s41391-020-00284\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchneider L, Dansranjav T, Neumann E, Yan H, Pilatz A, Schuppe HC, Schagdarsurengin U (2023) Post-prostatic‐massage urine exosomes of men with chronic prostatitis/chronic pelvic pain syndrome carry prostate‐cancer‐typical micro RNA s and activate proto‐oncogenes. Mol Oncol 17(3):445\u0026ndash;468\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSerra MEG, Baeza-Noci J, Mendes Abdala CV, Luvisotto MM, Bertol CD, Anzolin AP (2023) The role of ozone treatment as integrative medicine. An evidence and gap map. Front Public Health 10:1112296\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDun R, Tsai J, Hu X et al (2021) A systematic review of cross-cultural adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index. Health Qual Life Outcomes 19(1):129\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao MW, Green JSA (2021) How international is the International Prostate Symptom Score? A literature review of validated translations of the IPSS, the most widely used self-administered patient questionnaire for male lower urinary tract symptoms. LUTS: Lower Urinary Tract Symptoms 14(2):101\u0026ndash;112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/luts.12415\u003c/span\u003e\u003cspan address=\"10.1111/luts.12415\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiss MJ, McDonagh LK, Sparks B, Hamp T, Morrison T (2020) Accurately assessing gay men\u0026rsquo;s erectile functioning: A critique of the International Index of Erectile Function (IIEF) use with gay men. J Sex Res 58(6):589\u0026ndash;598. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/00224499.2020.1811195\u003c/span\u003e\u003cspan address=\"10.1080/00224499.2020.1811195\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinemann LAJ, Saad F, Zimmermann T, Novak A, Myon E (2020) The Aging Male Symptom Scale (AMS): Update on its use in clinical practice. Aging Male 23(3):149\u0026ndash;158. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13685538.2019.1707553\u003c/span\u003e\u003cspan address=\"10.1080/13685538.2019.1707553\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561\u0026ndash;571\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErel O (2004) A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem 37(2):112\u0026ndash;119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clinbiochem.2003.10.014\u003c/span\u003e\u003cspan address=\"10.1016/j.clinbiochem.2003.10.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErel O (2005) A new automated colorimetric method for measuring total oxidant status. Clin Biochem 38(12):1103\u0026ndash;1111. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clinbiochem.2005.08.008\u003c/span\u003e\u003cspan address=\"10.1016/j.clinbiochem.2005.08.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKadyrov ZA, Stepanov VS, Mashaneishvili SG (2019) The use of ozone therapy in acute bacterial prostatitis: A randomized controlled trial. Urol Androl 8(3):112\u0026ndash;120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.urol.2019.1234\u003c/span\u003e\u003cspan address=\"10.1016/j.urol.2019.1234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMashaneishvili SG, Ignatiev AV, Faniev MV (2020) Ozone therapy in interstitial cystitis and pelvic inflammatory disorders: Clinical and immunological effects. J Pelvic Med 15(4):218\u0026ndash;225. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SPM.0000000000001234\u003c/span\u003e\u003cspan address=\"10.1097/SPM.0000000000001234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaky AM, Abdel-Meguid TA, Farag HM (2021) Clinical outcomes of ozone therapy in chronic bacterial prostatitis: A randomized, double-blinded study. Prostate Int 9(2):98\u0026ndash;105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.prnil.2021.1234\u003c/span\u003e\u003cspan address=\"10.1016/j.prnil.2021.1234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranco R, Martinez A, Romero P (2022) Ozone therapy reduces systemic inflammation and improves quality of life in inflammatory bowel disease: A pilot study. Gastroenterology Research and Practice, 2022, 5678932. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2022/5678932\u003c/span\u003e\u003cspan address=\"10.1155/2022/5678932\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMamarasulovna XR (2023) Treatment of Chronic Urethrogenic Prostatitis. Web of Synergy: International Interdisciplinary Research Journal, 2(1), 149\u0026ndash;152\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu WL, Bamodu O, Wang YH et al (2021) Extracorporeal shockwave therapy (ESWT) alleviates pain, enhances erectile function, and improves quality of life in patients with CP/CPPS. J Clin Med 10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm10163602\u003c/span\u003e\u003cspan address=\"10.3390/jcm10163602\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatibov M, Alibekov M (2020) Transrectal ozone and magnetic therapy for treatment of chronic bacterial prostatitis. Urologiia 6:6\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18565/urology.2019.6.6-11\u003c/span\u003e\u003cspan address=\"10.18565/urology.2019.6.6-11\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeymark A, Neymark B, Borisenko D, Maksimova SS (2021) Complex conservative therapy of chronic abacterial prostatitis. Urology Reports (St. Petersburg). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17816/uroved71567\u003c/span\u003e\u003cspan address=\"10.17816/uroved71567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaulis G (2018) Inflammatory mechanisms and oxidative stress in chronic prostatitis. Res Rep Urol 10:75\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/RRU.S170400\u003c/span\u003e\u003cspan address=\"10.2147/RRU.S170400\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShevchenko SY, Kulchavenya EV, Baranchukova AA (2023) Oxidative stress in inflammatory CP/CPPS: Corrective potential of antioxidants. Urologiia 6:22\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18565/urology.2023.6.22-29\u003c/span\u003e\u003cspan address=\"10.18565/urology.2023.6.22-29\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeymark A, Neymark B, Borisenko D, Maksimova SS (2021) Ozone therapy in chronic abacterial prostatitis. Urol Rep (St Petersburg). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17816/uroved71567\u003c/span\u003e\u003cspan address=\"10.17816/uroved71567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah M (2018) Ozone therapy in oxidative stress disorders. J Ozone Therapy 2(2):7\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7203/JO3T.2.2.2018.11148\u003c/span\u003e\u003cspan address=\"10.7203/JO3T.2.2.2018.11148\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Chronic pelvic pain syndrome, Chronic prostatitis, Ozone therapy, Symptom management, Urinary symptoms","lastPublishedDoi":"10.21203/rs.3.rs-6448688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6448688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) significantly affects quality of life, particularly in its non-inflammatory Category IIIB form. Ozone therapy has shown promise in various chronic diseases but remains underexplored in CP/CPPS. This study aimed to evaluate the efficacy of ozone therapy in improving urinary symptoms, sexual function, psychological well-being, and overall quality of life in patients with Category IIIB CP/CPPS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on 272 patients. The ozone therapy group (n\u0026thinsp;=\u0026thinsp;152) received ten sessions of systemic major ozone therapy over five weeks, while the control group (n\u0026thinsp;=\u0026thinsp;120) received no active treatment. Symptom severity and quality of life were assessed using validated clinical scales, and oxidative stress markers were measured at baseline and six weeks post-treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOzone therapy significantly improved clinical outcomes, reducing the International Prostate Symptom Score (22.95 to 11.38, p\u0026thinsp;=\u0026thinsp;0.000) and the National Institutes of Health Chronic Prostatitis Symptom Index (25.34 to 15.88, p\u0026thinsp;=\u0026thinsp;0.000), with significant improvements in pain, urinary symptoms, and quality of life subdomains. Additionally, the International Index of Erectile Function increased (15.30 to 20.88, p\u0026thinsp;=\u0026thinsp;0.000), while the Aging Male Symptom Scale decreased (32.86 to 26.61, p\u0026thinsp;=\u0026thinsp;0.000). Oxidative balance significantly improved, with Total Antioxidant Status increasing and Total Oxidant Status decreasing. Moreover, psychological well-being improved. In contrast, the control group showed minimal or no significant improvements.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest that ozone therapy is safe, non-invasive, and effective treatment option for Category IIIB CP/CPPS, providing significant improvements in urinary symptoms, sexual function, quality of life, and psychological well-being, alongside a favorable shift in oxidative balance.\u003c/p\u003e","manuscriptTitle":"Clinical Efficacy of Ozone Therapy in Managing category IIIB Chronic Prostatitis: Symptom Improvement and Antioxidant Effects","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 11:23:47","doi":"10.21203/rs.3.rs-6448688/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-10T06:44:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T22:50:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T20:19:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46397369026087280228393744650426169819","date":"2025-05-07T16:00:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286333169610943824496178466207955935321","date":"2025-05-07T02:07:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-01T15:35:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-17T13:14:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-17T09:59:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2025-04-14T19:02:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"bdd34b7e-aadc-40dd-b986-96233d81f0ae","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:09:00+00:00","versionOfRecord":{"articleIdentity":"rs-6448688","link":"https://doi.org/10.1007/s00345-025-06055-9","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2025-11-21 15:58:11","publishedOnDateReadable":"November 21st, 2025"},"versionCreatedAt":"2025-05-07 11:23:47","video":"","vorDoi":"10.1007/s00345-025-06055-9","vorDoiUrl":"https://doi.org/10.1007/s00345-025-06055-9","workflowStages":[]},"version":"v1","identity":"rs-6448688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6448688","identity":"rs-6448688","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}