Chronic prostatitis/chronic pelvic pain syndrome

In the 20th century, the term "prostatitis" traditionally referred to inflammation in the prostate, often attributed to infection. Prostatitis in this century usually refers to a chronic pain syndrome for which the presence of inflammation and involvement of the prostate are not always certain. This article discusses chronic prostatitis/chronic pelvic pain syndrome and the various factors associated with diagnosis and treatment.     

Mechanisms in prostatitis/chronic pelvic pain syndrome

PURPOSE: We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS: National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS: The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.     

Acupuncture for chronic prostatitis/ chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.     

Quercetin for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition with a heterogeneous origin that responds best to multimodal therapy. The bioflavonoid quercetin has antioxidant and antiinflammatory effects that have proven useful for treating this condition. Using the clinical phenotype system UPOINT, quercetin can be helpful for those with organ-specific complaints (bladder or prostate) and pelvic floor spasm. This article discusses the current understanding of CP/CPPS and how treatment with quercetin can be used alone or as part of multimodal therapy.     

慢性前列腺炎/慢性盆腔疼痛综合征与勃起功能障碍的临床预测

目的应用临床指标,预测慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPSS）发生勃起功能障碍（ED）的可能性。方法以90例门诊确诊的慢性前列腺炎/慢性盆腔疼痛综合征患者为研究对象,分为发生ED组（A组）23例,未发生ED组（B组）67例,分别比较两组间在硫酸脱氢表雄酮（DHEAS）、24h尿香草扁桃体酸（VMA）、年龄等观察指标上的差异性,寻找其中能用于预测ED的临床指标。结果A组平均DHEAS值低于B组,VMA值高于B组,年龄方面两组差异无统计学意义。结论可通过DHEAS、VMA来预测慢性前列腺炎/慢性盆腔疼痛综合征患者ED的发生,有利于对慢性前列腺炎/慢性盆腔疼痛综合征发生ED患者的监控和治疗干预。     

Controversies in chronic abacterial prostatitis/pelvic pain syndrome

Chronic abacterial prostatitis (or prostatitis Category III according to the National Institutes of Health terminology) is subject to re-evaluation. Organizations such as the International Continence Society, the International Association for the Study of Pain and the European Association of Urology have been involved in a continuous endeavour to design a more accurate taxonomy system. The term prostate pain syndrome (PPS), as a subcategory of chronic pelvic pain syndromes, has recently been suggested as the most relevant. This condition is common, very bothersome and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased there have been no real breakthroughs; controversies and many unanswered questions remain. Examples of pertinent issues are as follows: the criteria that need to be fulfilled for a diagnosis; the significance or lack of significance of leucocytes in expressed prostatic secretion; and the association between erectile dysfunction and PPS. The fundamental question remains: is the prostate really involved in the majority of men with PPS? This article focuses on some of the controversies.     

Etiologic theories of chronic prostatitis/chronic pelvic pain syndrome

The etiology of chronic prostatitis/chronic pelvic pain syndrome is unknown. Whereas infection causes category I and II prostatitis, the evidence for an ongoing infection in category III patients is lacking. Immunologic, neurologic, and psychologic factors likely play a role in the development and maintenance of symptoms in these men. The traditional concept of pain as a simple response to a noxious stimulus has some merit, but modern research indicates that the response is much more complex, and we must look at a patient’s physiology and psychology to be able to interpret each individual’s pain response. It is some advance in the field to realize that we probably need to look beyond the prostate and address the entire biopsychosocial problem to be able to offer successful treatment to these men.     

Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome

Category III chronic prostatitis/chronic pelvic pain syndrome is a syndrome rather than a specific disease and the cause can be multifactorial. In clinical practice, monotherapy often has proven ineffective. Multimodal therapy, which sequentially or simultaneously can address infection, inflammation, and neuromuscular spasm appears to have the greatest potential for symptom improvement, especially in patients with longstanding symptoms.     

Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, α-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.     

Seminal fluid analysis in chronic prostatitis/chronic pelvic pain syndrome

Prostatitis is a common cause of morbidity among adult men. There are more than 2,000,000 doctor visits per year in the United States, approximately half to urologists (Collins et al., 1998, J Urol 159:1224; Roberts et al., 1998, Urology 51:578; Krieger et al., 2003, Urology). The problem is that very few patients have obvious infections, or functional or structural abnormalities. The aim of this study is to examine our experience with seminal fluid analysis in this patient population, and to outline the potential utility of this examination in patient evaluation.     

Role of bacteria in chronic prostatitis/ chronic pelvic pain syndrome

Throughout the past century, we have refined our understanding of prostatitis, moving from using a primarily clinical definition to considering it as a complex inflammatory condition. The inconsistency in identifying uropathogens in patients with symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has led to controversy in therapeutic management. There is compelling evidence that the normal prostate has minimal inflammation and no bacteria. Clinicians using the Meares/Stamey criteria identified uropathogens localized to the prostate in only 6% to 8% of CP/CPPS patients. This suggests that bacteria may have a role in less than 10% of men with CP/CPPS. That some patients respond to antimicrobials could suggest that eradication of bacteria reduces symptoms. However, the beneficial effect of antimicrobial drugs may not be due to their antibacterial action, but to their anti-inflammatory action. The normal prostate shows minimal inflammation, but only 50% of CP/CPPS patients exhibit prostatic leukocytosis. Prudence demands that we examine the function of the white blood cells—the cytokines produced. Several basic science advances allowed new avenues of research regarding the detection of molecular evidence of causative uropathogens. New research brings new controversy and unexpected findings, but further refines our understanding of the immune system and the CP/CPPS disease process.     

Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis

Purpose

This study aims to estimate the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) by conducting a meta-analysis.

Methods

Relevant publications were searched using PubMed, Embase, CBM, China National Knowledge Infrastructure, VIP and Wanfang databases up to August 2015. Studies that reported the prevalence of erectile dysfunction, premature ejaculation and total sexual dysfunction in men with CP/CPPS were included.

Results

A total of 24 studies involving 11,189 men were included. Overall prevalence of sexual dysfunction in men with CP/CPPS was 0.62 (95 % CI 0.48–0.75), while the prevalence of erectile dysfunction and premature ejaculation was 0.29 (95 % CI 0.24–0.33) and 0.40 (95 % CI 0.30–0.50), respectively. From 1999 to 2010, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.65 (95 % CI 0.45–0.83), 0.27 (95 % CI 0.22–0.33) and 0.41 (95 % CI 0.27–0.55), respectively. From 2011 to 2014, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.50 (95 % CI 0.22–0.75), 0.35 (95 % CI 0.29– 0.40) and 0.39 (95 % CI 0.37–0.41), respectively.

Conclusion

The prevalence of sexual dysfunction in men with CP/CPPS was high, even though overall sexual dysfunction demonstrated a slightly decreasing trend. Furthermore, erectile dysfunction prevalence rate had an increasing trend in recent years. More prospective studies are needed to evaluate sexual dysfunction improvement with better management of CP/CPPS.

     

Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: andrological implications

There is a consensus on the diagnostic management of bacterial prostatitis (acute and chronic). In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) the diagnostic approach remains unclear, because inflammatory and noninflammatory CP/CPPS might be one entity with varying findings over time. The WHO definition of male accessory gland infection does not differentiate between prostatitis, epididymitis, and other inflammatory alterations of the urethral compartment. The definition therefore cannot be further accepted as a rational tool for the diagnosis of prostatitis and related diseases in urological andrology. Therapy in infectious prostatitis is standardised and antibiotics are the primary agents. Andrological implications are well defined, side-effects are minimal. CP/CPPS therapy has the goal to reduce pelvic pain. However, treatment regimens are not as standardised. Andrological side-effects are well defined and mainly due to the functional background of these agents.