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Chronic prostatitis/chronic pelvic pain syndrome

What's new

Added 2024 EAU and 2015 PERG guidelines for the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome.

Background

Overview

Definition
CP/CPPS, also known as primary prostate pain syndrome, is characterized by persistent or recurrent pain in the prostate or perineal area for ≥ 3 of previous 6 months without evidence of UTI.
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Pathophysiology
The pathophysiology of this syndrome is not fully understood, but it is believed to involve dysregulation of neurotransmitters and inflammation. Abnormalities in the regulation of neurotransmitter release and/or abnormal levels of extracellular neurotransmitter concentrations have been implicated in the neuronal foundations of pain disorders. Inflammation, either with the presence of white cells in the prostatic secretions or without, may also play a role.
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Epidemiology
The global prevalence of CP/CPPS is estimated at 2-10%, and is reported to constitute about 14% of male urological outpatients visits.
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Disease course
Clinically, patients with CP/CPPS typically present with pain in the pelvic area but may also include the perineum, rectum, prostate, penis, testicles, and abdomen. They may also experience urinary symptoms, such as urgency, frequency, hesitancy, and poor or interrupted flow. Pain during ejaculation is also a common symptom.
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Prognosis and risk of recurrence
CP/CPPS can significantly impact the patient's QoL, leading to negative cognitive, behavioral, sexual, or emotional outcomes.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of chronic prostatitis/chronic pelvic pain syndrome are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024) and the Prostatitis Expert Reference Group (PERG 2015)....
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Diagnostic investigations

Initial evaluation: as per EAU 2024 guidelines, Modify diagnostic procedures to suit the patient's needs and rule out diseases with similar symptoms.
A
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Medical management

General principles: as per EAU 2024 guidelines, Offer multimodal and phenotypically directed treatment options for primary prostate pain syndrome.
B

More topics in this section

  • Antibiotic therapy

  • Alpha-blockers

  • NSAIDs

  • Other agents

  • Pentosan polysulfate

Nonpharmacologic interventions

Psychosocial support
As per PERG 2015 guidelines:
Assess for psychosocial symptoms in both early and late stages of CP/CPPS. Screen for psychological factors if there is a significant suspicion of their contribution to the patient's condition.
B
Consider offering CBT along with other treatments in later stages of CP/CPPS to enhance pain management and QoL.
C

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  • Alternative and complementary therapies

Therapeutic procedures

Therapeutic ultrasound: as per PERG 2015 guidelines, Insufficient evidence to recommend high-intensity focused ultrasound for the treatment of CP/CPPS, unless in a clinical trial setting.
I

Surgical interventions

Indications for surgery: as per PERG 2015 guidelines, Insufficient evidence to recommend surgical techniques, such as radical prostatectomy or TURP, for the treatment of CP/CPPS, unless in a clinical trial setting.
I

Specific circumstances

Patients with chronic scrotal content pain: as per EAU 2024 guidelines, Offer microsurgical denervation of the spermatic cord in patients with testicular pain experiencing improvement following a spermatic block.
B

Patient education

General counseling: as per PERG 2015 guidelines, Discuss potential differential diagnoses, including urological cancers and infertility, with patients at their initial presentation to establish a comprehensive patient history and guide future investigations.
B
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