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chronic pelvic pain syndrome (CPPS)

See pelvic pain for chronic pelvic pain in women. Etiology: - chronic prostatitis without demonstrable infection Epidemiology: - men (see pelvic pain for chronic pelvic pain in women) - risk increase with age. up to 13% in men > 65 years [4] Clinical manifestations: - pelvic pain - tenderness to prostate palpation - dysuria (LUTS) - erectile dysfunction [7] Laboratory: - serum prostate-specific antigen: non-specific - urinaylsis: no pyruria, no bacteriuria - urine culture: negative, including negative for Mycobacteria - urine cytology: negative [4] Special laboratory: - prostate biopsy not indicated [4] Differential diagnosis: - lower urinary tract symptoms (LUTS) Management: - nothing very effective - alpha-1 adrenergic receptor antagonists, NSAIDs & fluoroquinolones or combinations have been used with marginal benefits [2,6] - despite unfavorable benefit/risk ratio [2,6,10], GRS11 claims alpha-blockers treatment of choice - treat benign prostatic hypertrophy - gabapentin, pregabalin, or nortriptyline [6] - pollen extract & eviprostat may have benefit

Related

lower urinary tract symptom (LUTS, prostatism) pelvic pain

General

syndrome chronic pain

References

  1. Journal Watch 24(23):173, 2004 Alexander RB et al Chronic Prostatitis Collaborative Research Network. Ciprofloxacin or tamsulosin in men with chronic prostatitis/ chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med. 2004 Oct 19;141(8):581-9. PMID: 15492337
  2. Anothaisintawee T et al. Management of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and network meta-analysis. JAMA 2011 Jan 5; 305:78. PMID: 21205969
  3. Mishra VC et al Role of alpha-blockers in type III prostatitis: a systematic review of the literature. J Urol. 2007 Jan;177(1):25-30. Review. PMID: 17161995
  4. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Touma NJ, Nickel JC. Prostatitis and chronic pelvic pain syndrome in men. Med Clin North Am. 2011 Jan;95(1):75-86. PMID: 21095412
  6. Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19. American College of Physicians, Philadelphia 2012, 2018, 2022.
  7. Chen X, Zhou Z, Qiu X, Wang B, Dai J The Effect of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) on Erectile Function: A Systematic Review and Meta- Analysis. PLoS One. 2015 Oct 28;10(10):e014144 PMID: 26509575
  8. Magistro G, Wagenlehner FM2, Grabe M et al Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Eur Urol. 2015 Sep 24 PMID: 26411805
  9. John M. Eisenberg Center for Clinical Decisions and Communications Science. Effectiveness of Treatments for Noncyclic Chronic Pelvic Pain in Adult Women. Comparative Effectiveness Review Summary Guides for Clinicians. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 - AHRQ Comparative Effectiveness Reviews. 2012 Apr 16. PMID: 22624166 Free Books & Documents Free full text
  10. Franco JV, Turk T, Jung JH et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2019;10(10):CD012552 PMID: 31587256 PMCID: PMC6778620 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012552.pub2/full