Chronic prostatitis (CP) is a common condition, yet remains a challenge to treat in clinical practice due to the heterogeneity of symptoms.The aim of this article is to undertake a narrative review using key research papers in this field in order to develop a treatment algorithm and research recommendations for the management of type II and type III prostatitis taking a broader look at interventions beyond those recommended in the European Association of Urology Guidelines.A search was performed using multiple databases and trial registries with no language restrictions. Searches were completed on March 1, 2021, with a focus on randomized controlled trials (RCTs), meta-analyses, and systematic reviews. However, in areas with a dearth of such studies, we included case series and observational studies, thus allowing us to assess current levels of evidence and areas of potential research. We identified and reviewed 63 studies. The level of evidence and the quality of trials were assessed and reported. Research recommendations, where applicable, were also highlighted. CP/chronic pelvic pain syndrome (CPPS) is a heterogenous term referring to diverse symptomology that requires tailored treatments depending on the patients' complaints. After a review of the evidence available, we present a treatment algorithm that is based on the much-discussed UPOINT (urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles) framework. Future studies should focus on multimodal therapy based on such frameworks and provide the future direction of this complex condition.

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IntroductionBreast lymphoedema impacts the quality of life and cosmesis in women undergoing breast conserving surgery for cancer. The assessment of breast lymphoedema is complex and challenging. The varied reported incidence (0-94%) is due to lack of awareness, poor reporting, subjective characterisation, absence of standardised definitions and tools for diagnosis and monitoring. Extensive research has been done on secondary limb and trunk lymphoedema following lymph node surgery and/or radiotherapy. However, there is a lack of data on breast lymphoedema. Disruption of lymphatics due to advanced oncoplastic procedures, axillary surgery, modified incisions and adjuvant radiotherapy may contribute to this problem. The objective of this study is to identify the causes of delayed resolution of breast lymphoedema. Methods A retrospective audit was carried out in women who underwent breast conserving surgery between 2011-2017.Only patients with breast oedema, seen in the lymphoedema clinic were included in the study. Data on body mass index (BMI), types of incisions, breast procedures, axillary surgery, histopathology, adjuvant treatment including the extent of adjuvant radiotherapy was collated from the hospital database. Breast lymphoedema was diagnosed by clinical examination and/or by a Delfin lymph scanner (DLS). DLS is a mobile non-invasive device which uses tissue dielectric constant (TDC) for measuring subcutaneous tissue water. A reading of 45% or higher was accepted as indicative of breast lymphoedema in our unit. Percentage water content (PWC) value was recorded only in 55 patients using DLS. ResultsDuring the study period, 1905 patients underwent breast conserving surgery, out of which 120 (6.3%) were documented as having breast lymphoedema. The median time from surgery to assessment in the lymphedema clinic was 11 months. On univariate analysis, a high BMI (>30) and radiotherapy with boost lead to non-resolution of breast oedema. The median time taken for resolution of symptoms was 18 months. Other factors such as lateral skin crease incisions, single incisions to perform both breast and axillary surgery, oncoplastic procedures and re-excisions were not statistically significant. Using a DLS, the median PWC value was 56% in this cohort. Conclusions Our study shows that high BMI and radiotherapy with boost leads to delayed resolution of breast lymphoedema. The Delfin lymph scanner may be a potential tool for monitoring breast oedema but further prospective studies are required for validation of this tool. Citation Format: Pragnya Chigurupati, Manoj Gowda, Rebecca Elwell, Arie Hawazie, Kirti Katherine Kabeer, Sekhar Marla, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan. Factors causing delayed resolution of breast lymphoedema [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-45.

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