Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?

Abstract

National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes.

Recent trend of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management

“…Various complex causes (urinary tract infection, prostatic urinary tract counterflow [9], Cytokines [10], pelvic floor spasm [11], systemic nervous or endocrine cause [12] and neuropsychiatric cause [13]) affects CP/CPPS in terms of pathological physiology (Fig. 1).…”

Prostatitis: From Diagnosis to Treatment

“…The degree of elicited pain during prostatic palpation is variable and is unhelpful in differentiating a prostatitis syndrome. The prostate should be carefully checked for prostatic nodules before a vigorous prostatic massage is performed (Westesson and Shoskes, 2010). Most patients report dysuria as well as urgency, frequency, and nocturia.…”

“…Two or more bacterial localization tests may then be required to identify the pathogenic bacteria. If no organisms can be cultured, and the prostatic fluid has increased leukocyte count (> 10 per HPF), a diagnosis of chronic pelvic pain syndrome (inflammatory type) can be made (Westesson & Shoskes, 2010). Despite sterilization in the urine, the pathogen often remains sheltered in the prostate because most antibiotics diffuse poorly into prostatic fluid.…”

“…It includes: i) ABP, ii) CBP, represents the traditional forms of acute and chronic bacterial prostatitis, defined by the presence of both prostatic inflammation and uro-pathogenic bacteria in prostatic culture, iii) Chronic pelvic pain syndrome (CPPS) with the inflammatory and non-inflammatory type, which is characterized by prostatitis like symptoms in the absence of bacterial localization to the prostate iv) asymptomatic inflammatory prostatitis, which is characterized by pathogenic evidence of prostatic inflammation in patients without symptoms (includes patients who have prostatic inflammation diagnosed after prostatic biopsy) (Magri et al, 2010). Risk factors that allow bacterial colonization and/or infection of the prostate with potentially pathogenic bacteria include intraprostatic ductal reflux; phimosis; specific blood groups; unprotected anal intercourse; UTI; acute epididymitis; indwelling urethral or condom catheters; and transurethral operations (especially in men who have infected urine) (Westesson & Shoskes, 2010). In a study, nearly 9.7% of male respondents (aged 20 to 74 years) reported pain or discomfort in the perineum or with ejaculation or both, plus a total pain score (possible 0 to 21) of 4 or greater (Vaidyanathan & Mishra, 2008).…”

Kronik Prostatit/Kronik Pelvik Ağrı Sendromunda Etyoloji ve Tanı

“…Normal bir ejakülasyon, orgazm ve işeme için pelvik taban kaslarının normal ve koordineli çalışmasının son derece önemli olduğu bilinmektedir (97). Khorasani ve ark.…”