Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 23-03: Genitourinary Tract Infections + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Irritative voiding symptoms Perineal or suprapubic discomfort, similar to that of chronic bacterial prostatitis Positive white blood cells from expressed prostatic secretions, but negative culture +++ General Considerations ++ Nonbacterial chronic prostatitis and chronic pelvic pain syndromes are incompletely understood with symptomatology due to interrelated cascade of inflammatory, immunologic, endocrine, muscular, neuropathic, and psychologic mechanisms + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Chronic perineal, suprapubic, or pelvic pain is the most common presenting symptom Men may complain of pain in the testes, groin, and low back Pain during or after ejaculation is one of the most prominent and bothersome symptoms Psychosocial factors (depression, anxiety, catastrophizing, poor social support, stress) also likely play an important role in the exacerbation of chronic pelvic pain symptoms The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) (https://www.prostatitis.org/symptomindex.html) has been validated to quantify symptoms of chronic nonbacterial prostatitis or chronic pelvic pain syndrome +++ Differential Diagnosis ++ Chronic bacterial prostatitis Bladder cancer + Diagnosis Download Section PDF Listen +++ ++ Diagnosis is usually one of exclusion Increased numbers of leukocytes are typically seen in expressed prostatic secretions, but cultures of both expressed prostatic secretions and postprostatic urine specimens are negative + Treatment Download Section PDF Listen +++ ++ Multimodal therapy is recommended according to the various phenotypes of patient presentation Voiding symptoms are managed with an α-blocker (tamsulosin, alfuzosin, silodosin) Psychosocial disorders are treated with Cognitive behavioral therapy Antidepressants Anxiolytics Neuropathic pain is treated with Gabapentinoids Amitriptyline Neuromodulation Acupuncture Pelvic floor muscle dysfunction may respond to Diazepam Biofeedback techniques Pelvic floor physical therapy (eg, kegel exercises) Pelvic shock wave lithotripsy Heat therapy Sexual dysfunction with pain symptoms is treated with sexual therapy and phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil, vardenafil) Surgery is not recommended for chronic prostatitis + Outcome Download Section PDF Listen +++ +++ Prognosis ++ Annoying, recurrent symptoms are common, but serious sequelae have not been identified. Quality of life is greatly decreased for many patients +++ When to Refer ++ Patients who do not respond to psychosocial therapy should be referred to a mental health specialist Patients who do not respond to pain therapy should be referred to a pain management specialist + References Download Section PDF Listen +++ + +Doiron RC et al. Management of chronic prostatitis/chronic pelvic pain syndrome. Can Urol Assoc J. 2018 Jun;12(6 Suppl 3):S161–3. [PubMed: 29875042] + +Doiron RC et al. The evolving clinical picture of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a look at 1310 patients over 16 years. Can Urol Assoc J. 2018 Jun;12(6):196–202. [PubMed: 29485036] + +Franco JV et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018 Jan 26;1:CD012551. Update in: Cochrane Database Syst Rev 2018 May 12;5:CD012551. [PubMed: 29372565] + +Magistro G et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2016 Feb;69(2):286–97. [PubMed: 26411805] + +Polackwich AS et al. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis. 2016 Jun;19(2):132–8. [PubMed: 26951713] + +Sandhu J et al. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res. 2017 Sep 25;6. [PubMed: 29034074]