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Essentials of Diagnosis
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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
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General Considerations
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Nonbacterial chronic prostatitis and chronic pelvic pain syndromes are caused by an interrelated cascade of inflammatory, immunologic, endocrine, muscular, neuropathic, and psychologic mechanisms
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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
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Differential Diagnosis
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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
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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
Neuropathic pain is treated with
Gabapentinoids
Amitriptyline
Neuromodulation
Acupuncture
Pelvic floor muscle dysfunction may respond to
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
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Annoying, recurrent symptoms are common, but serious sequelae have not been identified.
Quality of life is greatly decreased for many patients
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Doiron
RC
et al. Male CP/CPPS: where do we stand? World J Urol. 2019;37:1015.
[PubMed: 30864007]
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Doiron
RC
et al. Management of chronic prostatitis/chronic pelvic pain syndrome. Can Urol Assoc J. 2018;12:S161.
[PubMed: 29875042]
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Doiron
RC
et al. The evolving clinical picture of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a look at 1310 patients over ...