Chronic Pelvic Pain Syndrome

  • The symptoms are very nonspecific, and can include any of the following: perineal aching, urinary frequency, pain on ejaculation, pelvic pain, testicular aching, perirectal pain, suprapubic discomfort, diminshed urinary flow, and dysuria.
  • Class 3A patients have, by definition, white blood cells and lipid laden macrophages in expressed prostatic secretion, semen, or VB3 specimens. Class 3B do not have these findings. Cultures are negative in all of these patients.
  • Etiology is unknown. Increased muscle tension in the pelvic floor (similar to a tension headache of the perineum) may play a role in some patients. Reflux of urine into the prostatic ducts can also be a potential cause. Videourodynamics and urine cytology can rule out other causes of this symptom complex in difficult cases.
  • The variety of treatments used for this syndrome attests to the lack of real knowledge as to its cause or causes, and to the absence of any single dramatic therapy. Nonsteroidal anti-inflammatory agents, dietary changes to avoid alcohol, caffeine, and hot spicy foods that can aggravate symptoms, warm tub baths and patient education are the staples of treatment. Anticholinergics, alpha blockers, prostate massage, antidepressants for chronic pain, sodium pentosanpolysulfate, and 5 alphareductase inhibitors can be tried as well. Most patients ultimately learn to live with the ebb and flow of their symptoms, and eventually a significant number of patients become asymptomatic over many years.
  • Transurethral resection of the bladder neck, microwave thermotherapy, and pelvic floor relaxation therapy have a place in some cases.

Suggested Reading

  • Selman, HC and Pontari, M: Prostatitis and lower urinary tract infections in men. In: Clinical Manual of Urology, Hanno, PM, Malkowicz, SB, and Wein, AJ (eds); WB Saunders, Philadelphia, pp185-193, 2001.
  • Abarbanel, J, Engelstein, D, Lask, D, and Livne, PM: Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation? Urology, 62:27-29, 2003.
  • Scheaffer, AJ, (ed): Advances in the diagnosis and treatment of prostatitis; Urology, 60, number 6A, December 2002 supplement.
  • Potts, JM: Diagnosing the prostatitis patient: the dilemma continues. Curr Urol Rep. 2002 Aug; 3(4):319-323.
  • Anderson, RU: Management of chronic prostatitis-chronic pelvic pain syndrome. Urol Clin North Am, 29:235-239, 2002.
  • Kreiger, JN, Ross, SO, Penson, DF, and Riley, DE: Symptoms and inflammation in chronic prostatitis/chronic pelvic pain syndrome. Urology, 60:959-963, 2002.