World Journal of Urology

, Volume 21, Issue 2, pp 64–69 | Cite as

Etiology: where does prostatitis stop and interstitial cystitis begin?

  • Evan R. Eisenberg
  • Robert M. Moldwin
Topic Paper


Male chronic pelvic pain syndrome (MCPPS) and interstitial cystitis (IC) patients show striking similarities in clinical presentation, diagnostic evaluation, purported pathogenesis, and even response to therapy. This makes the distinction between them very difficult. This review aims to show just how easy it is for the clinician to miss the features of IC in the MCPPS patient (and conversely). Misdiagnosis can result in the rejection of various potentially helpful therapies while accurate early diagnosis will lead to appropriate therapies and a better quality of life for the patient.


Prostatitis Interstitial cystitis Clinical presentation Diagnostic evaluation Appropriate therapy 


  1. 1.
    Alexander RB, Brady F, Ponniah S (1997) Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology 50:893–899CrossRefPubMedGoogle Scholar
  2. 2.
    Amir R, Pai RR, Raghuveer CV (1998) Mast cell profile in prostatic lesions. Indian J Med Sci 52:507–513PubMedGoogle Scholar
  3. 3.
    Anderson JB, Parivar F, Lee G et al. (1989) The enigma of interstitial cystitis: an autoimmune disease? Br J Urol 63:58–63Google Scholar
  4. 4.
    Bates S, Talbot M (2000) Short course oral prednisolone therapy in chronic abacterial prostatitis and prostatodynia: case reports of three responders and one non-responder. Sex Transm Infect 76:398–399CrossRefPubMedGoogle Scholar
  5. 5.
    Batstone GR, Doble A, Gaston JS (2002) Autoimmune T cell responses to seminal plasma in chronic pelvic pain syndrome (CPPS). Clin Exp Immunol 128:302–307CrossRefPubMedGoogle Scholar
  6. 6.
    Berger RE, Krieger JN, Rothman I et al. (1997) Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J Urol 157:863–865PubMedGoogle Scholar
  7. 7.
    Chen Y, Varghese R, Chiu P, et al. (1999) Urinary substance P is elevated in women with interstitial cystitis. J Urol 161:26Google Scholar
  8. 8.
    Collins, MM, Stafford RS, O'Leary MP et al. (1998) How common is prostatitis? A national survey of physician visits. J Urol 159:1224–128PubMedGoogle Scholar
  9. 9.
    Curhan GC, Speizer FE, Hunter DJ et al. (1999) Epidemiology of interstitial cystitis: a population based study. J Urol 161:549–552PubMedGoogle Scholar
  10. 10.
    Driscoll A, Teichman JMH (2001) How do patients with interstitial cystitis present? J Urol 166:2118–2120Google Scholar
  11. 11.
    Duncan JL, Schaeffer AJ (1997) Do infectious agents cause interstitial cystitis? Urology 49(Suppl 5A):48–51Google Scholar
  12. 12.
    Elbadawi A (1997) Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology 49(Suppl 5A):14–40CrossRefPubMedGoogle Scholar
  13. 13.
    Elgavish A, Robert B, Lloyd K et al. (1995) Evidence for a mechanism of bacterial toxin action that may lead to the onset of urothelial injury in the interstitial cystitis bladder. J Urol 153:329AGoogle Scholar
  14. 14.
    El-Mansoury M, Boucher W, Sant GR et al. (1994) Increased urine histamine and methylhistamine in interstitial cystitis. J Urol 153:350–353Google Scholar
  15. 15.
    Feltis JT, Perez-Marrero R, Emerson LE (1987) Increased mast cells of bladder in suspected cases of interstitial cystitis: possible disease marker. J Urol 138:746–752PubMedGoogle Scholar
  16. 16.
    Forrest JB, Vo Q (2001) Observations on the presentation, diagnosis, and treatment of interstitial cystitis in men. Urology 57(Suppl 6A):26–29Google Scholar
  17. 17.
    Hanno PM (2002) Analysis of long-term elmiron therapy for interstitial cystitis. J Urol 159:2253–2254Google Scholar
  18. 18.
    Hanno PM, Landis JR, Matthews-Cook Y et al. (1999) The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database Study. J Urol 161:552–557Google Scholar
  19. 19.
    Held PJ, Hanno PM, Wein AJ et al. (1990) Epidemiology of interstitial cystititis. In: Hanno PM, Staskin DR, Krane RJ, Wein AJ (eds) Interstitial iystitis. Springer, Berlin Heidelberg New York, pp 29–48.Google Scholar
  20. 20.
    Hochreiter WW, Duncan JL, Schaeffer AJ (2000) Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction. J Urol 163:127–130PubMedGoogle Scholar
  21. 21.
    Hohenfellner M, Nunues L, Schmidt RA et al. (1992) Interstitial cystitis: increased sympathetic innervation and related neuropeptide synthesis. J Urol 147:587–591PubMedGoogle Scholar
  22. 22.
    Holm-Bentzen M, Sondergaard I, Hald T (1987) Urinary excretion of a metabolite of histamine (1,4-methyl-imidazole-acetic-acid) in painful bladder disease. Br J Urol 59:230–233PubMedGoogle Scholar
  23. 23.
    Jarvi K, Wang W, Korithoski B et al. (2001) Identification of unusual bacteria in the semen and urine of men with NIH type III prostatitis. J Urol 165 (Suppl):27PubMedGoogle Scholar
  24. 24.
    Jokinen E, Alfthan S, Oravisto K (1972) Antitissue autoantibodies in interstitial cystitis. Clin Exp Immunol 11:333–339PubMedGoogle Scholar
  25. 25.
    Jones EG, Harper ME (1992) Studies on the proliferation, secretory activities, and epidermal growth factor expression in benign prostatic hyperplasia explant cultures. Prostate 20:133–149CrossRefPubMedGoogle Scholar
  26. 26.
    Kastrup J, Hald T, Larsen S et al. (1983) Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis. Br J Urol 55:495–500PubMedGoogle Scholar
  27. 27.
    Keay S, Zhang CO, Baldwin BR et al. (1998) Polymerase chain reaction amplification of bacterial 16S rRNA genes in interstitial cystitis and control patient bladder biopsies. J Urol 159:280–283PubMedGoogle Scholar
  28. 28.
    Keay S, Zhang CO, Baldwin BR, Alexander RB (1999) Polymerase chain reaction amplification of bacterial 16S rRNA genes in prostate biopsies from men without chronic prostatitis. Urology 53:487–491CrossRefPubMedGoogle Scholar
  29. 29.
    Keith IM, Jin J, Neal DJr et al. (2001) Cell relationship in a Wistar rat model of spontaneous prostatitis. J Urol 166:323–328PubMedGoogle Scholar
  30. 30.
    Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE (1982) Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol 54:729–731PubMedGoogle Scholar
  31. 31.
    Kirkemo A, Peabody M, Diokno AC et al. (1997) Associations among urodynamic findings and symptoms in women enrolled in the Interstitial Cystitis Database (IDCB) Study. Urology 49 (Suppl 5A):76–80CrossRefPubMedGoogle Scholar
  32. 32.
    Kushner L, Chiu PY, Brettschneider N et al. (2001) Urinary substance P concentration correlates with urinary frequency and urgency in interstitial cystitis patients treated with intravesical dimethyl sulfoxide and not intravesical anesthetic cocktail. Urology 57 (Suppl 1):129CrossRefGoogle Scholar
  33. 33.
    Lagunoff D, Martin TW, Read G (1983) Agents that release histamine from mast cells. Annu Rev Pharmacol Toxicol 23:331–351PubMedGoogle Scholar
  34. 34.
    Lilius HG, Oravisto KJ, Valtonen EJ (1973) Origin of pain in interstitial cystitis. Scand J Urol Nephrol 7:150–152PubMedGoogle Scholar
  35. 35.
    Lynes WL, Flynn SD, Shortliffe LD et al. (1987) Mast cell involvement in interstitial cystitis. J Urol 138:746–752PubMedGoogle Scholar
  36. 36.
    Mayo ME, Ross SO, Krieger JN (1998) Few patients with "chronic prostatitis" have significant bladder outlet obstruction. Urology 52:417–421CrossRefPubMedGoogle Scholar
  37. 37.
    McNaughton CM, Pontari MA, O'Leary MP et al. (2001) Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Int Med 16:656–662CrossRefGoogle Scholar
  38. 38.
    McNeal JE (1988) Normal histology of the prostate. Am J Surg Pathol 12:619–633PubMedGoogle Scholar
  39. 39.
    Miller JL, Rothman I, Bavendam TG, Berger RE (1995) Prostatodynia and interstitial cystitis: one and the same? Urology 45:587–590Google Scholar
  40. 40.
    Moldwin RM, Mendelowitz F (1993) Pelvic floor dysfunction and interstitial cystitis. Paper presented at the Research Symposium on Interstitial Cystitis, A century of awareness, a decade of progress. Orlando, Florida, October 8–9, 1993Google Scholar
  41. 41.
    Nickel JC (1998) Effective office management of chronic prostatitis. Urol Clin North Am 25:677–684PubMedGoogle Scholar
  42. 42.
    Nickel JC, Johnston B, Downey J et al. (2000) Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial. Urology 56: 413–417PubMedGoogle Scholar
  43. 43.
    Nickel JC, Downey J, Johnston B et al. (2001) Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter trial. J Urol 165:1539–1544PubMedGoogle Scholar
  44. 44.
    Nickel JC, Forrest J, Tomera KM et al. (2002) Effects of pentosanpolysulfate sodium: a multicenter randomized, placebo-controlled study. J Urol 167:63AGoogle Scholar
  45. 45.
    Ohkawa M, Yamaguchi K et al. (1993) Antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum. Urol Int 51:129–132PubMedGoogle Scholar
  46. 46.
    Pang X, Marchand J, Sant GR et al. (1995) Increased number of substance P positive fibers in interstitial cystitis. Br J Urol 75:744–750PubMedGoogle Scholar
  47. 47.
    Parsons CL (1996) Potassium sensitivity test. Tech Urol 2:171–173PubMedGoogle Scholar
  48. 48.
    Parsons CL, Albo M (2002) Intravesical potassium sensitivity in patients with prostatitis. J Urol 168:1054–1057PubMedGoogle Scholar
  49. 49.
    Parsons CL, Lilly JD, Stein P et al. (1991) Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol 145:732–735PubMedGoogle Scholar
  50. 50.
    Potts JM, Ward AM, Rackley RR (2000) Association of chronic urinary symptoms in women and ureaplasma urealyticum. Urology 55:486–489CrossRefPubMedGoogle Scholar
  51. 51.
    Schmidt RA, Vapnek JM (1991) Pelvic floor behavior and interstitial cystitis. Semin Urol 9:154–159PubMedGoogle Scholar
  52. 52.
    Seethalaskshmi L, Bala RS, Malhotra RK et al. (1996) 17 beta-estradiol induced prostatitis in the rat is an autoimmune disease. J Urol 156:1838–1842PubMedGoogle Scholar
  53. 53.
    Segura JW, Opitz JL, Greene LF (1979) Prostatitis, prostatosis or pelvic floor muscle tension myalgia? J Urol 122:168–169Google Scholar
  54. 54.
    Shirley SW, Stewart BH, Mirelman S (1978) Dimethyl sulfoxide in the treatment of inflammatory genitourinary disorders. Urology 11:215–220PubMedGoogle Scholar
  55. 55.
    Shortliffe LM, Sellers RG, Schachter J (1992) The characterization of nonbacterial prostatitis: search for an etiology. J Urol 148:1461–1466PubMedGoogle Scholar
  56. 56.
    Shoskes DA, Shahed AR (1970) Detection of bacterial signal by 16S rRNA polymerase chain reaction in expressed prostatic secretions predicts response to antibiotic therapy in men with chronic pelvic pain syndrome. Tech Urol 6:240–242Google Scholar
  57. 57.
    Silk MR (1970) Bladder antibodies in interstitial cystitis. J Urol 103:307–309PubMedGoogle Scholar
  58. 58.
    Siroky MB, Goldstein I, Krane RJ (1981) Functional voiding disorders in men. J Urol 126:200–204PubMedGoogle Scholar
  59. 59.
    Siroky MB (1994) Is it interstitial cystitis? Diagnostic distinctions in reduced bladder capacity. Contemp Urol 6:13–22Google Scholar
  60. 60.
    Spanos C, Pang X, Ligris K et al. (1997) Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol 157:669–672PubMedGoogle Scholar
  61. 61.
    Talbot M, Bates S (2001) Variability of the symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome during intermittent therapy with rectal prenisolone foam for ulcerative colitis. Int J STD AIDS 12:752–753Google Scholar
  62. 62.
    Theoarides TC, Sant GR (1991) Bladder mast cell activation in interstitial cystitis. Semin Urol 9:74–87PubMedGoogle Scholar
  63. 63.
    Theoharides TC, Flaris N, Cronin CT et al. (1990) Mast cell activation in sterile bladder and prostate inflammation. Int Arch Allergy Appl Immunol 92:281–286PubMedGoogle Scholar
  64. 64.
    Theoharides T, Duraisamy K, Sant G (2001) Mast cell involvement in interstitial cystitis: a review of human and experimental evidence. Urology 57(Suppl 6A):47–55CrossRefPubMedGoogle Scholar
  65. 65.
    Walsh PC (ed) Campbell's Urology, 8th edn. WB Saunders, PhiladelphiaGoogle Scholar
  66. 66.
    Warren JW (1994) Interstitial cystitis as an infectious disease. Urol Clin North Am 21:31–39PubMedGoogle Scholar
  67. 67.
    Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166:226–2231Google Scholar
  68. 68.
    Zisman A, Zisman E, Lindner A et al. (1995) Autoantibodies to prostate specific antigen in patients with benign prostatic hyperplasia. Urology 154:1052–1055Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Deptartment of Urology270-05 76th Avenue

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