Phenotypic approach to the Management of chronic prostatitis/chronic pelvic pain syndrome
- 82 Downloads
There is no one unifying etiological mechanism or specific curative therapy for chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS). However, there is sufficient evidence to suggest that each of the proposed mechanisms may be important in some patients, and that many of our evaluated treatments do in fact work in subgroups of patients. We hypothesize that CP/CPPS patients are not a homogenous group suffering from a single disease entity. Rather, CP/CPPS patients are actually unique individuals with differing clinical phenotypes based on various etiological mechanisms with distinctive symptom complexes and progression trajectories. We call this the “Snow Flake Hypothesis.” We propose the UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, and tenderness domains) clinical phenotyping classification; we have validated the concept in a CP/CPPS cohort and have suggested that phenotypically directed therapy will improve our clinical treatment outcomes.
KeywordsPregabalin Prostatitis Tamsulosin Interstitial Cystitis Chronic Prostatitis
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.McNaughton-Collins M, Joyce GF, Wise M, et al.: Prostatitis. In Urologic Diseases in America. Edited by Litwin MS, Saigal CS. US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington DC: US Government Printing Office; 2007:9–41.Google Scholar
- 4.Shoskes DA, Nickel JC, Rackley RR, Pontari MA: Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis 2009 (in press).Google Scholar
- 6.Nickel JC: Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In Campbell-Walsh Urology, edn 9. Edited by Wein AJ, Kavoussi LR, Novick AC, et al. Philadelphia: Elsevier; 2006:330–370.Google Scholar
- 13.Nickel JC, Krieger JN, McNaughton-Collins M, et al.: Effect of alfuzosin on symptoms in men with chronic prostatitis/ chronic pelvic pain syndrome. N Engl J Med 2009 (in press).Google Scholar
- 14.Nickel JC, Downey J, Pontari MA, et al.: Randomized placebo-controlled, multi-center study to evaluate the safety and efficacy of finasteride in the treatment of male chronic pelvic pain syndrome: category IIIA CPPS (chronic nonbacterial prostatitis). BJU Int 2004, 93:991–995.PubMedCrossRefGoogle Scholar
- 24.Nickel JC, Shoskes D, Irvine-Bird K: Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome (IC/PBS): a key to classification and potentially improved management. J Urol 2009 (in press).Google Scholar