Minimally Invasive Therapies for Chronic Pelvic Pain Syndrome
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Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial cystitis/painful bladder syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis or treatment of CPPS. The diagnosis is often challenging and is determined by elimination. Multiple treatment modalities exist, ranging from physical therapy to surgery. We discuss minimally invasive therapies for treatment of this complex of symptoms. Although data suggest reasonable efficacy of several medications, multimodal therapy remains the mainstay of treatment. We review the following minimally invasive therapeutic modalities: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation. We report data supporting their use and efficacy and highlight the limitations of each.
KeywordsChronic pelvic pain syndrome Interstitial cystitis Minimally invasive therapy Chronic prostatitis
The authors wish to thank Pamela Fried of Drexel University College of Medicine’s Academic Publishing Services for editorial assistance.
No potential conflicts of interest relevant to this article were reported.
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- 5.Berry SH, Stoto MA, Elliott M, et al.: Prevalence of interstitial cystitis/painful bladder syndrome in the United States. The Rand Interstitial Cystitis Epidemiology (RICE) study. Poster presented at the Annual Meeting of the American Urological Association. Chicago, IL; April 25–30, 2009.Google Scholar
- 13.Herati A, Shorter B, Tai J, et al.: Differences in food sensitivities between IC/PBS and CP/CPPS. J Urol 2009, 181(Suppl 4):60.Google Scholar
- 14.● Nickel JC, Baranowski AP, Pontari M, et al.: Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol 2007, 9:63–72. This important review outlines innovative treatment strategies for patients with CPPS. Google Scholar
- 24.van Tulder MW, Ostelo R, Vlaeyen JW, et al.: Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine (Phila PA 1976) 2000, 25:2688–2699Google Scholar
- 28.McCracken LM, Turk LC: Behavioral and Cognitive-Behavioral treatment for chronic pain: Outcome, predictors of outcome and treatment process. Spine (Phila Pa 1976) 2002, 27:2564–2573.Google Scholar
- 36.Nickel J, Zadeikis N, Spivey M: Clinical significance of antimicrobial therapy in chronic prostatitis associated with non-traditional uropathogens. J Urol 2005, 73:S30.Google Scholar
- 48.Dawson TE, Jamison J: Intravesical treatments for painful bladder syndrome/ interstitial cystitis. Cochrane Database Syst Rev 2007, Issue 4:CD006113.Google Scholar
- 75.Peters KM, Killinger KA, Boguslawski BM, Boura JA: Chronic pudendal neuromodulation: Expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn 2009 Sep 28 (Epub ahead of print).Google Scholar