Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is of considerable interest in clinical urology. During the past decade, several new approaches have been made to discover its aetiology and pathophysiological mechanisms and to develop treatment modalities. The aetiology of CPPS has remained unresolved. Bacterial, chemical, urodynamic and immunological aetiologies have been suggested, but none of these has been conclusively proven. The histopathological changes in CP and CPPS are relatively well known, but the pathophysiological changes that lead to chronic inflammation and prolonged symptoms are still poorly understood. This review proposes an additional approach to the pathophysiology of CPPS. The concept of prostate tissue pressure is introduced as an objectively measurable parameter in evaluating the inflammatory process in CPPS. Chronic pain due to neurogenic inflammation and altered mast cell function is also discussed.
Similar content being viewed by others
References
Alexander RB, Ponniah S, Hasday J, Hebel JR (1998) Elevated levels of proinflammatory cytokines in the semen of patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 52:744–749
Amir T, Pai RR, Raghuveer CV (1998) Mast cell profile in prostatic lesions. Indian J Med Sci 52:507–513
Asthon H (1975) The effect of increased tissue pressure on blood flow. Clin Orthop 113:15–26
Barbalias GA, Meares EMJr, Sant GR (1983) Prostatodynia: clinical and urodynamic characteristics. J Urol 130:514–517
Barbalias GA (1990) Prostatodynia or painful male urethral syndrome? Urology 36:146–153
Barbalias GA, Nikiforidis G, Liatsikos EN (1998) Alpha-blockers for treatment of chronic prostatitis in combination with antibiotics. J Urol 159:883–887
Batstone GR, Doble A, Gaston JS (2002) Autoimmune T cell responses to seminal plasma in chronic pelvic pain syndrome (CPPS). Clin Exp Immunol 128:302–307
Bennett BD, Richardson PH, Gardner WAJr (1993) Histopathology and cytology of prostatitis. In: Lepor H, Lawson RK (eds) Prostate disease, WB Saunders, Philadelphia, pp 399–413
Berger RE, Krieger JN, Kessler D, Ireton RC, Close C, Holmes K, Roberts PL (1989) Case-control study of men with suspected chronic idiopathic prostatitis. J Urol 141:328–331
Berger RE, Krieger JN, Rothman I, Muller CH, Hillier SL (1997) Bacteria in the prostate tissue of men with idiopathic prostatitis inflammation. J Urol 157:863–865
Berghuis JP, Heiman JR, Rothman I, Berger RE (1996) Psychological and physiological factors involved in chronic idiopathic prostatitis. J Psychosom Res 41:313–325
Chapple CR, Blease SCP, Rickards D (1990) What is the clinical significance of urethroprostatic reflux as a radiological finding during videocystourethrography in neurologically normal patients? Eur Urol 17:296–298
De la Rosette JJMCH, Ruijgrok MCM, Jeuken JMG, Karthaus HFM, Debruyne FMJ (1993) Personality variables involved in chronic prostatitis. Urology 42:654–662
Doble A, Walker MM, Harris JRW, Taylor-Robinson D, Whiterow RON (1990) Intraprostatic antibody deposition in chronic abacterial prostatitis. Br J Urol 65:598–605
Donadio AC, Depiante-Depaoli M (1997) Inflammatory cells and MHC class II antigens expression in prostate during time-course experimental autoimmune prostatitis development. Clin Immunol Immunopathol 85:158–165
Ebbehøj N, Svedsen LB, Madsen P (1984) Pancreatic tissue pressure: techniques and pathophysiological aspects. Scand J Gastroenterol 19:1066–1068
Ebbehøj N, Borly L, Madsen P, Svedsen LB (1986) Pancreatic tissue pressure and pain in chronic pancreatitis. Pancreas 1:556–558
Egan KJ, Krieger JN (1994) Psychological problems in chronic prostatitis with pain. Clin J Pain 10:218–226
Fowler JEJr, Mariano M (1982) Immunologic response of the prostate to bacteriuria and bacterial prostatitis. II. Antigen specific immunoglobulin in prostatic fluid. J Urol 128:165–170
Gardner WA, Bennet BD (1992) The prostate—overview: recent insights and speculations. Monogr Pathol 34:129–148
Gelberman RH, Szabo RM, Williamson RV, Hargens AR, Yaru NC, Minteer-Convery MA (1983) Tissue pressure threshold for peripheral nerve viability. Clin Orthop 178:285–291
Ghobish AA (2000) Quantitative and qualitative assessment of flow metrograms in patients with prostatodynia. Eur Urol 38:576–583
Guyton AC, Granger HJ, Taylor AE (1971) Interstitial fluid pressure. Physiol Rev 51: 527–563
Hellstrom WJG, Schmidt RA, Lue TF, Tanagho EA (1987) Neuromuscular dysfunction in nonbacterial prostatitis. Urology 30: 183–188
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 163:127–130
John H, Barghorn A, Funke G, Sulser T, Hailemariam S, Hauri D, Joller-Jemelka HI (2001) Noninflammatory chronic pelvic pain syndrome: immunological study in blood, ejaculate and prostate tissue. Eur Urol 39:72–78
Kaplan AP, Haak-Frendscho M, Fauci A, Dinarello C, Halbert E (1985) A histamine-releasing factor activated human mononuclear cells. J Immunol 135:2027–2032
Kaplan SA, Te AE, Jacobs BZ (1994) Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol 152:2063–2065
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 53:487–491
Keith IM, Jin J, Saban R (1995) Nerve-mast cell interaction in norman guinea pig urinary bladder. J Comp Neurol 363:28–36
Keith IM, Jin J, Neal D, Teunissen BD, Moon TD (2001) Cell relationship in a Wistar rat model of spontaneous prostatitis. J Urol 166:323–328
Keltikangas-Järvinen L, Ruokolainen J, Lehtonen T (1982) Personality pathology underlying chronic prostatitis. Psychother Psychosom 37:87–95
Keltikangas-Järvinen L, Mueller K, Lehtonen T (1989) Illness behavior and personality changes in patients with chronic prostatitis during a two-year follow-up period. Eur Urol 16:181–184
Kirby RS, Lowe D, Bultitude I, Shuttleworth KED (1982) Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol 54:729–731
Klimas R, Bennett B, Gardner WA (1985) Prostatic calculi: a review. Prostate 7:91–96
Kops SK, Van Loveren H, Rosenstein RW, Askenase PW (1984) Mast cell activation and vascular alterations in immediate hypersensitivity-like reactions induced by a T cell-derived antigen-binding factor. Lab Invest 50:421–434
Krieger JN, Riley DE (2002) bacteria in the chronic prostatitis-chronic pelvic pain syndrome: molecular approaches to critical research questions. J Urol 167:2574–2583
Krieger JN, Jacobs RR, Ross SO (2000) Detecting urethral and prostatic inflammation in patients with chronic prostatitis. Urology 55: 186–192
Krieger JN, Riley DE, Vesella RL, Miner DC, Ross SO, Lange PH (2000) Bacterial DNA sequences in prostate tissue from patients with prostate cancer and chronic prostatitis. J Urol 164:1221–1228
Lee JC, Muller CH, Rothman I, Agnew KJ, Eschenbach D, Ciol MA, Turner JA, Berger RE (2003) Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls. J Urol 169:584–588
Leppilahti M (2002) Interstitial cystitis. An epidemiological, experimental and clinical study. Acta Univ Tamperensis 889. Tampere University Press, Tampere
Leskinen MJ, Rantakokko-Jalava K, Manninen R, Leppilahti M, Marttila T, Kylmälä T, Tammela TLJ (2003) Negative bacterial PCR findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer. The Prostate 5:105–110
Leskinen MJ, Vainionpää R, Syrjänen S, Leppilahti M, Marttila T, Kylmälä T, Tammela TLJ (2003) Herpes simplex, cytomegalo- or papillomavirus DNA are not found in patients with chronic pelvic pain syndrome (CPPS) undergoing radical prostatectomy for localized prostate cancer. Urology 61:397–401
Lilius HG, Valtonen EJ (1972) Diaphragma pelvis spastica. Duodecim 88:399–402
Maksem JA, Johenning PW, Galang CF (1988) Prostatitis and aspiration biopsy cytology of prostate. Urology 32: 263–268
Matsumoto T, Soejima T, Tanaka M, Naito S, Kumazawa J (1992) Cytologic findings of fine needle aspirates in chronic prostatitis. Int Urol Nephrol 24: 43–47
McNaughton-Collins M, Stafford RS, O'Leary MP, Barry MJ (1998) How common is prostatitis? A national survey of physician visits. J Urol 159:1224–1228
McNeal JE (1988) Normal histology of the prostate. Am J Surg Pathol 12: 619–633
Mehik A, Hellström P, Lukkarinen O, Sarpola A, Alfthan O (1999) Increased intraprostatic pressure in patients with chronic prostatitis. Urol Res 27:277–279
Mehik A, Hellström P, Lukkarinen O, Sarpola A, Järvelin M-R (2000) Epidemiology of prostatitis in Finnish men: a population-based cross-sectional study. BJU Int 86:443–448
Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin M-R (2001) Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 88:35–38
Mehik A, Hellström P, Nickel JC, Kilponen A, Leskinen M, Sarpola A, Lukkarinen O (2002) The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements. J Urol 167:137–140
Miller LJ, Fischer KA, Goralnick SJ, Litt M, Burleson JA, Albertsen P, Kreutzer DL (2002) Interleukin-10 levels in seminal plasma: implications for chronic prostatitis-chronic pelvic pain syndrome. J Urol 167:753–756
Mueller CH, Berger RE, Mohr LE, Krieger JN (2001) Comparison of microscopic methods for detecting inflammation in expressed prostatic secretions. J Urol 166:2518–2524
Nadler RB, Koch AE, Calhoun EA, Campbell PL, Pruden DL, Bennett CL, Yarnold PR, Schaeffer AJ (2000) IL-1b and TNF-a in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 164:214–218
Nickel JC, Costerton JW (1992) Coagulase-negative staphylococcus in chronic prostatitis. J Urol 147:398–401
Nickel JC, Costerton JW (1993) Bacterial localization in antibiotic-refractory chronic bacterial prostatitis. Prostate 23:107–114
Nickel JC, Olson ME, Barabas A, Benediktsson H, Dasgupta MK, Costerton JW (1990) Pathogenesis of chronic bacterial prostatitis in an animal model. Br J Urol 66:47–54
Nickel JC, Downey J, Hunter D, Clark J (2001) Prevalence of prostatitis-like symptoms in population based study using the National Institutes of Health Chronic Prostatitis Symptom Index. J Urol 165:842–845
Nishimura T, Abe H, Ito H, Ikeda K, Oka F, Yamamoto M (1998) IL-1ra versus IL-1 levels in prostatic fluid from prostatitis patients. Urol Int 60:92–96
Orhan I, Onur R, Ilhan N, Ardiçoglu A (2001) Seminal plasma cytokine levels in diagnosis of chronic pelvic pain syndrome. Int J Urol 8:495–499
Pasqualotto FF, Sharma RK, Potts JM, Nelson DR, Thomas AJ, Agarwal A (2000) Seminal oxidative stress in patients with chronic prostatitis. Urology 55:881–885
Persson BE, Ronquist G (1996) Evidence for mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion J Urol 155:958–960
Pontari MA (2002) Inflammation and anti-inflammatory therapy in chronic prostatitis. Urology 60 (Suppl 6):29–34
Ramirez CT, Ruiz JA, Gomez AZ, Orgaz RE, Del Rio Samper S (1980) A crystallographic study of prostatic calculi. J Urol 124:840–843
Ricchiuti VS, Haas CA, Seftel AD, Chelimsky T, Goldstein I (1999) Pudendal nerve injury associated with avid bicycling. J Urol 162:2099–2100
Riley DE, Berger RE, Miner DC, Krieger JN (1998) Diverse and related 16S rRNA-encoding DNA sequences in prostate tissues of men with chronic prostatitis. J Clin Microbiol 36: 1646–1652
Scandalios JG (2002) The rise of ROS. Trends Biochem Sci 27: 483–486
Segura JW, Opitz JL, Greene LF (1979) Prostatosis, prostatitis or pelvic floor tension myalgia? J Urol 122:168–169
Shahed AR, Shoskes DA (2000) Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram-positive bacterial growth and treatment response. J Androl 21:669–675
Shoskes DA, Albakri Q, Thomas K, Cook D (2002) Cytokine polymorphism in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol 168:331–335
Söndergaard G, Vetner M, Christensen PO (1987) Prostatic calculi. Acta Pathol Microbiol Immunol Scand 95:141–145
Sutor DJ, Wooley SE (1974) The crystalline composition of prostatic calculi. Br J Urol 46:533–535
Theodorou C, Konidaris D, Moutzouris G, Becopoulos T (1999) The urodynamical profile of prostatodynia. BJU Int 84:461–463
Theoharides TC, Kempuraj D, Sant GR (2001) Mast cell involvement in interstitial cystitis: a review of human and experimental evidence. Urology 57 (Suppl 6):47–55
True LD, Berger RE, Rothman I, Ross SO, Krieger JN (1999) Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol 162:2014–2018
Turner PJ, Eardley I, Fowler RC (1996) The use of transrectal ultrasonography in the diagnosis of urethroprostatic reflux. Br J Urol 77:314–315
Weidner W, Schiefer HG, Krauss H, Jantos C, Friedrich HJ, Altmannsberger M (1991) Chronic prostatitis; a thorough search for etiologically involved microorganisms in 1,461 patients. Infection 19 (Suppl 3):119–125
Whitesides TEJr, Haney TC, Morimoto K, Harada H (1975) Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 113:43–51
Wiederhielm CA (1968) Dynamics of transcapillary fuid exchange. J Gen Physiol 52:29–63
Wiederhielm CA (1970) The interstitial space. In: Fung YC, Perrone N, Anliker M (eds) Biomechanics: its foundations and objectives. Prentice-Hall, New Jersey, pp 273–286
Witschger PM, Wegmüller M (1994) Apparative Muskeldruckmessung beim akuten und chronischen Compartmentsyndrom. Z Unfallchir Versich Med 87:45–51
Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA (1999) Chronic prostatitis: a myofascial pain syndrome. Infect Urol 12:84–88
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mehik, A., Leskinen, M.J. & Hellström, P. Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation. World J Urol 21, 90–94 (2003). https://doi.org/10.1007/s00345-003-0334-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-003-0334-3