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Similarities between interstitial cystitis and male chronic pelvic pain syndrome

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Abstract

Few clinical conditions encountered by the urologist cause more patient and clinician frustration than interstitial cystitis and male chronic pelvic pain syndrome, also know as nonbacterial prostatitis. This frustration is fueled by the chronicity of often disabling urogenital (and often associated systemic) symptoms coupled with delayed care, misdiagnosis, and suboptimal clinical responses. Basic research and therapeutic trials for these syndromes have historically taken two separate paths. However, mounting evidence suggests that significant overlap may exist between them in epidemiology, pathophysiology, and even therapy. This discussion reviews some of the common features of these clinical problems and makes a case that they might in fact represent different manifestations of the same disease process.

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References and Recommended Reading

  1. Curhan GC, Speizer FE, Hunter DJ, et al.: Epidemiology of interstitial cystitis: a population based study. J Urol 1999, 161:549–552. This study demonstrates a strikingly high prevalance of medical conditions that have historically received little investigation.

    Article  PubMed  CAS  Google Scholar 

  2. Collins MM, Stafford RS, O’Leary MP, et al.: How common is prostatitis? A national survey of physician visits. J Urol 1998, 159:1224–1228. This study also demonstrates a strikingly high prevalance of medical conditions that have historically received little investigation.

    Article  PubMed  CAS  Google Scholar 

  3. Collins MM, Meigs JB, Barry MJ, et al.: Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. J Urol 2002, 167:1363–1366. Like the preceding two studies, this study demonstrates a strikingly high prevalence of medical conditions that have historically received little investigative attention. The amassed data of these three studies have fueled significant clinical and political support for these conditions.

    Article  PubMed  Google Scholar 

  4. Held PJ, Hanno PM, Wein AJ, et al.: Epidemiology of interstitial cystitis. In Interstitial Cystitis. Edited by Hanno PM, Staskin DR, Krane RJ, Wein AJ. New York: Springer-Verlag; 1990:29–48.

    Google Scholar 

  5. Koziol JA, Clark DC, Gittes RF, Tan EM: The natural history of interstitial cystitis: a survey of 374 patients. J Urol 1993, 149:465–469.

    PubMed  CAS  Google Scholar 

  6. Simon LJ, Landis JR, Erickson DR, et al.: The interstitial cystitis data base study: concepts and preliminary baseline descriptive statistics. Urology 1997, 49(Suppl 5A):64–75.

    Article  PubMed  CAS  Google Scholar 

  7. Wenninger K, Heiman JR, Rothman I, et al.: Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 1996, 155:965–968.

    Article  PubMed  CAS  Google Scholar 

  8. McNaughton CM, Pontari MA, O’Leary MP, et al.: Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Int Med 2001, 16:656–662. An excellent study demonstrating the profound effects of prostatitis upon health-related quality-of-life issues.

    Article  Google Scholar 

  9. Jarvi K, Wang W, Korithoski B, et al.: Identification of unusual bacteria in the semen and urine of men with NIH type III prostatitis. J Urol 2001, 165(Suppl):27.

    Article  Google Scholar 

  10. Hochreiter WW, Duncan JL, Schaeffer AJ: Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction. J Urol 2000, 163:127–130.

    Article  PubMed  CAS  Google Scholar 

  11. Shortliffe LM, Sellers RG, Schachter J: The characterization of nonbacterial prostatitis: search for an etiology. J Urol 1992, 148:1461–1466.

    PubMed  CAS  Google Scholar 

  12. Berger RE, Krieger JN, Rothman I, et al.: Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J Urol 1997, 157:863–865.

    Article  PubMed  CAS  Google Scholar 

  13. Krieger JN, Riley DE, Vesella RL, et al.: Bacterial DNA sequences in prostatic tissue from patients with prostate cancer and chronic prostatitis. J Urol 2000, 164:1221–1228.

    Article  PubMed  CAS  Google Scholar 

  14. Shoskes DA, Shahed AR: 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 2000, 6:240–242.

    PubMed  CAS  Google Scholar 

  15. Nickel JC: Effective office management of chronic prostatitis. Urol Clin North Am 1998, 25:677–684. An excellent review detailing practical management approaches for the patient with MCPPS.

    Article  PubMed  CAS  Google Scholar 

  16. Nickel JC, Downey J, Johnston B, et al.: Predictors of patient response to antibiotic therapy for the chronic prostatitis/ chronic pelvic pain syndrome: a prospective multicenter trial. J Urol 2001, 165:1539–1544.

    Article  PubMed  CAS  Google Scholar 

  17. Keay S, Zhang CO, Baldwin BR, Alexander RB: Polymerase chain reaction amplification of bacterial 16s rRNA genes in prostate biopsies from men without chronic prostatitis. Urology 1999, 53:487–491.

    Article  PubMed  CAS  Google Scholar 

  18. Duncan JL, Schaeffer AJ: Do infectious agents cause interstitial cystitis? Urology 1997, 49(Suppl 5A):48–51.

    Article  PubMed  CAS  Google Scholar 

  19. Keay S, Zhang CO, Baldwin BR, et al.: Polymerase chain reaction amplification of bacterial 16S rRNA genes in interstitial cystitis and control patient bladder biopsies. J Urol 1998, 159:280–283.

    Article  PubMed  CAS  Google Scholar 

  20. Warren JW: Interstitial cystitis as an infectious disease. Urol Clin North Am 1994, 21:31–39.

    PubMed  CAS  Google Scholar 

  21. Potts JM, Ward AM, Rackley RR: Association of chronic urinary symptoms in women and ureaplasma urealyticum. Urology 2000, 55:486–489.

    Article  PubMed  CAS  Google Scholar 

  22. Elgavish A, Robert B, Lloyd K, et al.: Evidence for a mechanism of bacterial toxin action that may lead to the onset of urothelial injury in the interstitial cystitis bladder. J Urol 1995, 153:329A.

    Google Scholar 

  23. Moskowitz M, Byrne DS, Callahan HJ, et al.: Decreased expression of a glycoproteins component of bladder surface mucin (GP1) in interstitial cystitis. J Urol 1994, 151:343–345.

    PubMed  CAS  Google Scholar 

  24. Sant GR, Ucci AA, Jr, Alroy J: Bladder surface glycosaminoglycans (GAGs) in interstitial cystitis. J Urol 1986, 135:175A.

    Google Scholar 

  25. Lilly JD, Parsons CL: Bladder surface glycosaminoglycans is a human epithelial permeability factor. Surg Gynecol Obstet 1990, 171:493–496.

    PubMed  CAS  Google Scholar 

  26. Press SM, Moldwin R, Kushner L, et al.: Decreased expression of GP-51 glycosaminoglycan in cats afflicted with feline interstitial cystitis. J Urol 1995, 153:288A.

    Google Scholar 

  27. McNeal JE: Normal histology of the prostate. Am J Surg Pathol 1988, 12:619–633.

    Article  PubMed  CAS  Google Scholar 

  28. Jones EG, Harper ME: Studies on the proliferation, secretory activities, and epidermal growth factor expression in benign prostatic hyperplasia explant cultures. Prostate 1992, 20:133–149.

    Article  PubMed  CAS  Google Scholar 

  29. Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE: Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol 1982, 54:729–731. This “classic” article details the common reflux of carbon particles into the prostatic ducts during TURP. Reflux of urine could potentiate the development of infection or possibly cause symptoms by enabling urine to elicit a local inflammatory response.

    Article  PubMed  CAS  Google Scholar 

  30. Parsons CL: Potassium sensitivity test. Tech Urol 1996, 2:171–173.

    PubMed  CAS  Google Scholar 

  31. Nickel JC, Johnston B, Downey J, et al.: Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial. Urology 2000, 56:413–417.

    Article  PubMed  CAS  Google Scholar 

  32. Hohenfellner M, Nunues L, Schmidt RA, et al.: Interstitial cystitis: increased sympathetic innervation and related neuropeptide synthesis. J Urol 1992, 147:587–591.

    PubMed  CAS  Google Scholar 

  33. Pang X, Marchand J, Sant GR, et al.: Increased number of substance P positive fibers in interstitial cystitis. Br J Urol 1995, 75:744–750.

    PubMed  CAS  Google Scholar 

  34. Chen Y, Varghese R, Chiu P, et al.: Urinary substance P is elevated in women with interstitial cystitis. J Urol 1999, 161:26.

    Article  Google Scholar 

  35. Shirley SW, Stewart BH, Mirelman S: Dimethyl sulfoxide in the treatment of inflammatory genitourinary disorders. Urology 1978, 11:215–220.

    Article  PubMed  CAS  Google Scholar 

  36. Kushner L, Chiu PY, Brettschneider N, et al.: 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 2001, 57(Suppl 1):129.

    Article  PubMed  CAS  Google Scholar 

  37. Keith IM, Jin J, Neal D, Jr, et al.: Cell relationship in a Wistar rat model of spontaneous prostatitis. J Urol 2001, 166:323–328.

    Article  PubMed  CAS  Google Scholar 

  38. Elbadawi A: Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology 1997, 49(Supp 5A):14–40.

    Article  PubMed  CAS  Google Scholar 

  39. Theoharides TC, Sant GR: Bladder mast cell activation in interstitial cystitis. Semin Urol 1991, 9:74–87.

    PubMed  CAS  Google Scholar 

  40. Lagunoff D, Martin TW, Read G: Agents that release histamine from mast cells. Ann Rev Pharmacol Toxicol 1983, 23:331–351.

    Article  CAS  Google Scholar 

  41. Spanos C, Pang X, Ligris K, et al.: Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol 1997, 157:669–672.

    Article  PubMed  CAS  Google Scholar 

  42. Feltis JT, Perez-Marrero R, Emerson LE: Increased mast cells of bladder in suspected cases of interstitial cystitis: possible disease marker. J Urol 1987, 138:42–43.

    PubMed  CAS  Google Scholar 

  43. Lynes WL, Flynn SD, Shortliffe LD, et al.: Mast cell involvement in interstitial cystitis. J Urol 1987, 138:746–752.

    PubMed  CAS  Google Scholar 

  44. Theoharides T, Duraisamy K, Sant G: Mast cell involvement in interstitial cystitis: a review of human and experimental evidence. Urology 2001, 57(Suppl 6A):47–55.

    Article  PubMed  CAS  Google Scholar 

  45. Kastrup J, Hald T, Larsen S, et al.: Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis. Br J Urol 1983, 55:495–500.

    PubMed  CAS  Google Scholar 

  46. Holm-Bentzen M, Sondergaard I, Hald T: Urinary excretion of a metabolite of histamine (1,4-methyl-imidazole-acetic-acid) in painful bladder disease. Br J Urol 1987, 59:230–233.

    PubMed  CAS  Google Scholar 

  47. El-Mansoury M, Boucher W, Sant GR, et al.: Increased urine histamine and methylhistamine in interstitial cystitis. J Urol 1994, 153:350–353.

    Google Scholar 

  48. Theoharides TC, Flaris N, Cronin CT, et al.: Mast cell activation in sterile bladder and prostate inflammation. Int Arch Allergy Appl Immunol 1990, 92:281–286.

    PubMed  CAS  Google Scholar 

  49. Seethalakshmi L, Bala RS, Malhotra RK, et al.: 17 beta-estradiol induced prostatitis in the rat is an autoimmune disease. J Urol 1996, 156:1838–1842.

    Article  PubMed  CAS  Google Scholar 

  50. Fister GM: Similarity of interstitial cystitis to lupus erythematosus. J Urol 1938, 40:37.

    Google Scholar 

  51. Moran PA, Dwyer PL, Carey MP, et al.: Oral methotexate in the management of refractory interstitial cystitis. Aust N Z J Obstet Gynaecol 1999, 39:468–471.

    PubMed  CAS  Google Scholar 

  52. Silk MR: Bladder antibodies in interstitial cystitis. J Urol 1970, 103:307–309.

    PubMed  CAS  Google Scholar 

  53. Jokinen E, Alfthan S, Oravisto K: Antitissue autoantibodies in interstitial cystitis. Clin Exp Immunol 1972, 11:333–339.

    PubMed  CAS  Google Scholar 

  54. Anderson JB, Parivar F, Lee G, et al.: The enigma of interstitial cystitis: an autoimmune disease? Br J Urol 1989, 63:58–63.

    PubMed  CAS  Google Scholar 

  55. Alexander RB, Brady F, Ponniah S: Autoimmune prostatitis: evidence of T cell reactivity with normal prostastic proteins. Urology 1997, 50:893–899.

    Article  PubMed  CAS  Google Scholar 

  56. Zisman A, Zisman E, Lindner A, et al.: Autoantibodies to prostate specific antigen in patients with benign prostatic hyperplasia. Urology 1995, 154:1052–1055.

    Article  CAS  Google Scholar 

  57. Collins MM, Stafford RS, O’Leary MP, Barry MJ: Distinguishing chronic prostatitis and benign prostatic hyperplasia symptoms: results of a national survey of physician visits. Urology 1999, 53:921–925.

    Article  PubMed  CAS  Google Scholar 

  58. Hanash KA, Pool TL: Interstitial cystitis in men. J Urol 1969, 102:427–428.

    PubMed  CAS  Google Scholar 

  59. DeJuana CP, Everett JC, Jr: Interstitial cystitis, experience and review of recent literature. Urology 1977, 10:325–329.

    Article  PubMed  CAS  Google Scholar 

  60. Driscoll A, Teichman JMH: How do patients with interstitial cystitis present? J Urol 2001, 166:2118–2120. This investigation demonstrates that the symptoms of IC may progress and describes the chronology of progression. This often slow progression of symptoms may in part account for the frequent misdiagnosis of IC, particularly among the male population.

    Article  PubMed  CAS  Google Scholar 

  61. Nickel JC, Downey J, Hunter D, et al.: Prevalence of prostatitislike symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol 2001, 165:842–845.

    Article  PubMed  CAS  Google Scholar 

  62. Mayo ME, Ross SO, Krieger JN: Few patients with “chronic prostatitis” have significant bladder outlet obstruction. Urology 1998, 52:417–421.

    Article  PubMed  CAS  Google Scholar 

  63. Siroky MB: Is it interstitial cystitis? Diagnostic distinctions in reduced bladder capacity. Contemp Urol 1994, 6:13–22.

    Google Scholar 

  64. Hanno PM, Landis JR, Matthews-Cook Y, et al.: The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database Study. J Urol 1999, 161:552–557.

    Article  Google Scholar 

  65. Schmidt RA, Vapnek JM: Pelvic floor behavior and interstitial cystitis. Sem Urol 1991, 9:154–159.

    CAS  Google Scholar 

  66. Kirkemo A, Peabody M, Diokno AC, et al.: Associations among urodynamic findings and symptoms in women enrolled in the Interstitial Cystitis Database (ICDB) Study. Urology 1997, 49(Suppl 5A):76–80.

    Article  PubMed  CAS  Google Scholar 

  67. Holm-Bentzen M, Jacobsen F, Nerstrøm B, et al.: Painful bladder disease: clinical and pathoanatomical differences in 115 patients. J Urol 1987, 138:500–502.

    PubMed  CAS  Google Scholar 

  68. Moldwin RM, Mendelowitz F: Pelvic floor dysfunction and interstitial cystitis. Paper presented at the Research Symposium on Interstitial Cystitis, A Century of Awareness, A Decade of Progress. Orlando, FL. October 8–9, 1993.

  69. Lilius HG, Oravisto KJ, Valtonen EJ: Origin of pain in interstitial cystitis. Scand J Urol Nephrol 1973, 7:150–152.

    PubMed  CAS  Google Scholar 

  70. Weiss JM: Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001, 166:2226–2231. An excellent article detailing the frequent coexistence of pelvic floor dysfunction and IC. The article details symptom improvement with simple manual therapy techniques.

    Article  PubMed  CAS  Google Scholar 

  71. Segura JW, Opitz JL, Greene LF: Prostatitis, prostatosis or pelvic floor muscle tension myalgia? J Urol 1979, 122:168–169.

    PubMed  CAS  Google Scholar 

  72. Siroky MB, Goldstein I, Krane RJ: Functional voiding disorders in men. J Urol 1981, 126:200–204.

    PubMed  CAS  Google Scholar 

  73. Forrest JB, Vo Q: Observations on the presentation, diagnosis, and treatment of interstitial cystitis in men. Urology 2001, 57(Suppl 6A):26–29. The symptoms of IC often overlap with those of prostatitis and BPH. This article suggests keeping the diagnosis of IC in the differential diagnosis when evaluating the patient with lower urinary tract symptoms.

    Article  PubMed  CAS  Google Scholar 

  74. Miller JL, Rothman I, Bavendam TG, Berger RE: Prostatodynia and interstitial cystitis: one and the same? Urology 1995, 45:587–590.

    Article  PubMed  CAS  Google Scholar 

  75. Messing EM: The diagnosis of interstitial cystitis. Urology 1987, 29(Suppl 4):4–7.

    PubMed  CAS  Google Scholar 

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  1. Department of Urology, Long Island Jewish Medical Center, 170-5 76th Avenue, 11040, New Hyde Park, NY, USA

    Robert M. Moldwin MD, FACS

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Moldwin, R.M. Similarities between interstitial cystitis and male chronic pelvic pain syndrome. Curr Urol Rep 3, 313–318 (2002). https://doi.org/10.1007/s11934-002-0056-x

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