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Advancements in the Management of Urologic Chronic Pelvic Pain: What is New and What Do We Know?

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Abstract

Prostatitis is one of the most common urologic diagnoses in men of all ages. The etiology of this problem remains poorly understood. No uniform solitary treatment is known for chronic prostatitis. As a result, a multimodal approach is most likely to demonstrate benefit for this disease. Various treatment modalities have included the use of both pharmacologic and nonpharmacologic treatments. In addition, multiple interventional techniques including the injection of botulinum toxin, transurethral needle ablation of the prostate, microwave thermotherapy, neuromodulation, and, most recently, extracorporeal shockwave therapy have been utilized with varying degrees of benefit.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Pontari M: Chronic prostatitis/chronic pelvic pain syndrome. In UpToDate. Edited by Basow DS. Waltham, MA: UpToDate; 2010.

  2. Pontari MA, Ruggieri MR: Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 2004, 172:839–845.

    Article  PubMed  Google Scholar 

  3. Dellabella M, Milanese G, Sigala S, et al.: The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome. Inflamm Res, 2009, 58:829–836.

    Article  CAS  PubMed  Google Scholar 

  4. Watson RA, Irwin RJ Jr: Chronic pelvic pain syndrome and prostatodynia. Available at http://emedicine.medscape.com/article/437745-overview. Accessed March 2010.

  5. Nickel JC: Prostatitis: lessons from the 20th century. BJU Int 2000, 85:179–185.

    Article  CAS  PubMed  Google Scholar 

  6. Lee SW, Liong ML, Yuen KH, et al.: Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med 2008, 121:79.e1–e7.

    Google Scholar 

  7. Murphy AB, Macejko A, Taylor A, Nadler RB: Chronic prostatitis: management strategies. Drugs 2009, 69:71–84.

    Article  CAS  PubMed  Google Scholar 

  8. Tugcu V, Tas S, Eren G, et al.: Effectiveness of acupuncture in patients with category IIIB chronic pelvic pain syndrome: a report of 97 patients. Pain Med 2010 Jan 22 (Epub ahead of print).

  9. Kabay S, Kabay SC, Yucel M, Ozden H: Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: a Sham-Controlled Comparative Study. Urol Int 2009, 83:33–38.

    Article  PubMed  Google Scholar 

  10. Anderson RU, Sawyer T, Wise D, et al.: Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 2009, 182:2753–2758.

    Article  PubMed  Google Scholar 

  11. Schaeffer AJ: Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med 2006, 355:1690–1698.

    Article  CAS  PubMed  Google Scholar 

  12. Wagenlehner FM, Schneider H, Ludwig M, et al.: A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 2009, 56:544–551.

    Article  PubMed  Google Scholar 

  13. Jeong CW, Lim DJ, Son H, et al.: Treatment for chronic prostatitis/chronic pelvic pain syndrome: levofloxacin, doxazosin and their combination. Urol Int 2008, 80:157–161.

    Article  CAS  PubMed  Google Scholar 

  14. Nickel JC: Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents 2008, 31(Suppl 1):S112–S116.

    Article  CAS  PubMed  Google Scholar 

  15. Cheah PY, Liong ML, Yuen KH, et al.: Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial. J Urol 2003, 169:592–596.

    Article  CAS  PubMed  Google Scholar 

  16. • Nickel JC, Krieger JN, McNaughton-Collins M, et al.: Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med 2008, 359:2663–2673. This large randomized study found no benefit in symptom reduction from an α-blocker in patients with chronic prostatitis who were α-blocker–naïve. This contradicts previous studies supporting the use of α-blocker therapy.

    Article  CAS  PubMed  Google Scholar 

  17. Clemens JQ, Brown SO, Calhoun EA: Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study. J Urol 2008, 180:1378–1382.

    Article  PubMed  Google Scholar 

  18. Brown CS, Franks AS, Wan J, Ling FW: Citalopram in the treatment of women with chronic pelvic pain: an open-label trial. J Reprod Med 2008, 53:191–195.

    CAS  PubMed  Google Scholar 

  19. Shoskes DA, Berger R, Elmi A, et al.: Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol 2008, 179:556–560.

    Article  PubMed  Google Scholar 

  20. Simons DG, Travell JG, Simons LS: Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, edn 2. Baltimore: Lippincott Williams & Wilkins; 1999.

    Google Scholar 

  21. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA: Chronic prostatitis: a myofascial pain syndrome? Infect Urol 1999, 12:84–88.

    Google Scholar 

  22. Wessely S, Nimnuan C, Sharpe M: Functional somatic syndromes: one or many? Lancet 1999, 354:936–939.

    Article  CAS  PubMed  Google Scholar 

  23. Rao A, Abbott J: Using botulinum toxin for pelvic indications in women. Aust N Z J Obstet Gynaecol 2009, 49:352–357.

    Article  PubMed  Google Scholar 

  24. Abbott JA, Jarvis SK, Lyons SD, et al.: Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol 2006, 108: 915–923.

    Article  PubMed  Google Scholar 

  25. Eccleston KJ, Woolley PD: Botulinum toxin for urogenital conditions. Int J STD AIDS 2008, 19:797–799.

    Article  CAS  PubMed  Google Scholar 

  26. Chuang YC, Yoshimura N, Wu M, et al.: Intraprostatic capsaicin injection as a novel model for nonbacterial prostatitis and effects of botulinum toxin A. Eur Urol 2007, 51:1119–1127.

    Article  CAS  PubMed  Google Scholar 

  27. Chuang YC, Giannantoni A, Chancellor MB: The potential and promise of using botulinum toxin in the prostate gland. BJU Int 2006, 98:28–32.

    Article  CAS  PubMed  Google Scholar 

  28. El-Hakim A: Chronic prostatitis/chronic pelvic pain syndrome: is there a role for local drug infiltration therapy? J Endourol 2004, 18:227–231.

    Article  PubMed  Google Scholar 

  29. Lopatin WB, Martynik M, Hickey DP, et al.: Retrograde transurethral balloon dilation of prostate: innovative management of abacterial chronic prostatitis and prostatodynia. Urology 1990, 36:508–510.

    Article  CAS  PubMed  Google Scholar 

  30. Siegel S, Paszkiewicz E, Kirkpatrick C, et al.: Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 2001, 166:1742–1745.

    Article  CAS  PubMed  Google Scholar 

  31. Feler CA, Whitworth LA, Fernandez J: Sacral neuromodulation for chronic pain conditions. Anesthesiol Clin North America 2003, 21:785–795.

    Article  PubMed  Google Scholar 

  32. Aaltomaa S, Ala-Opas M: The effect of transurethral needle ablation on symptoms of chronic pelvic pain syndrome–a pilot study. Scand J Urol Nephrol 2001, 35:127–131.

    CAS  PubMed  Google Scholar 

  33. Lee KC, Jung PB, Park HS, et al.: Transurethral needle ablation for chronic nonbacterial prostatitis. BJU Int 2002, 89:226–229.

    Article  CAS  PubMed  Google Scholar 

  34. Chiang PH, Chiang CP: Therapeutic effect of transurethral needle ablation in non-bacterial prostatitis: chronic pelvic pain syndrome type IIIa. Int J Urol 2004, 11:97–102.

    Article  PubMed  Google Scholar 

  35. Leskinen MJ, Kilponen A, Lukkarinen, Tammela TL: Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized sham controlled study. Urology 2002, 60:300–304.

  36. Zeitlin SI: Heat therapy in the treatment of prostatitis. Urology 2002, 60(Suppl 6):38–40.

    Article  PubMed  Google Scholar 

  37. Mené MP, Ginsberg PC, Finkelstein LH, et al.: Transurethral microwave hyperthermia in the treatment of chronic nonbacterial prostatitis. J Am Osteopath Assoc 1997, 97:25–30.

    PubMed  Google Scholar 

  38. Nickel JC, Sorensen R: Transurethral microwave thermotherapy of nonbacterial prostatitis and prostatodynia: initial experience. Urology 1994, 44:458–460.

    Article  CAS  PubMed  Google Scholar 

  39. Nickel JC, Sorensen R: Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol 1996, 155:1950–1954.

    Article  CAS  PubMed  Google Scholar 

  40. Kastner C, Hochreiter W, Huidobro C, et al.: Cooled transurethral microwave thermotherapy for intractable chronic prostatitis–results of pilot study after 1 year. Urology 2004, 64:1149–1154.

    Article  PubMed  Google Scholar 

  41. Zimmerman R, Cumpanas A, Hoeltl L, et al.: Extracorporeal shock wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int 2008, 102:976–980.

    Article  Google Scholar 

  42. •• Zimmerman R, Cumpanas A, Miclea F, Janetschek G: Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomized, double-blind, placebo-controlled study. Eur Urol 2009, 56:418–424. This well-designed study of a potentially beneficial therapy with minimal side effects provides level 1 evidence to support a novel therapeutic approach.

    Article  Google Scholar 

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Correspondence to Philippe E. Spiess.

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Parker, J., Buga, S., Sarria, J.E. et al. Advancements in the Management of Urologic Chronic Pelvic Pain: What is New and What Do We Know?. Curr Urol Rep 11, 286–291 (2010). https://doi.org/10.1007/s11934-010-0121-9

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