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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most common form of prostatitis is National Institutes of Health category III, also known as chronic abacterial prostatitis/chronic pelvic pain syndrome. The search for effective and durable therapy for this condition remains frustrating for both patients and physicians. A new approach incorporating a neurobahavioral and musculoskeletal perspective is emerging as a means of diagnosing and treating affected patients. Adopting methods from gynecology, colorectal surgery, and physical therapy has had promising effects in men diagnosed with chronic prostatitis.
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PMID:Pelvic floor physical therapy for patients with prostatitis. 1208 30

Although bacterial prostatitis is a common diagnosis, well documented infections of the prostate are uncommon. Culture studies of prostate tissue led our group to hypothesize that bacterial colonization/invasion of the prostate gland might occur more commonly than is appreciated by standard microbiological techniques. Specific polymerase chain reaction (PCR) assays were used for each of the pathogens previously implicated in chronic prostatitis as well as broad-spectrum PCR assays to identify tetracycline resistance genes and bacterial ribosomal-encoding genes (16S rDNAs), followed by cloning and sequencing of the PCR products. Only ten (8%) of the 135 patients with chronic prostatitis had positive specific PCR assays including: Mycoplasma genitalium in four men, Chlamydia trachomatis in three and Trichomonas vaginalis in two, as well as one man positive for both M. genitalium and C. trachomatis. In contrast to the specific probes, the broad-spectrum PCR assays had a substantial proportion of positives. We found evidence of tetracycline resistance in 25% of patients. 16S rDNA-encoding sequences in 77% of the subjects. The tetracycline resistance positives were a subset of the 16S rDNA positive patients. Patients with 16S rDNA-encoding sequences were significantly more likely to have expressed prostatic secretion leukocytes. Many patients with chronic prostatitis/chronic pelvic pain syndrome have a wide variety of bacterial DNA-encoding sequences despite extensive negative microbiological investigations. Understanding the precise role of infection in this syndrome may well lead to better methods to elucidate the microbiology of the prostate in health and disease.
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PMID:Prostatitis: what is the role of infection. 1213 36

The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.
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PMID:The NIH Consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia. 1214 61

Prostatitis reflects a broad spectrum of prostatic infections, both acute and chronic. Chronic prostatitis, known as National Institutes of Health category III or chronic pelvic pain syndrome, broadly defines a disease that is still poorly understood, and as a consequence, difficult to treat. Typical symptoms include pelvic pain and voiding dysfunction. Infection is often cited as the cause of this condition, despite frequent negative cultures. A close look at the local prostatic microenvironment may yield clues. The role of inflammatory mediators and what stimulates them can point to potential sites of prevention. A genetic link or relationship to other diseases may prove to be part of the cause. Furthermore, a neurologic source, whether anatomic or psychologic, has been strongly debated. Ultimately, it may become clear that chronic prostatitis represents the final common result of a disease that originates from a cascade of multiple stimuli.
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PMID:Theories of prostatitis etiology. 1214 62

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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PMID:Similarities between interstitial cystitis and male chronic pelvic pain syndrome. 1214 63

National Institutes of Health Category III prostatitis/chronic pelvic pain syndrome continues to pose a diagnostic and treatment challenge to most urologists. While this form of so-called prostatitis is the most prevalent and frustrating, little progress has been made in proving an etiology and consequently, in finding an effective remedy. The diagnostic dilemma is illustrated by the conflicting data employed to describe prostatitis. What is prostatitis? Is it a malady of the prostate gland itself? Is it a form of voiding dysfunction? Is it a myofascial pain syndrome? Or, is prostatitis urology's brand of functional somatic syndrome? It is time we address the dilemma by looking beyond the prostate gland and toward a multidisciplinary perspective.
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PMID:Diagnosing the prostatitis patient: the dilemma continues. 1214 64

Patients with chronic prostatitis/pelvic pain syndrome typically report genital or pelvic pain (in or around the penis, perineum, scrotum) lasting > 3 months. Whereas true chronic bacterial prostatitis is an uncommon condition characterised by recurrent prostatic and urinary infection, chronic pelvic pain syndrome (CPPS) is a common condition in which no infection is found. Recent surveys suggest a prevalence of 2.5-3% for CPPS. The four-glass test, traditionally used to distinguish inflammatory and inflammatory forms of CPPS, has not been adequately validated; whether the distinction is clinically meaningful is increasingly questioned. The aetiology of CPPS is not known; urodynamic studies imply a neuromuscular origin. More recent work supports a role for proinflammatory cytokines in the pathogenesis. In the management of chronic bacterial prostatitis, trials support the use of quinolone antibiotics as first-line treatment. In contrast, the management of CPPS is generally unsatisfactory, as no reliable treatment has been identified. Treatments commonly tried include antibiotics (notably tetracyclines, quinolones and macrolides), anti-inflammatory agents, and alpha blockers. Newer approaches include trials of finasteride, quercetin and rofecoxib. A recent systematic review demonstrated that none of the current diagnostic and treatment methods for CPPS is supported by a robust evidence base.
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PMID:Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management. 1219 65

Chronic prostatitis is often refractory to antibiotics, however biopsy and molecular data indicate persistent symptoms may be due to occult infection. Combining antibiotic therapy with regular prostatic massage has been suggested as an effective therapy for some of these men. From November 1996 to December 1998, 73 men with chronic pelvic pain syndromes were treated with antibiotics and prostatic massage. Antibiotic selection was based on culture and sensitivity of prostatic fluid or empirically if cultures were negative. Prostatic massage was done 1 to 3 times per week and fluid examined for WBCs and cultured for bacteria. The average age of the group was 43.5 y (range 23-72) and average duration of symptoms 6.7 y (median 3 y, range 3 months-30 y). Prostatic cultures were negative in 19, grew uropathogens in 2, and Gram positive bacteria in 52 patients. Overall 29 patients (40%) had complete resolution of symptoms, 14 (19%) had complete resolution followed by a recurrence, 15 (21%) had some improvement and 15 (21%) had no improvement. All positive cultures were sterilized during treatment. Combination prostatic massage and culture specific antibiotics can be an effective treatment in a proportion of men with long standing refractory chronic prostatitis.
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PMID:Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. 1249 26

This study aims to identify a risk factor in the form of a distal urethral web in chronic prostatitis, resection of which should lead to significant symptom reduction. The distal urethral web has been identified as a risk factor in chronic prostatitis, surgical resection of which resulted in reduction of symptoms as measured by the prostatitis specific symptom indexes. A risk factor in chronic prostatitis has been identified as a reflux-causing distal urethral web, surgical resection of which resulted in significant symptom severity reduction and a smaller decline in the frequency of symptoms. Overall, this study shows that the distal urethral web is a risk factor for chronic prostatitis and chronic pelvic pain syndrome, and that its resection resulted in significant symptom severity reduction with a lesser decline in the frequency of symptoms. This would indicate that the patients rated surgery as having an overwhelming edge when it came to reducing the severity of symptoms, but not so overwhelming an edge as far as the frequency of symptoms was concerned. This is probably reflective of the patients' choice for a combination of surgery and conventional treatments rather than one or the other alone, and/or other risk factors as yet undiscovered. Like other treatments in the past, this may not be the complete answer to chronic pelvic pain syndrome (CPPS).
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PMID:Distal urethral web: a risk factor in prostatitis. 1249 78

Members of the Chronic Prostatitis Collaborative Research Network (CPCRN) met in a 1-day symposium to review recent findings and to debate unanswered issues in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The meeting was focused on producing an overview summary statement that would, as nearly as possible, represent the consensus views of the attendees. As discussed below, the participants agreed that a history, physical examination, and urinalysis/urine culture are mandatory for the evaluation of all patients presenting with CP/CPPS, with other assessments categorized as recommended or optional, depending on the history and physical findings. Observations and suggestions regarding first- and second-line therapies are also offered, with the recognition that randomized, placebo-controlled trials to guide selection of therapies for chronic nonbacterial prostatitis are currently lacking.
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PMID:Overview summary statement. Diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). 1252 76


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