Contemporary Management of Chronic Prostatitis

Chronic prostatitis (CP) is a common condition, yet remains a challenge to treat in clinical practice due to the heterogeneity of symptoms.To get more news about Chronic prostatitis treatment, you can visit our official website.

The aim of this article is to undertake a narrative review using key research papers in this field in order to develop a treatment algorithm and research recommendations for the management of type II and type III prostatitis taking a broader look at interventions beyond those recommended in the European Association of Urology Guidelines.

A search was performed using multiple databases and trial registries with no language restrictions. Searches were completed on March 1, 2021, with a focus on randomized controlled trials (RCTs), meta-analyses, and systematic reviews. However, in areas with a dearth of such studies, we included case series and observational studies, thus allowing us to assess current levels of evidence and areas of potential research.

We identified and reviewed 63 studies. The level of evidence and the quality of trials were assessed and reported. Research recommendations, where applicable, were also highlighted.

CP/chronic pelvic pain syndrome (CPPS) is a heterogenous term referring to diverse symptomology that requires tailored treatments depending on the patients’ complaints. After a review of the evidence available, we present a treatment algorithm that is based on the much-discussed UPOINT (urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles) framework. Future studies should focus on multimodal therapy based on such frameworks and provide the future direction of this complex condition.

Introduction & Background
Prostatitis is a common condition with an incidence of 4.5%-9% [1]. However, despite its prevalence, the syndrome remains a challenge in clinical practice. In part, this relates to the heterogeneous definition of prostatitis. The National Institutes of Health (NIH) classification system set out four syndromes that come under the umbrella of prostatitis.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined by Category II and Category III of the NIH classification system and is particularly difficult to treat, with a recurrence rate of up to 50% [2]. Table 1 illustrates the NIH classification system of prostatitis as published in the journal of the American Medical Association, which has been in use since 1999.The pathogenesis of CP/CPPS remains poorly understood. Infection and anatomical abnormalities have been implicated in this syndrome. High-pressure voiding dysfunction, intraprostatic ductal reflux, and autoimmune and neuromuscular mechanisms are all thought to play a role in the etiopathogenesis of CP/CPPS. Ultimately, the cause of CP/CPPS is often multifactorial, which leads to such diverse symptomology and presentation.

CP/CPPS is defined by pelvic pain lasting at least three of the prior six months and is often coupled with lower urinary tract symptoms (LUTS) [3]. Pain is usually felt in the pelvis, the lower abdomen, the back, and the genitals. CP/CPPS is commonly associated with other syndromes such as fibromyalgia, irritable bowel syndrome (IBS), depression, and stress [4].

The severity of CP/CPPS symptoms should be assessed using the validated NIH Chronic Prostatitis Symptom Index (CPSI), a nine-question survey covering three areas: pain, urinary symptoms, and quality of life (QoL) [5].

CP/CPPS requires a holistic treatment approach. A full physical examination with a focus on a digital rectal exam (DRE) must be performed to characterize the prostate and the origin of pain. Occasionally, the prostate itself is not the offending organ in CP/CPPS but it is rather pelvic floor tenderness/spasm, which will require a different treatment approach [6]. A prostate-specific antigen (PSA) should be performed if the patient is at risk of prostate cancer or if an examination has suggested it.

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