Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management.
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.
Wycombe Hospital, High Wycombe, HP11 2TT, UK. luzg@wycgu.demon.co.uk
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Luzzi
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017699:Pelvic Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D011472:Prostatitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D011794:Quercetin / Q000627:therapeutic use; D013577:Syndrome
D000317:Adrenergic alpha-Antagonists; D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D018120:Finasteride; D011794:Quercetin