The role of the prostatic stroma in chronic prostatitis/chronic  pelvic pain syndrome.
OBJECTIVE
To confirm the hypothesis of prostatic stromal involvement in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).


METHODS
A literature review to analyze mechanisms commonly indicated as a cause of CP/CPPS that can interfere with the processes of cell growth of smooth muscle fibrocells and may cause smooth muscle cell hypertrophy, periurethral edema, and inflammation.


RESULTS
Our review strongly suggests a prevalent stromal involvement, specifically of the smooth muscle cells, in CP/CPPS physiopathology. The involvement of the endocrine system, in particular the role of estrogens, the neurological pathway mediated by noradrenalin, and the presence of inflammation, support the hypothesis that CP/CPPS could be a disease with a prevalent role of smooth muscle stromal cells rather than glandular structures. Neurogenous inflammation, oxidative stress and psychological factors may be involved in the chronic nature of the disease.


CONCLUSIONS
We believe that new studies regarding chronic prostatitis should also be focused on prostatic stromal involvement in the inflammatory pathway.
Dellabella
Marco
M
Department of Clinic and Specialistic Sciences-Urology and Andrology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy. d.urologia@ao-umbertoprimo.marche.it
Milanese
Giulio
G
Sigala
Sandra
S
d'Anzeo
Gianluca
G
Arrighi
Nicola
N
Bodei
Serena
S
Muzzonigro
Giovanni
G
D000818:Animals; D002395:Catecholamines / Q000378:metabolism; D002908:Chronic Disease; D016208:Databases, Factual; D004967:Estrogens / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D032389:Myocytes, Smooth Muscle / Q000166:cytology / Q000502:physiology; D017699:Pelvic Pain / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011467:Prostate / Q000033:anatomy & histology / Q000473:pathology; D011472:Prostatitis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017154:Stromal Cells / Q000166:cytology / Q000502:physiology*
D002395:Catecholamines; D004967:Estrogens