title: Minimally invasive therapies for chronic pelvic pain syndrome.
abstract: Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial cystitis/painful bladder syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis or treatment of CPPS. The diagnosis is often challenging and is determined by elimination. Multiple treatment modalities exist, ranging from physical therapy to surgery. We discuss minimally invasive therapies for treatment of this complex of symptoms. Although data suggest reasonable efficacy of several medications, multimodal therapy remains the mainstay of treatment. We review the following minimally invasive therapeutic modalities: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation. We report data supporting their use and efficacy and highlight the limitations of each.
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, 207 North Broad Street, 4th Floor, Philadelphia, PA 19107, USA. swehbe@drexelmed.edu
authors.forename: Salim A
authors.initials: SA
authors.lastname: Wehbe
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Fariello
authors.forename: Kristene
authors.initials: K
authors.lastname: Whitmore
mesh_terms: D004599:Electric Stimulation Therapy; D006801:Humans; D008297:Male; D026441:Mind-Body Therapies; D026741:Physical Therapy Modalities; D011472:Prostatitis / Q000188:drug therapy / Q000628:therapy*
references.citation: Am Fam Physician. 2001 Oct 1;64(7):1199-206
references.pmid: 11601802
references.citation: Urology. 2007 Apr;69(4 Suppl):60-3
references.pmid: 17462482
references.citation: J Urol. 2005 Jun;173(6):2044-7
references.pmid: 15879822
references.citation: J Urol. 2003 Apr;169(4):1369-73
references.pmid: 12629364
references.citation: Am Fam Physician. 2001 Apr 15;63(8):1535-44
references.pmid: 11327429
references.citation: Urology. 1999 Dec;54(6):960-3
references.pmid: 10604689
references.citation: Urology. 2007 Apr;69(4 Suppl):24-33
references.pmid: 17462476
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):9-14
references.pmid: 11294536
references.citation: Urology. 2005 Apr;65(4):633-8
references.pmid: 15833497
references.citation: Prostate Cancer Prostatic Dis. 2006;9(3):261-5
references.pmid: 16683008
references.citation: Pain. 2001 Apr;91(3):297-306
references.pmid: 11275387
references.citation: J Urol. 2005 May;173(5):1590-4
references.pmid: 15821499
references.citation: Spine (Phila Pa 1976). 2000 Oct 15;25(20):2688-99
references.pmid: 11034658
references.citation: Urology. 2003 Jun;61(6):1156-9; discussion 1159
references.pmid: 12809886
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006113
references.pmid: 17943887
references.citation: Neurotherapeutics. 2008 Jan;5(1):107-13
references.pmid: 18164489
references.citation: BJU Int. 2001 Jul;88(1):35-8
references.pmid: 11446842
references.citation: Obstet Gynecol. 2006 Oct;108(4):915-23
references.pmid: 17012454
references.citation: J Urol. 2001 Dec;166(6):2226-31
references.pmid: 11696740
references.citation: Urology. 2007 Apr;69(4 Suppl):73-81
references.pmid: 17462484
references.citation: Pain. 2007 Nov;132 Suppl 1:S117-S123
references.pmid: 17689866
references.citation: J Urol. 2007 Jan;177(1):25-30
references.pmid: 17161995
references.citation: Urology. 1997 May;49(5A Suppl):108-10
references.pmid: 9146011
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2003 Nov;14(5):305-8; discussion 308-9
references.pmid: 14618305
references.citation: J Urol. 2001 Nov;166(5):1742-5
references.pmid: 11586214
references.citation: Urology. 2004 Nov;64(5):862-5
references.pmid: 15533464
references.citation: Aliment Pharmacol Ther. 2009 May 1;29(9):985-91
references.pmid: 19222415
references.citation: J Urol. 2003 Sep;170(3):816-7
references.pmid: 12913706
references.citation: J Urol. 2008 Feb;179(2):556-60
references.pmid: 18082223
references.citation: Curr Urol Rep. 2000 Aug;1(2):155-8
references.pmid: 12084330
references.citation: Drugs. 2009;69(1):71-84
references.pmid: 19192937
references.citation: J Urol. 2003 Apr;169(4):1401-5
references.pmid: 12629372
references.citation: Urology. 2009 Apr;73(4):743-6
references.pmid: 19193408
references.citation: Dis Colon Rectum. 1997 Feb;40(2):187-9
references.pmid: 9075755
references.citation: Curr Urol Rep. 2009 Jul;10(4):307-12
references.pmid: 19570493
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2003 Oct;14(4):223-8; discussion 228
references.pmid: 14530831
references.citation: Urology. 1987 Aug;30(2):183-8
references.pmid: 3497475
references.citation: Eur Urol. 2010 Jan;57(1):35-48
references.pmid: 19733958
references.citation: Clin J Pain. 2004 Jan-Feb;20(1):27-32
references.pmid: 14668653
references.citation: Neurourol Urodyn. 2006;25(1):46-9
references.pmid: 16167354
references.citation: Dis Colon Rectum. 1993 Feb;36(2):139-45
references.pmid: 8425417
references.citation: BJU Int. 2004 Apr;93(6):777-9
references.pmid: 15049989
references.citation: J Urol. 2001 Nov;166(5):1734-7
references.pmid: 11586212
references.citation: Urology. 2007 Apr;69(4 Suppl):48-52
references.pmid: 17462479
references.citation: Int Urogynecol J. 2010 May;21(5):613-6
references.pmid: 20012596
references.citation: BJU Int. 2009 Apr;103(7):910-8
references.pmid: 19021619
references.citation: J Urol. 2006 Dec;176(6 Pt 1):2375-82
references.pmid: 17085104
references.citation: Rev Urol. 2002;4 Suppl 1:S16-20
references.pmid: 16986029
references.citation: Br J Urol. 1993 Apr;71(4):433-8
references.pmid: 8499988
references.citation: World J Urol. 2003 Jun;21(2):64-9
references.pmid: 12774174
references.citation: Int J Urol. 2004 Aug;11(8):607-12
references.pmid: 15285750
references.citation: J Urol. 2002 Dec;168(6):2467-71
references.pmid: 12441942
references.citation: J Urol. 2008 Jan;179(1):177-85
references.pmid: 18001798
references.citation: Ann Intern Med. 2004 Oct 19;141(8):581-9
references.pmid: 15492337
references.citation: Neurourol Urodyn. 2005;24(7):643-7
references.pmid: 16178000
references.citation: J Urol. 2005 Apr;173(4):1252-5
references.pmid: 15758763
references.citation: Am J Med. 2008 Jan;121(1):79.e1-7
references.pmid: 18187077
references.citation: J Urol. 2005 Mar;173(3):841-3; discussion 843
references.pmid: 15711286
references.citation: Expert Opin Pharmacother. 2008 Dec;9(17):2979-94
references.pmid: 19006474
references.citation: Neurourol Urodyn. 2007;26(1):59-62
references.pmid: 17195176
references.citation: Eur Urol. 2004 Jan;45(1):65-9
references.pmid: 14667518
references.citation: J Urol. 2006 Aug;176(2):838
references.pmid: 16813957
references.citation: Neurourol Urodyn. 2005;24(3):226-30
references.pmid: 15825153
references.citation: Drugs. 2006;66(6):821-35
references.pmid: 16706553
references.citation: J Urol. 2001 Mar;165(3):884-6
references.pmid: 11176493
references.citation: J Urol. 2009 Aug;182(2):570-80
references.pmid: 19535099
references.citation: Rev Urol. 2007 Spring;9(2):63-72
references.pmid: 17592539
references.citation: Urology. 2009 May;73(5):1036-41
references.pmid: 19394499
references.citation: Spine (Phila Pa 1976). 2002 Nov 15;27(22):2564-73
references.pmid: 12435995
references.citation: Pain. 1991 Apr;45(1):29-34
references.pmid: 1830646
references.citation: J Urol. 2001 Mar;165(3):842-5
references.pmid: 11176483
references.citation: Dis Colon Rectum. 2000 Sep;43(9):1288-91
references.pmid: 11005499
references.citation: Scand J Urol Nephrol. 2005;39(1):73-7
references.pmid: 15764276