title: Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.
abstract: BACKGROUND
  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy.
  
  
  OBJECTIVE
  A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management.
  
  
  METHODS
  Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS.
  
  
  RESULTS
  Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management.
  
  
  CONCLUSIONS
  Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a monotherapy for management. No efficient monotherapeutic option is available. The best evidence-based management of CP/CPPS strongly suggests a multimodal therapeutic approach addressing the individual clinical phenotypic profile.
  
  
  RESULTS
  Chronic prostatitis/chronic pelvic pain syndrome presents a variable syndrome. Successful management of this condition is challenging. It appears that a tailored treatment strategy addressing individual patient characteristics is more effective than one single therapy.
authors.affiliation: Department of Urology, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany. Electronic address: giuseppe.magistro@med.uni-muenchen.de.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magistro
authors.affiliation: Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Florian M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Grabe
authors.affiliation: Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weidner
authors.affiliation: Department of Urology, Campus Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Urology, Queen's University, Kingston, Ontario, Canada.
authors.forename: J Curtis
authors.initials: JC
authors.lastname: Nickel
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000628:therapy*; D026741:Physical Therapy Modalities; D008517:Phytotherapy; D011472:Prostatitis / Q000175:diagnosis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D063189:Symptom Assessment; D013577:Syndrome
chemical_list: D000317:Adrenergic alpha-Antagonists; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D018377:Neurotransmitter Agents
keywords: Chronic pelvic pain syndrome; Chronic prostatitis; Monotherapies; Phenotypically directed multimodal management