eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Chronic Pelvic Pain Syndrome and Prostatodynia: Follow-up

Author: Richard A Watson, MD, Chief of Ambulatory Urology, HUMC Department of Urology, Professor of Surgery (Urology), Department of Surgery, Division of Urology, UMDNJ New Jersey Medical School, Hackensack University Medical Center
Coauthor(s): Robert J Irwin, Jr, MD, Chair, Harris L Willits Professor, Department of Surgery, Division of Urology, University Hospital, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Jul 17, 2009

Follow-up

Further Outpatient Care

  • Patients should keep a prostatodynia diary that has a page for each date, divided into 2 columns for a voiding diary and an environmental impact record.
    • In the voiding diary, (1) the time and approximate amount of each void and (2) the time and amount of each fluid intake are recorded. This record helps distinguish between urinary frequency (voiding normal amounts of urine over a 24-h period but in small, frequent voids) versus polyuria (voiding excessive amounts of urine each day overall).
      • In this light, objectively monitoring the patient's response to the advice to drink large quantities of water each day is often valuable. The general agreement is that dehydration should be avoided because good hydration contributes to overall well-being and may dilute the concentration of the urinary irritants that exacerbate symptoms of chronic pelvic pain syndrome (CPPS) type III.
      • On the other hand, advising a patient already seriously affected by excessive daytime and nocturnal frequency and urgency to maximally increase his intake of fluid seems counterintuitive.
      • While the same advice might be interpreted by one patient as meaning 1-2 qt of fluid each day, another might take it to mean 1-2 gal. Information from a voiding diary can help guide the patient safely between the Charybdis and Scylla (ie, two inevitable dangers) of too much and too little daily fluid intake.
    • In the environmental impact record, every possible incident of living, both on those days when symptoms flare up markedly and on days when symptoms are unusually quiescent, is detailed. All incidents of daily living are recorded, including but limited to, items on the following list.
      • Patients should record the type, time, and amount of food and beverage intake.
      • Patients should chart exercise performed or lack of activity, including bike riding, long car rides, and prolonged sitting or standing.
      • They should include incidents of sexual stimulation and whether or not they resulted in ejaculation.
      • They should also include a lack of sexual stimulation.
      • Patients should record any unusual physical or emotional stress.
      • Exposure to allergens such as animals, dust, or pollen can also be charted.
  • Each day, when either a marked flare-up or an unusual abatement of symptoms occurs, the patient is encouraged to complete both columns of the diary in fullest possible detail.
  • After a series of good days and bad days have been recorded, the patient can review these recordings with the physician, looking for patterns in diet, exposure, or activity that characterize either type of day.
  • The idea is to reduce factors associated with flare-ups and to maximize factors associated with relief.
  • This exercise should not be undertaken with the expectation of a cure, but rather, with the hope that clearer insight might be gained into some of the factors influencing the condition, which may provide the patient better control over this condition.

Deterrence/Prevention

  • Until the etiology of this condition is known, no specific preventative strategy is available.
  • In some cases, this condition may be caused by the sequela of sexually transmitted disease, and, if so, more vigorous treatment of the sexually transmitted disease and/or more lengthy antibiotic treatment (>4 wk) for an initial bout of acute prostatitis may reduce the percentage of cases that progress to a chronic, incurable state.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Further, remember that patients with a documented, long-standing diagnosis of prostatodynia are not exempt from the development of any of these and other serious conditions.
  • Periodically, particularly in the setting of a flare-up of symptoms, a streamlined repetition of basic screening investigations, eg, thorough physical examination with digital rectal examination of the prostate, PSA measurement, urine culture and cytology, renal and/or bladder ultrasonography or intravenous pyelography, should be judiciously undertaken.

Special Concerns

  • Prostatodynia, now termed CPPS in the male, is not a syndrome; it is not a discrete, narrowly defined constellation of consistent symptoms and objective findings ultimately traceable to a single, known etiology.
  • CPPS in the male is a catch-all category of convenience into which physicians arbitrarily group the heterogeneous admixture of male patients who meet the following 3 criteria:
    • Physicians can find no objective explanation for patients' multivariate, long-standing symptoms.
    • A significant number of patient symptoms relate to anatomical structures located within an arbitrary radius of the prostate gland (somewhere below the umbilicus and above the mid thigh).
    • Physicians can offer no satisfactory treatment, let alone a cure, for patient symptoms.
  • Ultimately, a cure for CPPS will be found by those who make distinctions among cases rather than those who place all cases into one category.
    • Clinical investigators who are able to recognize within this hapless conglomeration a discrete subset of patients whose symptoms and findings can be proven to relate to a single, common etiologic factor will achieve meaningful success in treatment.
    • Identification of that factor and development of an effective remedy will provide a cure for that particular subset of patients with CPPS.
    • In this way, multiple, individualized cures (as opposed to one cure) for CPPS will be achieved progressively for one subset of patients at a time.
  • The key to enabling this painstaking, multidirectional journey to success lies in wider encouragement and more effective funding of well-designed clinical, bench-top, and translational research projects.
  • Public awareness of the prevalence of this condition; its devastating effects in terms of personal suffering; and its remarkable financial impact in terms of work-loss, hospitalizations, polypharmacy, and seemingly endless office visits needs far greater promotion.
  • Funding for research from both private and public sectors needs to be increased.
  • The patients who experience this condition and the physicians who care for them must have the courage to be more vocal in demanding higher priority in terms of immediate care and long-term research.
 


More on Chronic Pelvic Pain Syndrome and Prostatodynia

Overview: Chronic Pelvic Pain Syndrome and Prostatodynia
Differential Diagnoses & Workup: Chronic Pelvic Pain Syndrome and Prostatodynia
Treatment & Medication: Chronic Pelvic Pain Syndrome and Prostatodynia
Follow-up: Chronic Pelvic Pain Syndrome and Prostatodynia
References
[ CLOSE WINDOW ]

References

  1. Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. Sep 2004;172(3):839-45. [Medline].

  2. Krieger JN, Riley DE. Chronic prostatitis: Charlottesville to Seattle. J Urol. Dec 2004;172(6 Pt 2):2557-60. [Medline].

  3. Cohen RJ, Shannon BA, McNeal JE, Shannon T, Garrett KL. Propionibacterium acnes associated with inflammation in radical prostatectomy specimens: a possible link to cancer evolution?. J Urol. Jun 2005;173(6):1969-74. [Medline].

  4. Soto SM, Smithson A, Martinez JA, Horcajada JP, Mensa J, Vila J. Biofilm formation in uropathogenic Escherichia coli strains: relationship with prostatitis, urovirulence factors and antimicrobial resistance. J Urol. Jan 2007;177(1):365-8. [Medline].

  5. Zermann DH, Ishigooka M, Doggweiler R. Chronic Prostatitis: a myofascial syndrome?. Infect Urol. 1999;12:82-92.

  6. Miller JL, Rothman I, Bavendam TG, Berger RE. Prostatodynia and interstitial cystitis: one and the same?. Urology. Apr 1995;45(4):587-90. [Medline].

  7. Parsons CL, Albo M. Intravesical potassium sensitivity in patients with prostatitis. J Urol. Sep 2002;168(3):1054-7. [Medline].

  8. Forrest JB, Schmidt S. Interstitial cystitis, chronic nonbacterial prostatitis and chronic pelvic pain syndrome in men: a common and frequently identical clinical entity. J Urol. Dec 2004;172(6 Pt 2):2561-2. [Medline].

  9. MacLennan GT, Eisenberg R, Fleshman RL, Taylor JM, Fu P, Resnick MI, et al. The influence of chronic inflammation in prostatic carcinogenesis: a 5-year followup study. J Urol. Sep 2006;176(3):1012-6. [Medline].

  10. Schaeffer A, Stern J. Chronic prostatitis. Clin Evid. Jun 2002;(7):788-95. [Medline].

  11. Nickel JC. Practical approach to the management of prostatitis. Tech Urol. Fall 1995;1(3):162-7. [Medline].

  12. Pansadoro V, Emiliozzi P, Defidio L, Scarpone P, Sabatini G, Brisciani A, et al. Prostate-specific antigen and prostatitis in men under fifty. Eur Urol. 1996;30(1):24-7. [Medline].

  13. Theodorou C, Konidaris D, Moutzouris G, Becopoulos T. The urodynamic profile of prostatodynia. BJU Int. Sep 1999;84(4):461-3. [Medline].

  14. Smart CJ, Jenkins JD, Lloyd RS. The painful prostate. Br J Urol. 1975;47(7):861-9. [Medline].

  15. Davis BE, Weigel JW. Adenocarcinoma of the prostate discovered in 2 young patients following total prostatovesiculectomy for refractory prostatitis. J Urol. Sep 1990;144(3):744-5. [Medline].

  16. Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. Oct 2006;176(4 Pt 1):1534-8; discussion 1538-9. [Medline].

  17. Sadeghi-Nejad H, Seftel A. Sexual dysfunction and prostatitis. Curr Urol Rep. Nov 2006;7(6):479-84. [Medline].

  18. Kaplan SA, Santarosa RP, D'Alisera PM, Fay BJ, Ikeguchi EF, Hendricks J, et al. Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. J Urol. Jun 1997;157(6):2234-7. [Medline].

  19. Meares EM Jr. Prostatitis. Med Clin North Am. Mar 1991;75(2):405-24. [Medline].

  20. Meares EM Jr. Non-specific infections of the genitourinary tract. In: Tanagho EH, McAninch JW, eds. Smith's General Urology. 14th ed. Appleton & Lange: Norwalk, Conn; 1995:231-4.

  21. Meares EM Jr. Prostatitis and related disorders. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:285-6.

  22. Lee JC, Muller CH, Rothman I, Agnew KJ, Eschenbach D, Ciol MA, et al. Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls. J Urol. Feb 2003;169(2):584-7; discussion 587-8. [Medline].

  23. Lowentritt JE, Kawahara K, Human LG, Hellstrom WJ, Domingue GJ. Bacterial infection in prostatodynia. J Urol. Oct 1995;154(4):1378-81. [Medline].

  24. Taylor BC, Noorbaloochi S, McNaughton-Collins M, Saigal CS, Sohn MW, Pontari MA. Excessive antibiotic use in men with prostatitis. Am J Med. May 2008;121(5):444-9. [Medline].

  25. Berger R. Editorial comment: Urological survey--infection and inflammation in the genitourinary tract. J Urol. Jan 2009;181:135.

  26. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. Mar 1998;159(3):883-7. [Medline].

  27. Arakawa S, Matsui T, Gohji K, Okada H, Kamidono S. Prostatitis--the Japanese viewpoint. Int J Antimicrob Agents. May 1999;11(3-4):201-3; discussion 213-6. [Medline].

  28. Atilla MK, Sargin H, Odabas O, Yilmaz Y, Aydin S. Evaluation of 42 patients with chronic abacterial prostatitis: are there any underlying correctable pathologies?. Int Urol Nephrol. 1998;30(4):463-9. [Medline].

  29. Domingue GJ Sr, Hellstrom WJ. Prostatitis. Clin Microbiol Rev. Oct 1998;11(4):604-13. [Medline].

  30. Egan KJ, Krieger JL. Chronic abacterial prostatitis--a urological chronic pain syndrome?. Pain. Feb 1997;69(3):213-8. [Medline].

  31. Hanno P. Take Home Messages: Prostatitis. In: AUA News. Baltimore, Md: American Urological Association;. June-July 2001;6(4):5.

  32. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. Jul 21 1999;282(3):236-7. [Medline].

  33. Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. Aug 1999;162(2):369-75. [Medline].

  34. Luzzi G, O'Leary M. Chronic pelvic pain syndrome. BMJ. May 8 1999;318(7193):1227-8. [Medline].

  35. Nickel JC. A new era in prostatitis research begins. Rev Urol. 2000;2(1):16-8. [Medline].

  36. Nickel JC. Effective office management of chronic prostatitis. Urol Clin North Am. Nov 1998;25(4):677-84. [Medline].

  37. Nickel JC. Prostatitis: myths and realities. Urology. Mar 1998;51(3):362-6. [Medline].

  38. Nickel JC, Alexander R, Anderson R, Krieger J, Moon T, Neal D, et al. Prostatitis unplugged? Prostatic massage revisited. Tech Urol. Mar 1999;5(1):1-7. [Medline].

  39. Nickel JC, Nigro M, Valiquette L, Anderson P, Patrick A, Mahoney J, et al. Diagnosis and treatment of prostatitis in Canada. Urology. Nov 1998;52(5):797-802. [Medline].

  40. [Guideline] Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology. Aug 1999;54(2):229-33. [Medline].

  41. Perry JD. When is prostatitis NOT prostatitis? When the diagnosis is made by a physiotherapist. Biofeedback Newsmagazine. 1999;27:24. [Full Text].

  42. Schaeffer AJ. Editorial: Emerging concepts in the management of prostatitis/chronic pelvic pain syndrome. J Urol. Feb 2003;169(2):597-8. [Medline].

  43. Schaeffer AJ. Prostatitis: US perspective. Int J Antimicrob Agents. May 1999;11(3-4):205-11; discussion 213-6. [Medline].

  44. Schaeffer AJ. Prostatitis: US perspective. Int J Antimicrob Agents. May 1998;10(2):153-9. [Medline].

  45. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol. Sep 2002;168(3):1048-53. [Medline].

  46. Szoke I, Torok L, Dosa E, Nagy E, Scultety S. The possible role of anaerobic bacteria in chronic prostatitis. Int J Androl. Jun 1998;21(3):163-8. [Medline].

  47. True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol. Dec 1999;162(6):2014-8. [Medline].

  48. Yavasçaoglu I, Oktay B, Simsek U, Ozyurt M. Role of ejaculation in the treatment of chronic non-bacterial prostatitis. Int J Urol. Mar 1999;6(3):130-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

prostatodynia, prostatalgia, nonbacterial prostatitis, prostatitis, chronic pelvic pain syndrome, CPPS, enlarged prostate, swollen prostate, chronic prostatitis, prostate pain, chronic voiding symptoms, irritative voiding, obstructive voiding, erectile dysfunction, ED, Ureaplasma urealyticum, U urealyticum, Chlamydia trachomatis, C trachomatis, myofascial pain syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Richard A Watson, MD, Chief of Ambulatory Urology, HUMC Department of Urology, Professor of Surgery (Urology), Department of Surgery, Division of Urology, UMDNJ New Jersey Medical School, Hackensack University Medical Center
Richard A Watson, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Urological Association, Association of Military Surgeons of the US, and Society of University Urologists
Disclosure: Nothing to disclose.

Coauthor(s)

Robert J Irwin, Jr, MD, Chair, Harris L Willits Professor, Department of Surgery, Division of Urology, University Hospital, University of Medicine and Dentistry of New Jersey
Robert J Irwin, Jr, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.