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Chronic Pelvic Pain Syndromes in Males

  • Chapter
The Overactive Pelvic Floor

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Abstract

Chronic pelvic pain syndromes affect both genders and usually present as a complex challenging diagnostic and therapeutic dilemma.

The most common syndrome in men is Chronic Prostatitis/Chronic Pelvic Pain syndrome (CP/CPPS). It is one of the most common urologic diagnoses in men. Patients often present with a complex symptoms that impact on quality of life. The etiology of this problem remains poorly understood.

No single therapy has been clearly shown to be effective for CP/CPPS. A multimodal approach that combines both pharmacologic and non-pharmacologic treatments is most likely to provide positive outcome.

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References

  1. McNaughton Collins M, Barry MJ. Epidemiology of chronic prostatitis. Curr Opin Urol. 1998;8:33–7.

    Article  CAS  PubMed  Google Scholar 

  2. Marszalek M, Wehrberger C, Hochreiter W, Temml C, Madersbacher S. Symptoms suggestive of chronic pelvic pain syndrome in an urban population: prevalence and associations with lower urinary tract symptoms and erectile function. J Urol. 2007;177:1815–9.

    Article  PubMed  Google Scholar 

  3. Clemens JQ, Meenan RT, O’Keeffe-Rosetti MC, et al. Prevalence of prostatitis-like symptoms in a managed care population. J Urol. 2006;176:593–6.

    Article  PubMed  Google Scholar 

  4. McNeal JE. The prostate and prostatic urethra: a morphologic synthesis. J Urol. 1972;107:1008–16.

    CAS  PubMed  Google Scholar 

  5. McNeal JE. Normal histology of the prostate. Am J Surg Pathol. 1988;12:619–33.

    Article  CAS  PubMed  Google Scholar 

  6. Myers RP. Radical prostatectomy: pertinent surgical anatomy. Atlas Urol Clin North Am. 1994;2:1–18.

    Google Scholar 

  7. Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate. 1983;4:473–85.

    Article  CAS  PubMed  Google Scholar 

  8. Burnett AL. Nitric oxide control of lower genitourinary tract functions: a review. Urology. 1995;45:1071–83.

    Article  CAS  PubMed  Google Scholar 

  9. Tauber PF, Zaneveld LJ, Propping D, Schumacher GF. Components of human split ejaculates. I. Spermatozoa, fructose, immunoglobulins, albumin, lactoferrin, transferrin and other plasma proteins. J Reprod Fertil. 1975;43:249–67.

    Article  CAS  PubMed  Google Scholar 

  10. Armbruster DA. Prostate-specific antigen: biochemistry, analytical methods, and clinical application. Clin Chem. 1993;39:181–95.

    CAS  PubMed  Google Scholar 

  11. Lilja H. A kallikrein-like serine protease in prostatic fluid cleaves the predominant seminal vesicle protein. J Clin Invest. 1985;76:1899–903.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968;5:492–518.

    CAS  PubMed  Google Scholar 

  13. Drach GW, Fair WR, Meares EM, Stamey TA. Classification of benign diseases associated with prostatic pain: prostatitis or prostatodynia? J Urol. 1978;120:266.

    CAS  PubMed  Google Scholar 

  14. Moon TD. Questionnaire survey of urologists and primary care physicians’ diagnostic and treatment practices for prostatitis. Urology. 1997;50:543–7.

    Article  CAS  PubMed  Google Scholar 

  15. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med. 2000;133:367–81.

    Article  CAS  PubMed  Google Scholar 

  16. Nickel JC. Prostatitis: myths and realities. Urology. 1998;51:362–6.

    Article  CAS  PubMed  Google Scholar 

  17. Krieger JN, Nyberg Jr L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7.

    Article  CAS  PubMed  Google Scholar 

  18. Nickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997;3:38–43.

    CAS  PubMed  Google Scholar 

  19. Maeda H, Toyooka N, Kinukawa T, Hattori R, Furukawa T. Magnetic resonance images of hematospermia. Urology. 1993;41:499–504.

    Article  CAS  PubMed  Google Scholar 

  20. Somford DM, Fütterer JJ, Hambrock T, Barentsz JO. Diffusion and perfusion MR imaging of the prostate. Magn Reson Imaging Clin N Am. 2008;16:685–95.

    Article  PubMed  Google Scholar 

  21. Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics. 2011;31:677–703.

    Article  PubMed Central  PubMed  Google Scholar 

  22. 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;30:463–9.

    Article  CAS  PubMed  Google Scholar 

  23. Weidner W, Schiefer HG, Krauss H, Jantos C, Friedrich HJ, Altmannsberger M. Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1,461 patients. Infection. 1991;19 Suppl 3:S119–25.

    Article  PubMed  Google Scholar 

  24. Schneider H, Ludwig M, Hossain HM, Diemer T, Weidner W. The 2001 Giessen Cohort Study on patients with Prostatitis syndrome—an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis. Andrologia. 2003;35:258–62.

    CAS  PubMed  Google Scholar 

  25. Bergman B. On the relevance of gram-positive bacteria in prostatitis. Infection. 1994;22 Suppl 1:S22.

    Article  PubMed  Google Scholar 

  26. Szöke I, Török L, Dósa E, Nagy E, Scultéty S. The possible role of anaerobic bacteria in chronic prostatitis. Int J Androl. 1998;21:163–8.

    Article  PubMed  Google Scholar 

  27. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006;355:1690–8.

    Article  CAS  PubMed  Google Scholar 

  28. Ludwig M, Weidner W, Schroeder-Printzen I, Zimmermann O, Ringert RH. Transrectal prostatic sonography as a useful diagnostic means for patients with chronic prostatitisor prostatodynia. Br J Urol. 1994;73:664–8.

    Article  CAS  PubMed  Google Scholar 

  29. Krieger JN, Egan KJ, Ross SO, Jacobs R, Berger RE. Chronic pelvic pains represent the most prominent urogenital symptoms of “chronic prostatitis”. Urology. 1996;48:715–21.

    Article  CAS  PubMed  Google Scholar 

  30. Shoskes DA, Landis JR, Wang Y, Nickel JC, Zeitlin SI, Nadler R. Impact of post-ejaculatory pain in men with category III chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2004;172:542–7.

    Article  PubMed  Google Scholar 

  31. Shoskes DA, Berger R, Elmi A, Landis JR, Propert KJ, Zeitlin S. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179:556–60.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Lee SW, Liong ML, Yuen KH, Leong WS, Cheah PY, Khan NA, et al. Adverse impact of sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. Urology. 2008;71:79–84.

    Article  PubMed  Google Scholar 

  33. Davis SN, Binik YM, Carrier S. Sexual dysfunction and pelvic pain in men: a male sexual pain disorder? J Sex Marital Ther. 2009;35:182–205.

    Article  PubMed  Google Scholar 

  34. Liang CZ, Hao ZY, Li HJ, Wang ZP, Xing JP, Hu WL, et al. Prevalence of premature ejaculation and its correlation with chronic prostatitis in Chinese men. Urology. 2010;76:962–6.

    Article  PubMed  Google Scholar 

  35. Wenninger K, Heiman JR, Rothman I, Berghuis JP, Berger RE. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol. 1996;155:965–8.

    Article  CAS  PubMed  Google Scholar 

  36. Turner JA, Hauge S, Von Korff M, Saunders K, Lowe M, Berger R. Primary care and urology patients with the male pelvic pain syndrome: symptoms and quality of life. J Urol. 2002;167:1768–73.

    Article  PubMed  Google Scholar 

  37. Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, et al. Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain. 2006;7:697–708.

    Article  PubMed  Google Scholar 

  38. Miller HC. Stress prostatitis. Urology. 1988;32:507–10.

    Article  CAS  PubMed  Google Scholar 

  39. Litwin MS, McNaughton-Collins M, Fowler Jr FJ, 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. 1999;162:369–75.

    Article  CAS  PubMed  Google Scholar 

  40. Propert KJ, Litwin MS, Wang Y, Alexander RB, Calhoun E, Nickel JC, et al; Chronic Prostatitis Collaborative Research Network (CPCRN). Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res. 2006;15:299–305.

    Google Scholar 

  41. 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. 1999;54:229–33.

    Article  CAS  PubMed  Google Scholar 

  42. Kohnen PW, Drach GW. Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Urol. 1979;121:755–60.

    CAS  PubMed  Google Scholar 

  43. Peeling WB, Griffiths GJ. Imaging of the prostate by ultrasound. J Urol. 1984;132:217–24.

    CAS  PubMed  Google Scholar 

  44. Eykyn S, Bultitude MI, Mayo ME, Lloyd-Davies RW. Prostatic calculi as a source of recurrent bacteriuria in the male. Br J Urol. 1974;46:527–32.

    Article  CAS  PubMed  Google Scholar 

  45. Nickel JC. Prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell Walsh urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 330–1.

    Google Scholar 

  46. Sutor DJ, Wooley SE. The crystalline composition of prostatic calculi. Br J Urol. 1974;46:533–5.

    Article  CAS  PubMed  Google Scholar 

  47. Meares Jr EM. Acute and chronic prostatitis: diagnosis and treatment. Infect Dis Clin North Am. 1987;1:855–73.

    PubMed  Google Scholar 

  48. Berger RE, Krieger JN, Kessler D, Ireton RC, Close C, Holmes KK, et al. Case-control study of men with suspected chronic idiopathic prostatitis. J Urol. 1989;141:328–31.

    CAS  PubMed  Google Scholar 

  49. Berger RE, Alexander ER, Harnisch JP, Paulsen CA, Monda GD, Ansell J, et al. Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases. J Urol. 1979;121:750–4.

    CAS  PubMed  Google Scholar 

  50. Mårdh PA, Ripa KT, Colleen S, Treharne JD, Darougar S. Role of Chlamydia trachomatis in non-acute prostatitis. Br J Vener Dis. 1978;54:330–4.

    PubMed Central  PubMed  Google Scholar 

  51. Doble A, Thomas BJ, Walker MM, Harris JR, Witherow RO, Taylor-Robinson D. The role of Chlamydia trachomatis in chronic abacterial prostatitis: a study using ultrasound guided biopsy. J Urol. 1989;141:332–3.

    CAS  PubMed  Google Scholar 

  52. Shortliffe LM, Sellers RG, Schachter J. The characterization of nonbacterial prostatitis: search for an etiology. J Urol. 1992;148:1461–6.

    CAS  PubMed  Google Scholar 

  53. Kaplan SA, Te AE, Jacobs BZ. Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol. 1994;152:2063–5.

    CAS  PubMed  Google Scholar 

  54. 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. 1997;157:2234–7.

    Article  CAS  PubMed  Google Scholar 

  55. Hruz P, Danuser H, Studer UE, Hochreiter WW. Non-inflammatory chronic pelvic pain syndrome can be caused by bladder neck hypertrophy. Eur Urol. 2003;44:106–10.

    Article  PubMed  Google Scholar 

  56. Persson BE, Ronquist G. Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol. 1996;155:958–60.

    Article  CAS  PubMed  Google Scholar 

  57. Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE. Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol. 1982;54:729–31.

    Article  CAS  PubMed  Google Scholar 

  58. Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM. Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. 2007;70:235–8.

    Article  PubMed  Google Scholar 

  59. Mehik A, Hellström P, Nickel JC, Kilponen A, Leskinen M, Sarpola A, et al. The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements. J Urol. 2002;167:137–40.

    Article  PubMed  Google Scholar 

  60. Shoskes DA, Albakri Q, Thomas K, Cook D. Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol. 2002;168:331–5.

    Article  CAS  PubMed  Google Scholar 

  61. Nadler RB, Koch AE, Calhoun EA, Campbell PL, Pruden DL, Bennett CL, et al. IL-1beta and TNF-alpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol. 2000;164:214–8.

    Article  CAS  PubMed  Google Scholar 

  62. Penna G, Mondaini N, Amuchastegui S, Degli Innocenti S, Carini M, et al. Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol. 2007;51:524–33.

    Article  CAS  PubMed  Google Scholar 

  63. Batstone GR, Doble A. Chronic prostatitis. Curr Opin Urol. 2003;13:23–9.

    Article  PubMed  Google Scholar 

  64. Ponniah S, Arah I, Alexander RB. PSA is a candidate self-antigen in autoimmune chronic prostatitis/chronic pelvic pain syndrome. Prostate. 2000;44:49–54.

    Article  CAS  PubMed  Google Scholar 

  65. Doble A, Walker MM, Harris JR, Taylor-Robinson D, Witherow RO. Intraprostatic antibody deposition in chronic abacterial prostatitis. Br J Urol. 1990;65:598–605.

    Article  CAS  PubMed  Google Scholar 

  66. Clemens JQ, Brown SO, Calhoun EA. Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronicprostatitis/chronic pelvic pain syndrome: a case/control study. J Urol. 2008;180:1378–82.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V. Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2008;179:956–60.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Berghuis JP, Heiman JR, Rothman I, Berger RE. Psychological and physical factors involved in chronic idiopathic prostatitis. J Psychosom Res. 1996;41:313–25.

    Article  CAS  PubMed  Google Scholar 

  69. Egan KJ, Krieger JN. Psychological problems in chronic prostatitis patients with pain. Clin J Pain. 1994;10:218–26.

    Article  CAS  PubMed  Google Scholar 

  70. Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O’Leary MP, Pontari MA, Fowler Jr JE, Nyberg LM, Kusek JW, National Institutes of Health-Chronic Prostatitis Collaborative Research Network (NIH-CPCRN) Study Group. Catastrophizing and pain-contingent rest predict patient adjustment in men with chronicprostatitis/chronic pelvic pain syndrome. Pain. 2006;7:697–708.

    Article  Google Scholar 

  71. Tripp DA, Curtis Nickel J, Landis JR, Wang YL, Knauss JS, CPCRN Study Group. Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study. BJU Int. 2004;94:1279–82.

    Article  PubMed  Google Scholar 

  72. Meares Jr EM. Prostatodynia—clinical findings and rational for treatment. In: Weidner W, Brunner H, Krause W, Rothauge CF, editors. Therapy of prostatitis. Munich: W. Zuckschwerdt Verlag; 1986. p. 207–12.

    Google Scholar 

  73. Meares Jr EM. Prostatitis syndromes: new perspectives about old woes. J Urol. 1980;123:141–7.

    PubMed  Google Scholar 

  74. Baert L, Leonard A. Chronic bacterial prostatitis: 10 years of experience with local antibiotics. J Urol. 1988;140:755–7.

    CAS  PubMed  Google Scholar 

  75. Naber KG. Use of quinolones in urinary tract infections and prostatitis. Rev Infect Dis. 1989;11:1321–37.

    Article  Google Scholar 

  76. Wolfson JS, Hooper DC. Fluoroquinolone antimicrobial agents. Clin Microbiol Rev. 1989;2:378–424.

    PubMed Central  CAS  PubMed  Google Scholar 

  77. Sabbaj J, Hoagland VL, Cook T. Norfloxacin versus co-trimoxazole in the treatment of recurring urinary tract infections in men. Scand J Infect Dis Suppl. 1986;48:48–53.

    CAS  PubMed  Google Scholar 

  78. Guibert J, Destrée D, Konopka C, Acar J. Ciprofloxacin in the treatment of urinary tract infection due to enterobacteria. Eur J Clin Microbiol. 1986;5:247–8.

    Article  CAS  PubMed  Google Scholar 

  79. Naber KG, Roscher K, Botto H, Schaefer V. Oral levofloxacin 500 mg once daily in the treatment of chronic bacterial prostatitis. Int J Antimicrob Agents. 2008;32:145–53.

    Article  CAS  PubMed  Google Scholar 

  80. Weidner W, Schiefer HG, Dalhoff A. Treatment of chronic bacterial prostatitis with ciprofloxacin. Results of a one-year follow-up study. Am J Med. 1987;82:280–3.

    CAS  PubMed  Google Scholar 

  81. Meares EM. Prostatitis and related disorders. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campbell’s urology. 7th ed. Philadelphia: W.B. Saunders; 1998. p. 623.

    Google Scholar 

  82. Blacklock NJ. Anatomical factors in prostatitis. Br J Urol. 1974;46:47–54.

    Article  CAS  PubMed  Google Scholar 

  83. Weidner W. Prostatitis-diagnostic criteria, classification of patients and recommendations for therapeutic trials. Infection. 1992;20 Suppl 3:227–31.

    Article  Google Scholar 

  84. Nickel JC. Special Report on Prostatitis: State of the Art: Highlights of the Third Annual International Prostatitis Collaborative Network Meeting October 23–25, 2000, Washington, DC. Rev Urol. 2001;3:94–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  85. Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J, et al. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology. 2003;62:614–7.

    Article  PubMed  Google Scholar 

  86. Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O’Leary MP, et al; Chronic Prostatitis Collaborative Research Network. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med. 2004;141:581–9.

    Google Scholar 

  87. Neal Jr DE, Moon TD. Use of terazosin in prostatodynia and validation of a symptom score questionnaire. Urology. 1994;43:460–5.

    Article  PubMed  Google Scholar 

  88. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. 1998;159:883–7.

    Article  CAS  PubMed  Google Scholar 

  89. Mehik A, Alas P, Nickel JC, Sarpola A, Helström PJ. Alfuzosin treatment for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, double-blind, placebo-controlled, pilot study. Urology. 2003;62:425–9.

    Article  PubMed  Google Scholar 

  90. Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, et al; Chronic Prostatitis Collaborative Research Network. Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med. 2008;359:2663–73.

    Google Scholar 

  91. Canale D, Scaricabarozzi I, Giorgi P, Turchi P, Ducci M, Menchini-Fabris GF. Use of a novel non-steroidal anti-inflammatory drug, nimesulide, in the treatment of abacterial prostatovesiculitis. Andrologia. 1993;25:163–6.

    Article  CAS  PubMed  Google Scholar 

  92. Bates SM, Hill VA, Anderson JB, Chapple CR, Spence R, Ryan C, et al. A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2007;99:355–9.

    Article  CAS  PubMed  Google Scholar 

  93. Nickel JC, Pontari M, Moon T, Gittelman M, Malek G, Farrington J, et al; Rofecoxib Prostatitis Investigator Team. A randomized, placebo controlled, multicenter study to evaluate the safety and efficacy of rofecoxibin the treatment of chronic nonbacterial prostatitis. J Urol. 2003;169:1401–5.

    Google Scholar 

  94. Osborn DE, George NJ, Rao PN, Barnard RJ, Reading C, Marklow C, et al. Prostatodynia–physiological characteristics and rational management with muscle relaxants. Br J Urol. 1981;53:621–3.

    Article  CAS  PubMed  Google Scholar 

  95. Simmons PD, Thin RN. Minocycline in chronic abacterial prostatitis: a double-blind prospective trial. Br J Urol. 1985;57:43–5.

    Article  CAS  PubMed  Google Scholar 

  96. Leskinen M, Lukkarinen O, Marttila T. Effects of finasteride in patients with inflammatory chronic pelvic pain syndrome: a double-blind, placebo-controlled, pilot study. Urology. 1999;53:502–5.

    Article  CAS  PubMed  Google Scholar 

  97. Nickel JC, Downey J, Pontari MA, Shoskes DA, Zeitlin SI. A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int. 2004;93:991–5.

    Article  CAS  PubMed  Google Scholar 

  98. De Rose AF, Gallo F, Giglio M, Carmignani G. Role of mepartricin in category III chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized prospective placebo-controlled trial. Urology. 2004;63:13–6.

    Article  PubMed  Google Scholar 

  99. Hennenfent BR, Feliciano AE. Changes in white blood cell counts in men undergoing thrice-weekly prostatic massage, microbial diagnosis and antimicrobial therapy for genitourinary complaints. Br J Urol. 1998;81:370–6.

    Article  CAS  PubMed  Google Scholar 

  100. Mishra VC, Browne J, Emberton M. Role of repeated prostatic massage in chronic prostatitis: a systematic review of the literature. Urology. 2008;72:731–5.

    Article  PubMed  Google Scholar 

  101. Shoskes DA, Zeitlin SI. Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer Prostatic Dis. 1999;2:159–62.

    Article  PubMed  Google Scholar 

  102. Ateya A, Fayez A, Hani R, Zohdy W, Gabbar MA, Shamloul R. Evaluation of prostatic massage in treatment of chronic prostatitis. Urology. 2006;67:674–8.

    Article  PubMed  Google Scholar 

  103. Yavascaoglu I, Oktay B, Simşek U, Ozyurt M. Role of ejaculation in the treatment of chronic non-bacterial prostatitis. Int J Urol. 1999;6:130–4.

    Article  CAS  PubMed  Google Scholar 

  104. Anderson RU, Sawyer T, Wise D, Morey A, Nathanson BH. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2009;182:2753–8.

    Article  PubMed  Google Scholar 

  105. Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174:155–60.

    Article  PubMed  Google Scholar 

  106. Cornel EB, van Haarst EP, Schaarsberg RW, Geels J. The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III. Eur Urol. 2005;47:607–11.

    Article  PubMed  Google Scholar 

  107. Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brähler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56:544–51.

    Article  PubMed  Google Scholar 

  108. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999;54:960–3.

    Article  CAS  PubMed  Google Scholar 

  109. Iglesias-Gato D, Carsten T, Vesterlund M, Pousette A, Schoop R, Norstedt G. Androgen-independent effects of Serenoa repens extract (prostasan®) on prostatic epithelial cell proliferation and inflammation. Phytother Res. 2012;26:259–64.

    Article  PubMed  Google Scholar 

  110. Djavan B, Fong YK, Chaudry A, Reissigl A, Anagnostou T, Bagheri F, et al. Progression delay in men with mild symptoms of bladder outlet obstruction: a comparative study of phytotherapy and watchful waiting. World J Urol. 2005;23:253–6.

    Article  PubMed  Google Scholar 

  111. Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004;172:839–45.

    Article  PubMed Central  PubMed  Google Scholar 

  112. Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, et al; Chronic Prostatitis Collaborative Research Network-2. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010;170:1586–93.

    Google Scholar 

  113. Yang CC. Neuromodulation in male chronic pelvic pain syndrome: rationale and practice. World J Urol. 2013;31:767–72.

    Article  PubMed Central  PubMed  Google Scholar 

  114. Kabay S, Kabay SC, Yucel M, Ozden H. Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: a sham-controlled comparative study. Urol Int. 2009;83:33–8.

    Article  PubMed  Google Scholar 

  115. Zabihi N, Mourtzinos A, Maher MG, et al. Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful bladder syndrome, and chronic pelvic pain. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:553–7.

    Article  PubMed  Google Scholar 

  116. Chen R, Nickel JC. Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. 2003;61:1156–9.

    Article  PubMed  Google Scholar 

  117. Herati AS, Shorter B, Srinivasan AK, Tai J, Seideman C, Lesser M, Moldwin RM. Effects of foods and beverages on the symptoms of chronic prostatitis/chronic pelvic pain syndrome. Urology. 2013;82:1376–80.

    Article  PubMed  Google Scholar 

  118. Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009;73:1036–41.

    Article  PubMed  Google Scholar 

  119. Parker J, Buga S, Sarria JE, Spiess PE. Advancements in the management of urologic chronic pelvic pain: what is new and what do we know? Curr Urol Rep. 2010;11:286–91.

    Article  PubMed  Google Scholar 

  120. Leippold T, Strebel RT, Huwyler M, John HA, Hauri D, Schmid DM. Sacral magnetic stimulation in non-inflammatory chronic pelvic pain syndrome. BJU Int. 2005;95:838–41.

    Article  PubMed  Google Scholar 

  121. Chuang YC, Chancellor MB. The application of botulinum toxin in the prostate. J Urol. 2006;176:2375–82.

    Article  CAS  PubMed  Google Scholar 

  122. Gottsch HP, Yang CC, Berger RE. A pilot study of botulinum toxin a for male chronic pelvic pain syndrome. Scand J Urol Nephrol. 2011;45:72–6.

    Article  CAS  PubMed  Google Scholar 

  123. Mené MP, Ginsberg PC, Finkelstein LH, Manfrey SJ, Belkoff L, Ogbolu F, et al. Transurethral microwave hyperthermia in the treatment of chronic nonbacterial prostatitis. J Am Osteopath Assoc. 1997;97:25–30.

    PubMed  Google Scholar 

  124. Nickel JC, Siemens DR, Johnston B. Transurethral radiofrequency hot balloon thermal therapy in chronic nonbacterial prostatitis. Tech Urol. 1998;4:128–30.

    CAS  PubMed  Google Scholar 

  125. Leskinen MJ, Kilponen A, Lukkarinen O, Tammela TL. Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study. Urology. 2002;60:300–4.

    Article  PubMed  Google Scholar 

  126. Nickel JC, Sorensen R. Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol. 1996;155:1950–4.

    Article  CAS  PubMed  Google Scholar 

  127. Kastner C, Hochreiter W, Huidobro C, et al. Cooled transurethral microwave thermotherapy for intractable chronic prostatitis results of pilot study after 1 year. Urology. 2004;64:1149–54.

    Article  PubMed  Google Scholar 

  128. Zimmerman R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomized, double-blind, placebo-controlled study. Eur Urol. 2009;56:418–24.

    Article  Google Scholar 

  129. Doggweiler-Wiygul R. Urologic myofascial pain syndromes. Curr Pain Headache Rep. 2004;8:445–51.

    Article  PubMed  Google Scholar 

  130. 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. 2006;176:1534–8.

    Article  PubMed  Google Scholar 

  131. FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182:570–80.

    Article  PubMed Central  PubMed  Google Scholar 

  132. Hetrick DC, Ciol MA, Rothman I, Turner JA, Frest M, Berger RE. Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: a case control study. J Urol. 2003;170:828–31.

    Article  PubMed  Google Scholar 

  133. Khorasani B, Arab AM, Sedighi Gilani MA, Samadi V, Assadi H. Transabdominal ultrasound measurement of pelvic floor muscle mobility in men with and without chronic prostatitis/chronic pelvic pain syndrome. Urology. 2012;80:673–7.

    Article  PubMed  Google Scholar 

  134. Orland SM, Hanno PM, Wein AJ. Prostatitis, prostatosis, and prostatodynia. Urology. 1985;25:439–59.

    Article  CAS  PubMed  Google Scholar 

  135. Theodorou C, Konidaris D, Moutzouris G, Becopoulos T. The urodynamic profile of prostatodynia. BJU Int. 1999;84:461–3.

    Article  CAS  PubMed  Google Scholar 

  136. Barbalias GA, Meares Jr EM, Sant GR. Prostatodynia: clinical and urodynamic characteristics. J Urol. 1983;130:514–7.

    CAS  PubMed  Google Scholar 

  137. Segura JW, Opitz JL, Greene LF. Prostatosis, prostatitis or pelvic floor tension myalgia? J Urol. 1979;122:168–9.

    CAS  PubMed  Google Scholar 

  138. Sinaki M, Merritt JL, Stillwell GK. Tension myalgia of the pelvic floor. Mayo Clin Proc. 1977;52:717.

    CAS  PubMed  Google Scholar 

  139. Wagenlehner FM, van Till JW, Magri V, Perletti G, Houbiers JG, Weidner W, Nickel JC. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2013;63:953–9.

    Article  PubMed  Google Scholar 

  140. Berger RE, Ciol MA, Rothman I, Turner JA. Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS. BMC Urol. 2007;7:17.

    Article  PubMed Central  PubMed  Google Scholar 

  141. Zermann DH, Schmidt RA. Neurophysiology of the pelvic floor: its role in prostate and pelvic pain. In: Nickel JC, editor. Textbook of prostatitis. Oxford: ISIS Medical Media Ltd; 1999. p. 95–105.

    Google Scholar 

  142. Siroky MB, Goldstein I, Krane RJ. Functional voiding disorders in men. J Urol. 1981;126:200–4.

    CAS  PubMed  Google Scholar 

  143. Kaplan SA, Ikeguchi EF, Santarosa RP, D’Alisera PM, Hendricks J, Te AE, Miller MI. Etiology of voiding dysfunction in men less than 50 years of age. Urology. 1996;47:836–9.

    Article  CAS  PubMed  Google Scholar 

  144. Mayo ME, Ross SO, Krieger JN. Few patients with “chronic prostatitis” have significant bladder outlet obstruction. Urology. 1998;52:417–21.

    Article  CAS  PubMed  Google Scholar 

  145. Forrest JB, Nickel JC, Moldwin RM. Chronic prostatitis/chronic pelvic pain syndrome and male interstitial cystitis: enigmas and opportunities. Urology. 2007;69(4 Suppl):60–3.

    Article  PubMed  Google Scholar 

  146. Messing EM, Stamey TA. Interstitial cystitis: early diagnosis, pathology, and treatment. Urology. 1978;12:381–92.

    Article  CAS  PubMed  Google Scholar 

  147. Miller JL, Rothman I, Bavendam TG, Berger RE. Prostatodynia and interstitial cystitis: one and the same? Urology. 1995;45:587–90.

    Article  CAS  PubMed  Google Scholar 

  148. Sant GR, Theoharides TC. Interstitial cystitis. Curr Opin Urol. 1999;9:297–302.

    Article  CAS  PubMed  Google Scholar 

  149. Eisenberg ER, Moldwin RM. Etiology: where does prostatitis stop and interstitial cystitis begin? World J Urol. 2003;21:64–9.

    Article  PubMed  Google Scholar 

  150. Parsons CL. Prostatitis, interstitial cystitis, chronic pelvic pain, and urethral syndrome share a common pathophysiology: lower urinary dysfunctional epithelium and potassium recycling. Urology. 2003;62:976–82.

    Article  PubMed  Google Scholar 

  151. Berger RE, Miller JE, Rothman I, Krieger JN, Muller CH. Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol. 1998;159:83–5.

    Article  CAS  PubMed  Google Scholar 

  152. Parsons CL. Argument for the use of the potassium sensitivity test in the diagnosis of interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:430–1.

    Article  PubMed  Google Scholar 

  153. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143:936–9.

    CAS  PubMed  Google Scholar 

  154. Wesselmann U, Burnett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain. 1997;73:269–94.

    Article  CAS  PubMed  Google Scholar 

  155. Costabile RA, Hahn M, McLeod DG. Chronic orchialgia in the pain prone patient: the clinical perspective. J Urol. 1991;146:1571–4.

    CAS  PubMed  Google Scholar 

  156. Chen TF, Ball RY. Epididymectomy for post-vasectomy pain: histological review. Br J Urol. 1991;68:407–13.

    Article  CAS  PubMed  Google Scholar 

  157. Nickel JC, Siemens DR, Nickel KR, Downey J. The patient with chronic epididymitis: characterization of an enigmatic syndrome. J Urol. 2002;167:1701–4.

    Article  PubMed  Google Scholar 

  158. Van Haarst EP, van Andel G, Rijcken TH, Schlatmann TJ, Taconis WK. Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination. Urology. 1999;54:1068–72.

    Article  PubMed  Google Scholar 

  159. Strebel RT, Leippold T, Luginbuehl T, Muentener M, Praz V, Hauri D. Chronic scrotal pain syndrome: management among urologists in Switzerland. Eur Urol. 2005;47:812–6.

    Article  PubMed  Google Scholar 

  160. Granitsiotis P, Kirk D. Chronic testicular pain: an overview. Eur Urol. 2004;45:430–6.

    Article  CAS  PubMed  Google Scholar 

  161. Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther Adv Urol. 2010;2:209–14.

    Article  PubMed Central  PubMed  Google Scholar 

  162. Singh V, Sinha RJ. Idiopathic chronic orchialgia: a frustrating issue for the clinician and the patient. Indian J Surg. 2008;70:107–10.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  163. Lau MW, Taylor PM, Payne SR. The indications for scrotal ultrasound. Br J Radiol. 1999;72:833–7.

    Article  CAS  PubMed  Google Scholar 

  164. Jara Rascon J, Escribano Patino G, Herranz Amo F, Moncada Iribarren I, Hernandez FC. Testicular microlithiasis: diagnosis associated with orchialgia. Arch Esp Urol. 1998;51:82–5.

    CAS  PubMed  Google Scholar 

  165. Strebel RT, Schmidt C, Beatrice J, Sulser T. Chronic scrotal pain syndrome (CSPS): the widespread use of antibiotics is not justified. Andrology. 2013;1:155–9.

    Article  CAS  PubMed  Google Scholar 

  166. Levine LA, Matkov TG. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. J Urol. 2001;165:1927–9.

    Article  CAS  PubMed  Google Scholar 

  167. West AF, Leung HY, Powell PH. Epididymectomy is an effective treatment for scrotal pain after vasectomy. BJU Int. 2000;85:1097–9.

    Article  CAS  PubMed  Google Scholar 

  168. Heidenreich A, Olbert P, Engelmann UH. Management of chronic testalgia by microsurgical testicular denervation. Eur Urol. 2002;41:392–7.

    Article  PubMed  Google Scholar 

  169. Nangia AK, Myles JL, Thomas AJ. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol. 2000;164:1939–42.

    Article  CAS  PubMed  Google Scholar 

  170. Gray CL, Powell CR, Amling CL. Outcomes for surgical management of orchialgia in patients with identifiable intrascrotal lesions. Eur Urol. 2001;39:455–9.

    Article  CAS  PubMed  Google Scholar 

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  1. Neurourology Division, Department of Urology, Assaf-Harofeh Medical Center, Zerifin, 70300, Israel

    Kobi Stav M.D.

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  1. Urogynecology and Pelvic Floor Service, Assaf Harofeh Medical Center, Zerifin, Israel

    Anna Padoa

  2. Inner Stability, Ltd, Beit Shemesh, Israel

    Talli Y. Rosenbaum

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Stav, K. (2016). Chronic Pelvic Pain Syndromes in Males. In: Padoa, A., Rosenbaum, T. (eds) The Overactive Pelvic Floor. Springer, Cham. https://doi.org/10.1007/978-3-319-22150-2_6

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