| What is CPP? | Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 90% of prostatitis cases in outpatient clinics and is characterized by chronic pelvic pain symptoms lasting at least 3 months during the past 6 months, in the absence of a urinary tract bacterial infection but in the presence of urinary symptoms and sexual dysfunction |
| How is prevalence of CPP? | CP/CPPS has a worldwide prevalence between 2 and 16% and is the most common urologic disease in men below 50 years old |
| What are etiologies of CPP? | The symptoms of chronic prostatitis/chronic pelvic pain syndrome appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.” |
| How is pathophysiology of CPP? | . |
| How is classification of CPP? | . |
| How is clinical presentation of CPP? | The predominant symptom is pain, which was most commonly localized to the perineum, suprapubic area, and penis but can also occur in the testes, groin, or low back.
Pain during or after ejaculation is one of the most prominent, important, and bothersome features in many patients .
Storage and voiding urinary symptoms including urgency, frequency, hesitancy, and poor interrupted flow are most common
Erectile dysfunction and sexual disturbances have been reported in patients with CPPS |
| How is evaluation of CPP? | . |
| What are triggers and inhibitors of CPP? | 1/Food sensitivities
The most aggravating items were spicy foods, coffee, hot peppers, alcoholic beverages, tea, and chili. Higher symptom severity was associated with increased consumption of alcohol and coffee.
2/Psychosocial factors
3/Impact of exercise
Higher leisure-time activity (i.e. brisk walking of at least 10 h/week) was associated with a 28% significant reduction in the risk of developing CP/CPPS compared to controls |
| How are economic costs of CPP? | IC/PBS and CP/CPPS are pelvic pain conditions with unknown etiologies and no consistently effective treatment
Cost : $ 7000/year /person in USA
Surpassing other chronic disease ( rheumatoid arthritis ,low back pain , peripheral neuropathy) |
| How is tx of CPP? | 1- Life style and diet changes
avoiding spicy foods, caffeine and alcohol
2- Alpha adrenergic antagonist
a recent multicenter, randomized study showed the beneficial effect of silodosin when compared to placebo
3- 5-alpha reductase inhibitor
Dutasteride reduced prostatitis symptom scores compared to placebo in men enrolled in the REDUCE study ( > 58% improvement)
4- Antibiotic therapy :Use in the first presentation mainly Quinolones ( ciprofloxacine ) for 4 weeks at least (placebo, eradicate organisms, antiinflammatory)
5- Anti -inflammatory agents and Immune Modulators used as adjunctive therapy
6- Floor physiotherapy as adjunctive therapy
7-Psychotherapy (CBT...)
8-TUMT
9--Extracorporeal shock wave therapy and last neuro tx |
