Prostatitis pictures

Prostatitis pictures DEFAULT

Prostate Problems

On this page:

What are common prostate problems?

Common prostate problems include

Read more about prostate cancer at www.cancer.gov.

What is the prostate?

The prostate is a walnut-shaped gland that is part of a man’s sex organs, which also include the penis, scrotum, and testicles. The prostate makes fluid that goes into semen, which is a mix of sperm and prostate fluid. Prostate fluid is important for a man’s ability to father children.

The prostate is in front of the rectum and just below the bladder. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis during sexual climax, or ejaculation. The bladder and urethra are parts of the lower urinary tract.

Urine and semen flowing through the urethra pass through the prostate.

Side view of male genitalia and rectum

What causes prostate problems?

The cause of prostate problems may be

Your doctor may not always know the exact cause of your prostate problem.

Prostatitis

The cause of prostatitis depends on whether you have chronic prostatitis or bacterial prostatitis.

Chronic prostatitis. Doctors do not know the exact cause of chronic prostatitis. Researchers think that an infection of tiny organisms, though not bacteria, can cause chronic prostatitis. Other causes may include chemicals in your urine, your body’s response to a previous urinary tract infection (UTI), or nerve damage in your pelvic area. Most of the time doctors don’t find any infection in men with chronic prostatitis.

Bacterial prostatitis. Bacteria, tiny organisms that can lead to infection, cause some kinds of prostatitis.

Benign Prostatic Hyperplasia

Doctors do not know the exact cause of BPH. Changes in male-hormone levels in older men, aging, inflammation, and fibrosis may play a role in causing BPH. Fibrosis is when extra tissue forms around your organs and becomes thick and stiff.

Who develops prostate problems and how common are they?

Any man can develop a prostate problem. Prostatitis can affect men of all ages. However, it is the most common prostate problem in men younger than age 50. BPH is the most common prostate problem in men older than age 50.

Prostatitis

If you have a UTI, you may be more likely to get bacterial prostatitis. If you have nerve damage in your lower urinary tract or have emotional stress, you may be more likely to get chronic prostatitis.

Benign Prostatic Hyperplasia

Men younger than age 40 rarely have BPH symptoms. The number of men with BPH symptoms increases with age.

If you have a family history of BPH, you may be more likely to get BPH. Other factors that increase your chances for BPH may include certain medical conditions and lifestyle choices.

3 Men sitting in chairs

What are the symptoms of prostate problems?

The symptoms of a prostate problem may include problems with urinating and bladder control. Bladder control is how well you can delay, start, or stop urination. These problems can cause you to

  • go to the bathroom frequently
  • feel as if you need to rush to the bathroom, only to find you can’t urinate or you urinate only a little
  • leak or dribble urine
  • have a weak urine stream

Depending on the cause of your prostate problems, you may have other symptoms.

Prostatitis

If you have chronic prostatitis, your symptoms may cause long-lasting pain and discomfort in

  • your penis or scrotum
  • the area between your scrotum and anus
  • your belly
  • your lower back

If you have bacterial prostatitis, your symptoms may come on quickly, or they may come on slowly and last a long time. You may not be able to empty your bladder completely. You may have a fever, chills, or body aches.

Benign Prostatic Hyperplasia

If you have BPH, you may need to wake up often to urinate when you sleep. Your urine may have an unusual color or smell. You may also have pain while urinating or after ejaculation.

Male getting out of his bed, next to him a bed-side table with lamp.

See your doctor if you have symptoms

If you can’t urinate at all, you should get medical help right away. Sometimes this problem happens suddenly to men after they take certain cold or allergy medicines.

You should see your doctor if you have one or more of these symptoms:

  • a weak urine stream
  • blood in your urine
  • dribbling at the end of urination
  • fever, chills, or body aches
  • great discomfort or pain in your belly
  • pain in the area between your scrotum and anus
  • pain in your penis or scrotum
  • pain while urinating or after ejaculation
  • trouble starting or keeping a urine stream
  • unable to delay urination
  • unable to empty your bladder completely
  • urinating eight or more times a day
  • urine that has an unusual color or smell
  • waking often to urinate when you sleep

Do prostate problems cause other problems?

Yes, a prostate problem may cause other problems, such as

  • problems having sex
  • a UTI
  • feeling stressed due to chronic pain
  • inflammation in areas near your prostate
  • bladder stones
  • kidney failure

Which problem you may get depends on the type of prostate problem you have. Other problems may vary from man to man for each type of prostate problem.

How does my doctor know if I have a prostate problem?

Your doctor will know if you have a prostate problem based on the following:

  • your medical and family history
  • a physical exam, including a digital rectal exam of your prostate
  • tests on your urine, blood, and lower urinary tract
  • ultrasound
  • prostate biopsy

Medical and Family History

Taking a medical and family history is one of the first things a doctor may do to help diagnose your prostate problem.

Physical Exam

A physical exam may help diagnose the cause of a prostate problem. During a physical exam, a doctor typically

  • checks your body.
  • looks for fluids leaking from your urethra.
  • checks for swollen or tender lymph nodes in your groin. Lymph nodes are glands that help you fight infections.
  • checks for a swollen or tender scrotum.
  • examines your prostate using a digital rectal exam.

For a digital rectal exam, your doctor slides a gloved, lubricated finger into your rectum and feels your prostate. This exam gives your doctor a general idea of the size and condition of your prostate. A digital rectal exam most often takes place in your doctor’s office. You will not need pain medicine.

Diagram of male genitalia, rectum with doctor’s finger insertion.

Tests

Urine test. A urine test involves collecting a sample of your urine in a special container in your doctor’s office or a medical facility. A health care professional tests your urine sample at your doctor’s office or sends your sample to a lab. Your doctor may want to test your urine sample for signs of infection.

Blood test. A blood test involves drawing a sample of your blood at your doctor’s office or a medical facility. A health care professional sends your blood sample to a lab. Your doctor may want to test your blood sample for prostate-specific antigen (PSA). PSA is a protein that your prostate makes. If your PSA level is high, it may be a sign that you have prostate cancer. However, this test isn’t perfect. Many men with high PSA levels don’t have prostate cancer. Your doctor may also test your blood sample for signs of infection.

Urodynamic tests. Your doctor may perform a urodynamic test to see how well your bladder and urethra hold and release urine. Your doctor most often does a urodynamic test during an office visit. The tests can show signs of blockage in your urethra due to prostate enlargement.

More information is provided in the NIDDK health topic, Urodynamic Testing.

Cystoscopy. For this test, your doctor uses a tubelike instrument called a cystoscope to look inside your urethra and bladder. Your doctor performs a cystoscopy during an office visit or in an outpatient center or a hospital. You will receive pain medicine. In some cases, your doctor will give you medicines to help you relax or fall asleep. With a cystoscopy, your doctor can see blockage in your urethra and problems in your bladder.

More information is provided in the NIDDK health topic, Cystoscopy and Ureteroscopy.

Ultrasound

An ultrasound is when a doctor uses a device called a transducer to bounce safe, painless sound waves off of your organs to make pictures of them. A health care professional does an ultrasound in a doctor’s office, an outpatient center, or a hospital, and a doctor interprets the pictures. You will not need pain medicine. To make pictures of the prostate, a health care professional inserts a small transducer into your rectum. The pictures can show the size and shape of your prostate.

More information is provided in the NIDDK health topic, Imaging of the Urinary Tract.

Prostate Biopsy

Prostate biopsy is a test that involves taking small pieces of tissue from your prostate to look at with a microscope. Your doctor does a prostate biopsy in an outpatient center or a hospital. Your doctor will give you medicines to help you relax and stop you from feeling pain, or your doctor may give you medicine so you are asleep during the biopsy. A specially trained doctor examines the tissue in a lab for signs of disease. A biopsy can show whether you have prostate cancer.

More information is provided in the NIDDK health topic, Medical Tests for Prostate Problems.

How do doctors treat prostate problems?

Treatment depends on the type of prostate problem you have.

Prostatitis

Treatment depends on the type of prostatitis.

Chronic prostatitis. If you have chronic prostatitis, your doctor will try treatments to lessen pain, discomfort, and inflammation. Your doctor may give you a medicine called an alpha-blocker to relax the muscles in your prostate and part of your bladder. Tamsulosin (Flomax) and silodosin (Rapaflo) are two commonly used alpha-blockers. Warm baths, relaxation exercises, and physical therapy may help.

Bacterial prostatitis. If you have bacterial prostatitis, your doctor will give you an antibiotic, a medicine that kills bacteria. Bacterial prostatitis generally clears up quickly after treatment with antibiotics. As part of treatment, your doctor may ask you to change your diet and drink more liquids.

Benign Prostatic Hyperplasia

Treatments for BPH include

  • watchful waiting
  • lifestyle changes
  • medicines
  • surgery

Watchful waiting. If your symptoms don’t bother you too much, you may choose to live with them rather than take medicines or have surgery. However, you should have regular checkups to make sure your condition isn’t getting worse. With watchful waiting, you can be ready to choose a treatment as soon as you decide to treat your BPH.

Lifestyle changes. Your doctor may suggest changes to your lifestyle if your symptoms are mild and bother you only a little. Your symptoms may get better if you

  • drink fewer liquids before going out or before going to sleep
  • avoid or drink fewer liquids that have caffeine or alcohol in them
  • avoid medicines that may affect your bladder, such as certain cold and allergy medicines
  • change the timing of your medicines, such as diuretics, also called water pills, or those that treat high blood pressure.

Medicines. Your doctor may prescribe medicines such as finasteride (Proscar) and dutasteride (Avodart). These medicines can stop prostate growth or actually shrink the prostate in some men. Your doctor also may prescribe an alpha-blocker like doxazosin (Cardura) or tadalafil (Cialis), another medicine that relaxes prostate and bladder muscles.

Surgery. If your prostate keeps growing or your symptoms get worse, your doctor may recommend surgery to shrink your prostate. Most of the surgeries are transurethral, which means your doctor inserts a thin tube into your urethra to reach the prostate. Your doctor performs the transurethral surgery in an outpatient center or a hospital. Your doctor will give you medicines to help you relax and stop you from feeling pain, or your doctor may give you medicine so you are asleep during surgery. Most men can go home the same day as the surgery.

In most cases, surgery to shrink or remove prostate tissue offers long-term relief from problems due to BPH. In a few cases, the prostate may continue to grow and problems may return. Surgery for BPH does not prevent cancer. You should continue to have your prostate checked after surgery to make sure your prostate has not grown larger.

In some cases, your doctor may recommend removing your prostate. Your doctor performs this surgery in a hospital. Your doctor will give you medicine so you are asleep during surgery. You will need a hospital stay after your surgery.

What are the side effects of treatments for prostate problems?

The side effects of treating prostate problems may include the following:

  • The medicines you take for prostatitis and BPH may make you feel sick or uncomfortable. Tell your doctor right away if you think the medicine is causing you to feel this way.
  • Surgery for BPH may have a temporary effect on your ability to have sex. Most men recover their ability to have sex within a year of surgery. The exact length of time depends on the type of surgery and how long you had symptoms before surgery.
  • You also may have bladder control problems after treatment for BPH. In most cases, these problems go away after several months.

If you have any problems after treatment for prostate problems, talk with your doctor. Chances are good that your doctor can help you.

If your doctor removes your prostate, you’re more likely to have long-lasting problems with bladder control and having sex. Your doctor can recommend the best treatment options for these problems.

Older couple embracing

How can I prevent a prostate problem?

Researchers have not found ways to prevent prostate problems. Men with a greater chance of developing a prostate problem should talk with their doctor about any lower urinary tract symptoms and the need for regular prostate exams. Recognizing lower urinary tract symptoms and knowing whether you have a prostate problem can help you get early treatment and reduce the effects of prostate problems.

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing prostate problems.

Points to Remember

  • Common prostate problems include
    • prostatitis—inflammation, or swelling, of the prostate
    • benign prostatic hyperplasia (BPH)—an enlarged prostate due to something other than cancer
    • prostate cancer
  • Prostatitis is the most common prostate problem in men younger than age 50.
  • BPH is the most common prostate problem in men older than age 50.
  • The symptoms of a prostate problem may include problems with urinating and bladder control.
  • If you have chronic prostatitis, your symptoms may cause long-lasting pain and discomfort in
    • your penis or scrotum
    • the area between your scrotum and anus
    • your belly
    • your lower back
  • If you have bacterial prostatitis, your symptoms may come on quickly, or they may come on slowly and last a long time.
  • If you have BPH, you may need to wake up often to urinate when you sleep.
  • If you can’t urinate at all, you should get medical help right away.
  • Your doctor will know if you have a prostate problem based on the following:
    • your medical and family history
    • a physical exam, including a digital rectal exam of your prostate
    • tests on your urine, blood, and lower urinary tract
    • ultrasound
    • prostate biopsy
  • Treatment depends on the type of prostate problem you have.
  • If you have chronic prostatitis, your doctor will try treatments to lessen pain, discomfort, and inflammation.
  • If you have bacterial prostatitis, your doctor will give you an antibiotic, a medicine that kills bacteria.
  • Treatments for BPH include
    • watchful waiting
    • lifestyle changes
    • medicines
    • surgery

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

Last Reviewed March 2016

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Sours: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems

The evolving clinical picture of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): A look at 1310 patients over 16 years

Can Urol Assoc J. 2018 Jun; 12(6): 196–202.

Published online 2018 Feb 23. doi: 10.5489/cuaj.4876

R. Christopher Doiron, MD,corresponding author1Dean A. Tripp, PhD,1,2Victoria Tolls, MD,1and J Curtis Nickel, MD, FRCSC1

R. Christopher Doiron

1Department of Urology, Queen’s University, Kingston, ON, Canada

Find articles by R. Christopher Doiron

Dean A. Tripp

1Department of Urology, Queen’s University, Kingston, ON, Canada

2Department of Psychology, Queen’s University, Kingston, ON, Canada

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Victoria Tolls

1Department of Urology, Queen’s University, Kingston, ON, Canada

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J Curtis Nickel

1Department of Urology, Queen’s University, Kingston, ON, Canada

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Author informationCopyright and License informationDisclaimer

1Department of Urology, Queen’s University, Kingston, ON, Canada

2Department of Psychology, Queen’s University, Kingston, ON, Canada

corresponding authorCorresponding author.

Correspondence: Dr. R. Christopher Doiron, Department of Urology, Queen’s University, Kingston, ON, Canada; [email protected]

Copyright : © 2018 Canadian Urological Association or its licensors

This article has been cited by other articles in PMC.

Supplementary Materials

Supplementary Table 1

UPOINT associations in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

UPOINT

n=941n=361n=660n=440n=402n=644
 Age44.8 (±13.3)44.1 (±13.0)44.8 (±13.4)45.9 (±12.4)43.5 (±12.6)43.6 (±13.5)
 CPSI pain11.2 (±4.8)10.8 (±5.1)11.0 (±4.8)10.5 (±4.7)11.0 (±4.9)11.5 (±4.7)
 CPSI urination6.3 (±2.3)5.2 (±3.0)4.9 (±3.2)4.5 (±3.1)5.1 (±3.1)5.1 (±3.2)
 CPSI QoL8.2 (±2.9)8.4 (±3.1)8.1 (±3.1)7.8 (±3.0)7.9 (±3.2)8.3 (±8.8)
 CPSI total25.8 (±8.2)24.4 (±9.1)24.1 (±9.0)22.8 (±8.8)24.0 (±9.3)24.9 (±8.0)
Pain location
 Perineum575 (61.1%)223 (61.8%)418 (63.3%)274 (62.3%)262 (65.2%)443 (68.8%)
 Testicular503 (53.5%)191 (52.9%)344 (52.1%)217 (49.3%)223 (55.5%)356 (55.3%)
 Tip of penis348 (37.0%)113 (31.3%)226 (34.2%)153 (34.8%)132 (32.8%)225 (34.9%)
 Pubic/bladder629 (66.8%)226 62.6%)416 (63.0%)255 (58.0%)269 (66.9%)423 (65.7%)
 Dysuria454 (48.2%)156 (43.2%)294 (44.5%)194 (44.1%)182 (45.3%)293 (45.5%)
 Ejaculation473 (50.3%)177 (49.0%)316 (47.9%)218 (49.5%)211 (52.5%)324 (50.3%)
Treatment by referring physician*
 Alpha-blockers659 (70.0%)235 (65.1%)445 (67.4%)240 (54.5%)247 (61.4%)422 (65.5%)
 Antidepressants150 (15.9%)105 (29.1%)109 (16.5%)54 (12.3%)65 (16.2%)121 (18.8%)
 Quercetin304 (32.3%)115 (31.9%)244 (37.0%)158 (35.9%)151 (37.6%)227 (35.2%)
 QUrol87 (9.2%)41 (11.4%)57 (8.6%)25 (5.7%)32 (8.0%)68 (10.6%)
 Gabapentinoids61 (6.5%)37 (10.2%)43 (6.5%)19 (4.3%)20 (5.0%)52 (8.1%)
 Acupuncture8 (0.9%)8 (2.2%)5 (0.8%)3 (0.7%)2 (0.5%)5 (0.8%)
 Physiotherapy20 (2.1%)13 (3.6%)14 (2.1%)6 (1.4%)9 (2.2%)27 (4.2%)
 Antibiotics216 (23.0%)72 (19.9%)167 (25.3%)113 (25.7%)100 (24.9%)144 (22.4%)
 Prostate massage22 (2.3%)10 (2.8%)24 (3.6%)24 (5.5%)12 (3.0%)18 (2.8%)

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Supplementary Table 2

Associations of number of UPOINT domains in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

123456

n=249n=408n=368n=192n=39n=7
 Age45.3 (±14.1)44.5 (±12.7)44.3 (±13.2)44.7 (±13.1)43.8 (±13.8)49.4 (±3.3)
 CPSI pain9.2 (±4.6)10.6 (±4.6)11.1 (±4.9)11.6 (±5.2)11.8 (±4.3)14.3 (±2.8)
 CPSI urination3.4 (±2.9)4.6 (±3.1)5.7 (±3.0)6.3 (±2.5)5.4 (±2.8)6.3 (±1.1)
 CPSI QoL6.9 (±3.1)7.9 (±3.0)8.3 (±3.0)8.4 (±3.1)8.4 (±2.9)10.9 (±1.1)
 CPSI total19.5 (±8.2)23.2 (±8.4)25.1 (±8.8)26.4 (±9.1)25.6 (±8.1)31.4 (±6.0)
UPOINT
 U118 (47.4%)287 (70.3%)311 (84.5%)181 (94.3%)35 (89.7%)7 (100%)
 P11 (4.4%)63 (15.4%)128 (34.8%)119 (62.0%)33 (84.6%)7 (100%)
 O45 (18.1%)169 (41.4%)252 (68.5%)148 (77.1%)37 (94.9%)7 (100%)
 I44 (17.7%)129 (31.6%)143 (38.9%)86 (44.8%)29 (74.4%)7 (100%)
 N33 (13.3%)103 (25.2%)123 (33.4%)106 (55.2%)27 (69.2%)7 (100%)
 T62 24.9%)160 (39.2%)227 (61.7%)153 (79.7%)34 (87.2%)7 (100%)
Pain locations
 Perineum125 (50.2%)243 (59.6%)241 (65.5%)123 (64.1%)30 (76.9%)4 (57.1%)
 Testicular108 (43.4)192 (47.1%)203 (55.2%)104 (54.2%)24 (61.5%)5 (71.4%)
 Tip of penis74 (29.7%)146 (35.8%)128 (34.8%)65 (33.9%)16 (41.0%)1 (14.3%)
 Pubic/bladder130 (52.2%)242 (59.3%)243 (66.0%)132 (68.8%)24 (61.5%)7 (100%)
 Dysuria85 (34.1%)166 (40.7%)177 (48.1%)91 (47.4%)23 (59.0%)3 (42.9%)
 Ejaculatory101 (40.6%)185 45.3%)187 (50.8%)106 (55.2%)18 (46.2%)4 (57.1%)
Treatment by referring physician*
 Alpha-blockers128 (51.4%)236 (57.8%)265 (72.0%)125 (65.1%)30 (76.9%)6 (85.7%)
 Antidepressants23 (9.2%)53 (13.0%)70 (19.0%)37 (19.3%)12 (30.8%)2 (28.6%)
 Quercetin83 (33.3%)139 (34.1%)137 (37.2%)62 (32.3%)11 (28.2%)3 (42.9%)
 QUrol18 (7.2%)33 (8.1%)38 (10.3%)18 (9.4%)5 (12.8%)0 (0%)
 Gabapentinoids13 (5.2%)17 (4.2%)25 (6.8%)16 (8.3%)5 (12.8%)1 (14.3%)
 Acupuncture1 (0.4%)2 (0.5%)3 (0.8%)3 (1.6%)1 (2.6%)0 (0%)
 Physiotherapy6 (2.4%)8 (2.0%)9 (2.4%)7 (3.6%)1 (2.6%)0 (0%)
 Antibiotics48 (19.3%)98 (24.0%)84 (22.8%)48 (25.0%)8 (20.5%)2 (28.6%)
 Prostate massage8 (3.2%)19 (4.7%)10 (2.7%)5 (2.6%)1 (2.6%)0 (0%)

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Supplementary Table 3

Associations of pain locations in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

Perineum painTesticular painTip of penis painPubic/bladder painDysuriaEjaculatory pain

n=788n=658n=441n=798n=553n=615
 Age43.9 (±13.0)43.9 (±12.8)44.4 (±13.8)44.1 (±13.6)44.5 (±13.6)42.8 (±12.6)
 CPSI pain12.3 (±3.9)12.8 (±3.7)13.1 (±3.7)12.4 (±3.8)13.0 (±3.8)12.8 (±3.8)
 CPSI urination5.1 (±3.1)5.3 (±3.1)5.6 (±3.1)5.5 (±3.0)5.9 (±3.0)5.4 (±3.1)
 CPSI QoL8.6 (±2.7)8.7 (±2.7)8.9 (±2.4)8.8 (±2.6)8.8 (±2.6)8.8 (±2.6)
 CPSI total26.0 (±7.8)26.9 (±7.5)27.6 (±7.2)26.7 (±7.4)27.6 (±7.5)27.0 (±7.5)
UPOINT
 U575 (73.0%)503 (76.4%)348 (78.9%)629 (78.8%)454 (82.1%)473 (76.9%)
 P223 (28.3%)191 (29.0%)113 (25.6%)226 (28.3%)156 (28.2%)177 (28.2%)
 O418 (53.0%)344 (52.3%)226 (51.2%)416 (52.1%)294 (53.2%)316 (51.4%)
 I274 (34.8%)217 (33.0%)153 (34.7%)255 (32.0%)194 (35.1%)218 (35.4%)
 N262 (33.2%)223 (33.9%)132 (29.9%)269 (33.7%)182 (32.9%)211 (34.3%)
 T443 (56.2%)356 (54.1%)225 (51.0%)423 (53.0%)293 (53.0%)324 (52.7%)
Pain locations
 Perineum788 (100%)479 (72.8%)296 (67.1%)524 65.7%)362 (65.5%)424 (68.9%)
 Testicular479 (60.8%)658 (100%)257 (58.3%)483 (60.5%)323 (58.4%)359 (58.4%)
 Tip of penis296 (37.6%)257 (58.3%)441 (100%)308 (38.6%)280 (50.6%)263 (42.8%)
 Pubic/bladder524 (66.5%)483 (73.4%)308 (69.8%)798 (100%)398 (72.0%)418 (68.0%)
 Dysuria362 (45.9%)323 (49.1%)280 (63.5%)398 (49.9%)553 (100%)347 (56.4%)
 Ejaculatory424 (53.8%)359 (54.6%)263 (59.6%)418 (52.4%)347 (62.7%)615 (100%)
Treatment by referring physician*
 Alpha-blockers502 (63.7%)412 (62.6%)303 (68.7%)529 (66.3%)386 (69.8%)402 (65.4%)
 Antidepressants136 (17.3%)108 (16.4%)72 (16.4%)140 (17.5%)98 (17.7%)103 (16.7%)
 Quercetin311 (39.5%)242 (36.8%)168 (38.1%)298 (37.3%)210 (38.0%)239 (38.9%)
 QUrol77 (9.8%)59 (9.0%)51 (11.6%)71 (8.9%)53 (9.6%)62 (10.1%)
 Gabapentinoids55 (7.0%)49 (7.4%)35 (7.9%)55 (6.9%)44 (8.0%)43 (7.0%)
 Acupuncture7 (0.9%)4 (0.6%)2 (0.5%)6 (0.8%)4 (0.7%)6 (1.0%)
 Physiotherapy27 (3.4%)22 (3.3%)17 (3.9%)28 (3.5%)19 (3.4%)14 (2.3%)
 Antibiotics183 (23.2%)142 (21.6%)88 (20.0%)179 (22.4%)121 (21.9%)138 (22.4%)
 Prostate massage35 (4.4%)22 (3.3%)17 (3.9%)22 (2.8%)20 (3.6%)18 (2.9%)

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Abstract

Introduction

Two decades of increasing understanding of etiopathogenesis and clinical phenotyping produces an impression the clinical face of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is changing. We sought to retrospectively analyze trends in CP/CPPS patients presenting to our clinic for evaluation over a 16-year period.

Methods

: Patients with CP/CPPS presenting to a tertiary clinic were evaluated prospectively from 1998–2014 with Chronic Prostatitis Symptom Index (CPSI) and UPOINT (urinary, psychosocial, organ-specific, infection, neurogenic, and tenderness) categorization. Patients were stratified in four cohorts, based on year of presentation, and we retrospectively analyzed variations in symptom scores and patterns, UPOINT categorization, and treatment modalities amongst cohorts.

Results

: Mean age of the 1310 CP/CPPS patients was 44.7 years, while mean CPSI pain, urination, and total scores were 10.6, 4.8, and 23.3, respectively. The most prevalent UPOINT domain, urinary (U) (71.8%) was associated with a higher CPSI urination score (6.3), more frequent penile tip pain (37%), dysuria (48%), and more treatment with alpha-blockers (70%). Increase in UPOINT domains was associated with higher CPSI pain, quality of life (QoL), and total scores. Trends over time included increased prevalence of psychosocial (P), organ (O), and tenderness (T) domains, as well as increased use of alpha-blockers, neuromodulation, and phytotherapy as treatment modalities. There was little variation in age, CPSI scores, and pain locations over time.

Conclusions

: The changing clinical face of CP/CPPS reflects the increased recognition of psychosocial (P domain) and pelvic floor pain (T domain), along with the concomitant use of associated therapies. There was little variation of pain/urinary symptom patterns and QoL.

Introduction

Prostatitis syndromes, including prostate pain complaints among men, have long been recognized as a common clinical scenario encountered by physicians.1,2 It took several years of concerted effort from the National Institutes of Health (NIH) via their Chronic Prostatitis Collaborative Research Network (CPCRN) to help define the disease of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). International consensus following a 1995 chronic prostatitis workshop classified CP/CPPS into four categories3,4 — this helped define the disease for clinicians, provided a framework from which to approach a disease with a challenging, heterogeneous presentation, and furthermore, allowed for a more standardized approach to research in the field.

The continued enthusiasm of the NIH collaboration led to the development of a validated symptom index tool5 — the NIH Chronic Prostatitis Symptom Index (CPSI) — which has allowed for objective evaluation of patients and their response to treatment.

This tool has proved invaluable in evaluating various treatments for CP/CPPS in clinical trials,68 has proved helpful in evaluating CP/CPPS prevalence,9 and has been used to validate tiers of disease severity.10

Despite these advancements, CP/CPPS remained a difficult entity to manage. Randomized controlled trials of various treatment modalities failed to show significant improvements in measured outcomes.11 Furthermore, the etiology and pathogenesis of CP/CPPS remained an enigma and likely represented a constellation of disease contributors and pathways. There were, however, some subgroups that appeared to benefit from various treatment modalities.11,12 It was becoming accepted that the heterogeneous nature of patients presenting with CP/CPPS would be best evaluated by subgrouping patients according to either mechanisms, biomarkers, or symptoms. Using available clinical assessment, a phenotypic approach to classifying patients in clinical practice was proposed. UPOINT phenotyping13 built on the improvements made by the NIH classification by further recognizing that even within these four broad categories, patients were still heterogeneous. Assessing individual patients according to the proposed six domains allowed for improved patient-centred care, leading to development of individualized clinical treatment strategies.14

It has now been close to two decades since our updated classification system came into general use and a decade since UPOINT was first introduced, and this has led to a plethora of current research in the field. But have any of these developments made an impact on patient evaluation and subsequent treatment?

This study is a retrospective look at CP/CPPS patients evaluated in a single outpatient clinic over the course of a 16-year period, beginning with introduction of our current classification system and spanning the introduction of UPOINT phenotyping. We were interested in observing the initial presentation of CP/CPPS patients in a tertiary prostatitis clinic to determine changes in symptom patterns, UPOINT phenotype, and treatment modality trends over time.

Methods

Participants and study design

This study is a retrospective examination of a cohort of CP/ CPPS patients examined at a single outpatient clinic. The cohort was examined as part of a large, prospective clinical quality assurance database and was examined by a single urologist (JCN). The evaluation of this patient population has been described in previous publications.6 Data presented was collected from initial presentation between the years 1998–2014. This study was done under ongoing IRB approval for continued quality assurance with all patient data de-identified before analysis.

Measures

Data regarding the patients’ demographics, symptom duration, CPSI scores (pain, urinary, impact/quality of life [QoL]), and UPOINT scoring were collected through initial evaluations at the CP/CPPS outpatient clinic (UPOINT scoring was retrospective prior to 2009 and prospective from 2009). Data regarding treatments received, therefore, represent interventions prior to initial evaluation at CP/CPPS clinic and would have been administered by referring physicians. Data was examined first as an overall cohort and then over time in four separate cohorts ranging from 1998–2001, 2003–2005, 2006–2009, and 2010–2014.

Data analysis

Statistical analysis was completed using Microsoft Excel 2010 Data Analysis package and the online Social Science Statistics software (http://www.socscistatistics.com). Continuous variables (age and CPSI scores) were analyzed using ANOVA (using R version 3.3.1), with p<0.05 regarded as significant. Categorical variables (UPOINT, pain locations, and treatments) were analyzed using Chi-squared test for trend in proportions (using R version 3.3.1), with p<0.05 regarded as significant.

Results

Between the years of 1998–2014, 1349 patients with CP were evaluated at a single tertiary referral outpatient clinic. Of these, 39 patients were diagnosed with bacterial prostatitis (Category II) and were excluded from the current analysis. The remaining 1310 patients were given a diagnosis of Category III CP/CPPS. The majority of patients (n=804, 61.4%) were referred by a general practitioner, while 474 (36.2%) patients were referred by another urologist. Mean age of the 1310 CP/CPPS patients was 44.7 years (Table 1). Their mean CPSI pain, urination, QoL and total scores were 10.6, 4.8, 7.9, and 23.3, respectively (Table 1).

Table 1

Age, CPSI scores, UPOINT analysis, pain locations, and treatments provided by referring physicians for 1310 CP/CPPS patients evaluated in a single outpatient clinic from 1998–2014

1998–2014

n=1310
 Age44.7 (±13.3)
 CPSI pain10.6 (±4.9)
 CPSI urination4.8 (±3.1)
 CPSI QoL7.9 (±3.1)
 CPSI total23.3 (±9.0)
UPOINT
 U941 (71.8%)
 P361 (27.6%)
 O660 (50.4%)
 I440 (33.6%)
 N402 (30.7%)
 T644 (49.2%)
Pain location
 Perineum788 (60.2%)
 Testicular658 (50.2%)
 Tip of penis441 (33.7%)
 Pubic/bladder798 (60.9%)
 Urination553 (42.2%)
 Ejaculation615 (46.9%)
Treatment by referring physician*
 Alpha-blockers806 (61.5%)
 Antidepressants198 (15.1%)
 Quercetin449 (34.3%)
 QUrol115 (8.8%)
 Gabapentinoids79 (6.0%)
 Acupuncture/acupressure10 (0.8%)
 Physiotherapy33 (2.5%)
 Antibiotics293 (22.4%)
 Prostate massage43 (3.3%)

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Overall, the most prevalent UPOINT domain was the urinary (U) domain (n=941, 71.8%), followed by organ-specific (O) (n=660, 50.4%), tenderness (T) (n=644, 49.2%), infection (I) (n=440, 33.6%), neurologic (N) (n=402, 30.7%), and psychosocial (P) (n=361, 27.6%) domains (Table 1). Positive reporting of the urinary domain was associated with a higher CPSI total score (25.8), higher CPSI urination score (6.3), more frequent penile tip pain (n=348, 37%), more frequent dysuria (n=454, 48.2%), and treatment with alpha-blockers (n=659, 70%) (Supplementary Table 1). Those patients who reported in the P domain were associated with a higher UPOINT total score (3.3) and were more commonly treated with antidepressants (n=105, 29.1%) and gabapentinoids (n=37, 10.2%) compared with the other domains (Supplementary Table 1).

An increased reporting of total UPOINT domains was associated with higher CPSI pain score (14.3), worse QoL (10.9), and higher total CPSI scores (31.4) (Supplementary Table 2). Pain location was not associated with severity of disease, nor was it associated with UPOINT domain or treatment modality (Supplementary Table 3).

An analysis of trends over time through examination of the four separate time cohorts revealed an increased prevalence of P domain (p=0.0009), O (p≤0.0001), and T (p≤0.0001) (Table 2). A decrease in the I domain (p≤0.0001) over time was also noted (Table 2). In terms of treatment modalities, there was an increased prevalence of use of alpha-blockers (p≤0.0001), neuromodulation (p≤0.0001), and phytotherapy (p=0.0001) with time, while the use of antibiotics — which ranged from 20.5–27.2% among the cohorts — did not change significantly with time (Table 2). There was little variation in age, CPSI scores, and pain locations over time.

Table 2

Trends observed over time in 1310 CP/CPPS patients stratified by time of initial presentation to chronic prostatitis clinic

1998–20012002–20052006–20092010–2014p

n=195n=387n=357n=371
 Age42.1 (±11.3)44.9 (±12.3)45.8 (±13.2)44.9 (±15.3)0.0185
 CPSI pain11.1 (±4.6)10.6 (±4.6)10.2 (±5.1)10.7 (±5.0)0.2000
 CPSI urination4.5 (±2.9)5.1 (±3.0)4.6 (±3.1)5.0 (±3.3)0.0564
 CPSI QoL7.8 (±3.0)7.7 (±3.0)7.8 (±3.1)8.2 (±3.2)0.2272
 CPSI total23.4 (±8.3)23.4 (±8.8)22.7 (±9.2)23.8 (±9.3)0.3599
UPOINT
 U144 (73.8%)291 (75.2%)250 (70.0%)256 (69.0%)0.0636
 P45 (23.1%)94 (24.3%)94 (26.3%)128 (34.5%)0.0009
 O67 (34.4%)175 (45.2%)224 (62.7%)194 (52.3%)<0.0001
 I116 (59.5%)140 (36.2%)90 (25.2%)94 (25.3%)<0.0001
 N88 (45.1%)115 (29.7%)95 (26.6%)104 (28.0%)0.0003
 T55 (28.2%)173 (44.7%)156 (43.7%)260 (70.1%)<0.0001
Pain locations
 Perineum138 (70.8%)230 (59.4%)210 (58.8%)210 (56.6%)0.0049
 Testicular95 (48.7%)215 (55.6%)163 (45.7%)185 (49.9%)0.3924
 Tip of penis57 (29.2%)137 (35.4%)115 (32.2%)132 (35.6%)0.3195
 Pubic/bladder121 (62.1%)246 (63.6%)217 (60.8%)214 (57.7%)0.1456
 Dysuria92 (47.2%)165 (42.6%)146 (40.9%)150 (40.4%)0.1368
 Ejaculation104 (53.3%)182 (47.0%)165 (46.2%)164 (44.2%)0.0591
Treatment by referring physician*
 Alpha-blockers64 (32.8%)244 (63%)263 (73.7%)235 (63.3%)<0.0001
 Neuromodulation16 (8.2%)45 (11.6%)79 (22.1%)95 (25.6%)<0.0001
 Phytotherapy62 (31.8%)139 (35.9%)204 (57.1%)159 (42.9%)0.0001
 Physiotherapy13 (6.6%)21 (5.4%)13 (3.6%)36 (9.7%)0.1078
 Antibiotics53 (27.2%)82 (21.2%)82 (23%)76 (20.5%)0.1759

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Discussion

We describe the change in specific CP/CPPS symptoms (CPSI scoring), clinical phenotypes (as expressed by UPOINT), and the correlation between these parameters over time in this retrospective study of 1310 CP/CPPS patients presenting to a single clinic over a 16-year period. The analysis confirmed that an increased number of UPOINT domains was associated with increased CPSI scores, as previously suggested by Shoskes et al.12 It further showed that referring physicians tailored treatments to clinical presentation before UPOINT was described. It appears that both before and after UPOINT introduction, physicians were treating patients with urinary symptoms (U domain) with alpha-blockers, using antidepressants with secondary pain modulation in patients with psychological problems (P domain), neuromodulatory medications (gabapentinoids) for neurogenic pain (N domain), and increasing use of physiotherapy for pelvic floor pain (T domain). Although many patients, particularly in the earlier cohorts, were identified with infection at some time in their past (I domain), our observation of a trend of less antibiotics being employed over time for these patients was compatible with increased understanding of the inappropriateness of antimicrobial therapy in the majority of CP/CPPS patients.

We were surprised that patient-identified pain locations (CPSI) did not necessarily correlate with total CPSI score, UPOINT domains, or treatment. This is in keeping with a large, multinational study of 1563 CP/CPPS patients by Wagenlehner et al,10 where they found that pain severity and frequency were more important than pain location. CP/CPPS is a heterogeneous disease, and pain location may not be overly useful in helping direct treatment, i.e., pain is pain, regardless of location.

We observed a number of trends in UPOINT domain prevalence over time, specifically an increase over time in the P and T domains. This likely does not reflect a change in patient population presenting characteristics, but rather our referring physicians’ understanding of the importance of identifying these domains for better treatment outcomes. In fact, it appears that the patients are not changing over time. The age, CPSI score (and pain, urinary, and impact/QoL subscores), and pain locations did not appreciably change from 1998–2014.

The low use of antibiotics (22.4% overall) was interesting to note, given that current guidelines, acknowledging the generally poor evidence for use in Category III CP/CPPS patients, recommend or suggest consideration of a course of antimicrobial therapy as a first-line treatment option.1517 Although no trends in antibiotic use were seen over time, their relatively low usage as a treatment modality may reflect an increased attention to antimicrobial stewardship among general practitioners. This is in contrast to the increased trend over time in usage of neuromodulation and phytotherapy. This could similarly reflect an increased comfort among general practitioners with neuromodulatory medication prescribing, while increased use of phytotherapy may illustrate a patient population increasingly interested in seeking alternative health strategies and natural products.

While it is encouraging to note that referring physicians appeared to be embracing specific treatments towards identified phenotypes prior to referral to our specialty clinic, it is difficult to know if this has made a significant difference to patient outcome. Certainly, even with the described treatment identified in this referral population, baseline symptoms were similar to those of patients being enrolled in clinical treatment trials.11 Further research will attempt to determine whether identification of specific phenotypes, along with assessment of failed therapies, resulted in therapeutic strategies that provided favourable patient outcomes by examining this same patient population one year after the first clinic assessment described in the present study.

Conclusion

The increased recognition of the UPOINT P and T domains by referring physicians may be responsible for the changing clinical face of CP/CPPS. This increased recognition of specific domains coincides with increased use of their associated therapies. However, there was little change in pain or urinary symptom patterns and QoL over the 16 years of assessment. The more things “appear” to change, the more they stay the same.

Supplementary materials

Supplementary Table 1

UPOINT associations in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

UPOINT

n=941n=361n=660n=440n=402n=644
 Age44.8 (±13.3)44.1 (±13.0)44.8 (±13.4)45.9 (±12.4)43.5 (±12.6)43.6 (±13.5)
 CPSI pain11.2 (±4.8)10.8 (±5.1)11.0 (±4.8)10.5 (±4.7)11.0 (±4.9)11.5 (±4.7)
 CPSI urination6.3 (±2.3)5.2 (±3.0)4.9 (±3.2)4.5 (±3.1)5.1 (±3.1)5.1 (±3.2)
 CPSI QoL8.2 (±2.9)8.4 (±3.1)8.1 (±3.1)7.8 (±3.0)7.9 (±3.2)8.3 (±8.8)
 CPSI total25.8 (±8.2)24.4 (±9.1)24.1 (±9.0)22.8 (±8.8)24.0 (±9.3)24.9 (±8.0)
Pain location
 Perineum575 (61.1%)223 (61.8%)418 (63.3%)274 (62.3%)262 (65.2%)443 (68.8%)
 Testicular503 (53.5%)191 (52.9%)344 (52.1%)217 (49.3%)223 (55.5%)356 (55.3%)
 Tip of penis348 (37.0%)113 (31.3%)226 (34.2%)153 (34.8%)132 (32.8%)225 (34.9%)
 Pubic/bladder629 (66.8%)226 62.6%)416 (63.0%)255 (58.0%)269 (66.9%)423 (65.7%)
 Dysuria454 (48.2%)156 (43.2%)294 (44.5%)194 (44.1%)182 (45.3%)293 (45.5%)
 Ejaculation473 (50.3%)177 (49.0%)316 (47.9%)218 (49.5%)211 (52.5%)324 (50.3%)
Treatment by referring physician*
 Alpha-blockers659 (70.0%)235 (65.1%)445 (67.4%)240 (54.5%)247 (61.4%)422 (65.5%)
 Antidepressants150 (15.9%)105 (29.1%)109 (16.5%)54 (12.3%)65 (16.2%)121 (18.8%)
 Quercetin304 (32.3%)115 (31.9%)244 (37.0%)158 (35.9%)151 (37.6%)227 (35.2%)
 QUrol87 (9.2%)41 (11.4%)57 (8.6%)25 (5.7%)32 (8.0%)68 (10.6%)
 Gabapentinoids61 (6.5%)37 (10.2%)43 (6.5%)19 (4.3%)20 (5.0%)52 (8.1%)
 Acupuncture8 (0.9%)8 (2.2%)5 (0.8%)3 (0.7%)2 (0.5%)5 (0.8%)
 Physiotherapy20 (2.1%)13 (3.6%)14 (2.1%)6 (1.4%)9 (2.2%)27 (4.2%)
 Antibiotics216 (23.0%)72 (19.9%)167 (25.3%)113 (25.7%)100 (24.9%)144 (22.4%)
 Prostate massage22 (2.3%)10 (2.8%)24 (3.6%)24 (5.5%)12 (3.0%)18 (2.8%)

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Supplementary Table 2

Associations of number of UPOINT domains in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

123456

n=249n=408n=368n=192n=39n=7
 Age45.3 (±14.1)44.5 (±12.7)44.3 (±13.2)44.7 (±13.1)43.8 (±13.8)49.4 (±3.3)
 CPSI pain9.2 (±4.6)10.6 (±4.6)11.1 (±4.9)11.6 (±5.2)11.8 (±4.3)14.3 (±2.8)
 CPSI urination3.4 (±2.9)4.6 (±3.1)5.7 (±3.0)6.3 (±2.5)5.4 (±2.8)6.3 (±1.1)
 CPSI QoL6.9 (±3.1)7.9 (±3.0)8.3 (±3.0)8.4 (±3.1)8.4 (±2.9)10.9 (±1.1)
 CPSI total19.5 (±8.2)23.2 (±8.4)25.1 (±8.8)26.4 (±9.1)25.6 (±8.1)31.4 (±6.0)
UPOINT
 U118 (47.4%)287 (70.3%)311 (84.5%)181 (94.3%)35 (89.7%)7 (100%)
 P11 (4.4%)63 (15.4%)128 (34.8%)119 (62.0%)33 (84.6%)7 (100%)
 O45 (18.1%)169 (41.4%)252 (68.5%)148 (77.1%)37 (94.9%)7 (100%)
 I44 (17.7%)129 (31.6%)143 (38.9%)86 (44.8%)29 (74.4%)7 (100%)
 N33 (13.3%)103 (25.2%)123 (33.4%)106 (55.2%)27 (69.2%)7 (100%)
 T62 24.9%)160 (39.2%)227 (61.7%)153 (79.7%)34 (87.2%)7 (100%)
Pain locations
 Perineum125 (50.2%)243 (59.6%)241 (65.5%)123 (64.1%)30 (76.9%)4 (57.1%)
 Testicular108 (43.4)192 (47.1%)203 (55.2%)104 (54.2%)24 (61.5%)5 (71.4%)
 Tip of penis74 (29.7%)146 (35.8%)128 (34.8%)65 (33.9%)16 (41.0%)1 (14.3%)
 Pubic/bladder130 (52.2%)242 (59.3%)243 (66.0%)132 (68.8%)24 (61.5%)7 (100%)
 Dysuria85 (34.1%)166 (40.7%)177 (48.1%)91 (47.4%)23 (59.0%)3 (42.9%)
 Ejaculatory101 (40.6%)185 45.3%)187 (50.8%)106 (55.2%)18 (46.2%)4 (57.1%)
Treatment by referring physician*
 Alpha-blockers128 (51.4%)236 (57.8%)265 (72.0%)125 (65.1%)30 (76.9%)6 (85.7%)
 Antidepressants23 (9.2%)53 (13.0%)70 (19.0%)37 (19.3%)12 (30.8%)2 (28.6%)
 Quercetin83 (33.3%)139 (34.1%)137 (37.2%)62 (32.3%)11 (28.2%)3 (42.9%)
 QUrol18 (7.2%)33 (8.1%)38 (10.3%)18 (9.4%)5 (12.8%)0 (0%)
 Gabapentinoids13 (5.2%)17 (4.2%)25 (6.8%)16 (8.3%)5 (12.8%)1 (14.3%)
 Acupuncture1 (0.4%)2 (0.5%)3 (0.8%)3 (1.6%)1 (2.6%)0 (0%)
 Physiotherapy6 (2.4%)8 (2.0%)9 (2.4%)7 (3.6%)1 (2.6%)0 (0%)
 Antibiotics48 (19.3%)98 (24.0%)84 (22.8%)48 (25.0%)8 (20.5%)2 (28.6%)
 Prostate massage8 (3.2%)19 (4.7%)10 (2.7%)5 (2.6%)1 (2.6%)0 (0%)

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Supplementary Table 3

Associations of pain locations in 1310 CP/CPPS patients treated at a single outpatient clinic from 1998–2014

Perineum painTesticular painTip of penis painPubic/bladder painDysuriaEjaculatory pain

n=788n=658n=441n=798n=553n=615
 Age43.9 (±13.0)43.9 (±12.8)44.4 (±13.8)44.1 (±13.6)44.5 (±13.6)42.8 (±12.6)
 CPSI pain12.3 (±3.9)12.8 (±3.7)13.1 (±3.7)12.4 (±3.8)13.0 (±3.8)12.8 (±3.8)
 CPSI urination5.1 (±3.1)5.3 (±3.1)5.6 (±3.1)5.5 (±3.0)5.9 (±3.0)5.4 (±3.1)
 CPSI QoL8.6 (±2.7)8.7 (±2.7)8.9 (±2.4)8.8 (±2.6)8.8 (±2.6)8.8 (±2.6)
 CPSI total26.0 (±7.8)26.9 (±7.5)27.6 (±7.2)26.7 (±7.4)27.6 (±7.5)27.0 (±7.5)
UPOINT
 U575 (73.0%)503 (76.4%)348 (78.9%)629 (78.8%)454 (82.1%)473 (76.9%)
 P223 (28.3%)191 (29.0%)113 (25.6%)226 (28.3%)156 (28.2%)177 (28.2%)
 O418 (53.0%)344 (52.3%)226 (51.2%)416 (52.1%)294 (53.2%)316 (51.4%)
 I274 (34.8%)217 (33.0%)153 (34.7%)255 (32.0%)194 (35.1%)218 (35.4%)
 N262 (33.2%)223 (33.9%)132 (29.9%)269 (33.7%)182 (32.9%)211 (34.3%)
 T443 (56.2%)356 (54.1%)225 (51.0%)423 (53.0%)293 (53.0%)324 (52.7%)
Pain locations
 Perineum788 (100%)479 (72.8%)296 (67.1%)524 65.7%)362 (65.5%)424 (68.9%)
 Testicular479 (60.8%)658 (100%)257 (58.3%)483 (60.5%)323 (58.4%)359 (58.4%)
 Tip of penis296 (37.6%)257 (58.3%)441 (100%)308 (38.6%)280 (50.6%)263 (42.8%)
 Pubic/bladder524 (66.5%)483 (73.4%)308 (69.8%)798 (100%)398 (72.0%)418 (68.0%)
 Dysuria362 (45.9%)323 (49.1%)280 (63.5%)398 (49.9%)553 (100%)347 (56.4%)
 Ejaculatory424 (53.8%)359 (54.6%)263 (59.6%)418 (52.4%)347 (62.7%)615 (100%)
Treatment by referring physician*
 Alpha-blockers502 (63.7%)412 (62.6%)303 (68.7%)529 (66.3%)386 (69.8%)402 (65.4%)
 Antidepressants136 (17.3%)108 (16.4%)72 (16.4%)140 (17.5%)98 (17.7%)103 (16.7%)
 Quercetin311 (39.5%)242 (36.8%)168 (38.1%)298 (37.3%)210 (38.0%)239 (38.9%)
 QUrol77 (9.8%)59 (9.0%)51 (11.6%)71 (8.9%)53 (9.6%)62 (10.1%)
 Gabapentinoids55 (7.0%)49 (7.4%)35 (7.9%)55 (6.9%)44 (8.0%)43 (7.0%)
 Acupuncture7 (0.9%)4 (0.6%)2 (0.5%)6 (0.8%)4 (0.7%)6 (1.0%)
 Physiotherapy27 (3.4%)22 (3.3%)17 (3.9%)28 (3.5%)19 (3.4%)14 (2.3%)
 Antibiotics183 (23.2%)142 (21.6%)88 (20.0%)179 (22.4%)121 (21.9%)138 (22.4%)
 Prostate massage35 (4.4%)22 (3.3%)17 (3.9%)22 (2.8%)20 (3.6%)18 (2.9%)

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Acknowledgements

Dr. Nickel is supported by grants from the CIHR and NIH/NIDDK.

Footnotes

Competing interests: Dr. Nickel has been a consultant for Astellas, Auxillium, Eli Lilly, Farr Labs, Ferring, GSK, Pfizer, Redleaf Pharma, Taris Biomedical, Tribute, and Trillium Therapeutics; a lecturer for Astellas and Eli Lilly; and has participated in clinical trials supported by Eli Lilly, GSK, J&J, Pfizer, and Taris Biomedical. The remaining authors report no competing personal or financial interests related to this work.

This paper has been peer-reviewed.

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Articles from Canadian Urological Association Journal are provided here courtesy of Canadian Urological Association


Sours: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994985/
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What Is Prostatitis?

Prostatitis is a condition that involves inflammation of the prostate, a walnut-shaped gland responsible for producing the fluid portion of semen. Prostatitis can also involve inflammation in areas adjacent to the prostate (though this cannot happen without inflammation of the prostate first).

Male prostate and surrounding structures.

Interestingly, the symptoms of prostatitis can include pain in the male genitourinary system, or it may be completely painless. There are several variations of the condition. Prostatitis treatment, symptoms, and likeliness depend on the type of prostatitis that one experiences.

Types of Prostatitis

There are four types of prostatitis.

ChronicProstatitis, or Chronic Pelvic Pain Syndrome (CP/CPPS)

The exact underlying origin of chronic, or long-term, prostatitis is unknown, but researchers believe it may be linked to the immune system’s response to a previous UTI (urinary tract infection).

Chronic prostatitis is the most common type of prostatitis, impacting 10 to 15 percent of males in the United States.

This type of prostatitis is not caused by a bacterial infection, but, rather, is the result of other causes. A study published in the Indian Journal of Urology reports that chronic prostatitis/chronic pain syndrome “accounts for 90 percent of prostatitis cases in outpatient clinics and is characterized by chronic pelvic pain symptoms lasting at least three months during the past six months, in the absence of a urinary tract bacterial infection, but in the presence of urinary symptoms and sexual dysfunction.”

However, it is not completely evident that CPPS symptoms are caused by prostate disease in all cases. One biopsy study showed that CPPS patients had the same prostate biopsy results as people with healthy prostates.

Acute Bacterial Prostatitis

This type of prostatitis involves symptoms (such as pain) which are usually severe and come on suddenly.  

Chronic Bacterial Prostatitis

A type of prostatitis that is also caused by a bacterial infection, but develops slowly, over time. The symptoms are usually mild in comparison with acute bacterial prostatitis.

Asymptomatic Inflammatory Prostatitis

A type of prostatitis that is not associated with pain or any other symptoms. The condition oftentimes is found unexpectedly in laboratory results when a person is being tested for urinary tract or reproductive disorders, such as fertility problems. It is usually not treated.

Prostatitis Symptoms

Symptoms of (CP/CPPS)

CP/CPPS involves pain (lasting three months or longer) in one or more areas, including:

  • The penis (including during ejaculation)
  • The scrotum (skin sack under the penis)
  • Between the anus and scrotum (the perineum).
  • The lower abdomen (in the center area)
  • The lower back
  • The urethra (after urination) in the penis (during urination)

Other symptoms of CP/CPPS may include:

  • Urinary frequency (urinating more than seven times per day)
  • Difficulty urinating, such as dribbling or hesitant urination
  • Urinary urgency (inability to hold it when needing to urinate)
  • A weak or interrupted urine stream.

The pain experienced as a result of CP/CPPS may occur in one or more areas at a time, it may appear suddenly or come on gradually.

Symptoms of Acute Prostatitis

Acute prostatitis usually occurs suddenly and involves:

  • Urinary frequency and/or urgency
  • Severe pain in the genital area, perineum, groin, lower back, and abdomen
  • Difficulty urinating, such as dribbling or hesitant urination
  • Fever and chills
  • Burning or pain during urination (dysuria)
  • Nocturia (frequent urination during sleep)
  • Nausea and vomiting
  • Body aches
  • Inability to empty the bladder completely (urinary retention)
  • Trouble starting the urine stream
  • A weak or an interrupted urine stream
  • The complete inability to urinate (urinary blockage)
  • Bacteria in the urine (urinary tract infection, referred to as a UTI)
  • Cloudy or bloody urine.

Symptoms of Chronic Bacterial Prostatitis

While some symptoms occur in multiple types of prostatitis, others are unique to each kind.

  • Urinary frequency or urgency
  • Pain in the genital area, groin, lower abdomen, or lower back
  • Painful ejaculation
  • Urinary retention
  • Touble starting a urine stream or a weak or interrupted urine stream
  • Urinary blockage (inability to urinate)
  • Urinary tract infection (UTI)

Causes

Prostatitis accounts for two million visits to healthcare providers each year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In men under age 50, prostatitis is said to be the most common urinary tract condition. In men over age 50, it’s the third most common urinary tract problem.  

There are several factors that put a person at higher risk for getting prostatitis, including:

  • Age (young or middle-aged men are more at risk)
  • Having a previous diagnosis of prostatitis
  • Having an infection in the bladder or in the urethra (urethritis)
  • Having pelvic trauma (like a biking or horseback riding injury)
  • Using a urinary catheter (a tube used to drain the bladder)
  • Having HIV/AIDS
  • Having had a prostate biopsy

In conversations with your healthcare provider, it's important to share the details of your medical history so that your practitioner can assess your risk.

Diagnosis

In addition to your medical history and a physical rectal exam to check for abnormalities of the prostate, a healthcare provider may recommend prostatitis treatment based on the results of a battery of tests.

  • Urinalysis: a test from a urine sample, to check for bacteria
  • Blood tests: Blood samples check for signs of infection or other prostate problems, such as prostate cancer
  • Cystoscopy: a scope that is inserted into the penis under local anesthesia; used to examine the urinary tract for narrowing, a blockage, or stones
  • Transrectal ultrasound: a device that is placed in the rectum to portray an ultrasound picture of the prostate, allowing for the assessment of the size and any abnormalities of the prostate, such as tumors
  • Biopsy of the prostate: a procedure performed under anesthesia, involving the removal and examination of a very small piece of prostate tissue to check for prostate cancer                    
  • Semen analysis: often used to measure the quality and amount of sperm in semen; for prostatitis the fluid can be evaluated for markers of infection and cultured to look for microorganisms

The detection and diagnosis of asymptomatic inflammatory prostatitis is usually made as a result of lab test results (such as a urinalysis or PSA test to evaluate the risk of prostate cancer). Your healthcare provider will do workup to ensure there are no other causes to your symptoms before determining it as asymptomatic inflammatory prostatitis.

Treatment

Just like the symptoms and characteristics of the condition differ according to the type of prostatitis, so too do prostatitis treatment strategies.

Chronic Prostatitis Treatment (CS/CPPS)

Because there is such a wide range of symptoms that may occur in CS/CPPS, treatment is not the same for everyone with this type of prostatitis. Although antibiotics are not usually effective in CS/CPPS (because it’s not caused by a bacterial infection) the treating healthcare provider may initially prescribe antibiotics until bacterial prostatitis can be ruled out and the exact type of prostatitis can be diagnosed.

Other medications that may be prescribed include:

  • Anti-inflammatory drugs such as NSAIDS, including ibuprofen or naproxen for pain and inflammation.
  • Muscle relaxants such as Robaxin (methocarbamol) and Flexeril (cyclobenzaprine) to relax pelvic muscles and relieve pain while lowering anxiety.
  • Anti-depressants such as amitriptyline (Elavil) or nortriptyline [Pamelor) for neuropathic pain, urinary problems, or psychological depression that can occur from dealing with a chronic medical condition like prostatitis. Neuropathic pain is pain caused by damage or disease that affects the sensory system in the body.
  • Alpha blockers such as Flomax (tamsulosin) or Uroxatral (alfuzosin) to help with pain and discomfort a well as improving urinary retention.
  • 5 alpha reductase inhibitors such as Proscar (finasteride) and Avodart (dutasteride) to improve urinary symptoms by helping to relax the muscles of the bladder. This improves urine flow.
  • Anticholinergic agents such as Ditropan for symptoms of overactive bladder or “sudden urge” to urinate.
  • Gabapentinoids such as Neurontin (gabapentin) and Lyrica (pregabalin) are non-opioid, non-NSAID, non-acetaminophen medications for neuropathic pain.

Supplements that may be useful include:

  • Quercetin, a flavonoid-type antioxidant found in fruit, including red grapes and apples; quercetin is thought to have very strong anti-inflammatory properties).
  • Graminex pollen-including extracts of rye grass pollen (Secale cereal), corn pollen (Zea mays), and timothy pollen (Phleum pretense)

Other Types of Prostatitis Treatment for CS/CPPS

Some at-home strategies may also help, including:

  • Warm sitz baths (warm soaks)
  • Heat therapy to the local area (using heating pads or hot water bottles)
  • Physical therapy (including pelvic muscle exercises to improve urinary function).
  • myofascial release
  • Stress management techniques (such as relaxation exercises, yoga, or meditation)

Acute Bacterial Prostatitis Treatment

Antibiotics are considered the gold standard of treatment for bacterial types (chronic and acute) of prostatitis. Oral antibiotics are usually prescribed for at least 14 days. If symptoms recur, oral antibiotics may be prescribed for up to six to eight weeks. In severe cases of bacterial prostatitis, hospitalization may be required so that IV antibiotics can be given. 

In addition to antibiotics, changes in the diet may include avoiding foods that irritate the bladder, including caffeinated beverages, acidic foods, and spicy foods.

Chronic Bacterial Prostatitis Treatment

Although antibiotics are given for both acute and chronic bacterial prostatitis, a longer course may be prescribed for the chronic type of bacterial prostatitis. In fact, a low dose of antibiotics may be given for up to six months, according to the NIDDK. Just like in the treatment of acute bacterial type prostatitis, a diet change, eliminating foods that irritate the bladder and increasing fluids, may be ordered.

Alpha blockers, such as Flomax (tamsulosin) or Uroxatral (alfuzosin) may be prescribed for urinary retention caused by bacterial prostatitis. Alpha blockers help relax the bladder muscles and relieve painful urination (dysuria).  

Another prostatitis treatment that may be recommended for the chronic bacterial type is surgical removal of enlarged prostate tissue or scar tissue in the urethra. This can help improve the urine flow and reduce symptoms of urinary retention.

Asymptomatic Prostatitis Treatment

As the name of the condition indicates, there are typically no symptoms of pain or urinary problems associated with asymptomatic prostatitis, but there is inflammation of the prostate. Oftentimes, however, when a urinalysis is done, bacteria and other organisms are discovered in the urine. In this instance, the healthcare provider will usually prescribe antibiotics.

Studies have discovered a link between asymptomatic inflammatory prostatitis and the PSA level. In fact, one report showed that as many as one-third of men with increased PSA levels have asymptomatic inflammatory prostatitis. A PSA level, also known as prostate-specific antigen level, is one indicator that a man could have an increased risk of prostate cancer. After a biopsy is performed to rule out prostate cancer, a diagnosis of asymptomatic prostatitis may be considered. 

Complications

Complications of prostatitis may occur, particularly when prostatitis treatment is postponed. These may include:

  • Abacterial infection in the bloodstream (bacteremia)
  • An abscess (pus-filled area in the prostate, called a prostatic abscess)
  • Inflammation of reproductive organs near the prostate (such as the epididymis, a coil-shaped tube attached to the back of the testicle)
  • Sexual dysfunction
  • Infertility and semen abnormalities (from chronic prostatitis)

If acute prostatitis does not respond well enough to antibiotic treatment, prostatitis is likely to recur, making it more difficult to treat and longer term. In this scenario, acute prostatitis transforms into chronic (long-term) prostatitis.

You should discuss any complications you're experiencing with your healthcare provider. They may be able to recommend strategies for improving the complication, or at least preventing it from getting worse.

A Word From Verywell

Researchers are working to try to understand the causes of various types of prostatitis so that appropriate treatment and prevention strategies can be implemented. Currently, there is no known measure of prevention of prostatitis, although preventing urinary tract infections can aid in lowering the incidence of bacterial prostatitis (both chronic and acute).

Medical and Sexual Applications of Prostate Massage

Thanks for your feedback!

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  • NIDDK Staff. Prostatitis: Inflammation of the Prostate. What is prostatitis? U.S. Department of Health and Human Services. The National Institute of Diabetes and Digestive and Kidney Disease.

  • Reacher, J. Does Using Pollen for Prostatitis Treatment Work? Prostate.net.

  • Smith, C.P., (2016). Male chronic pelvic pain: An update. Indian Journal of Urology; 32 (1): 34-30. DOI: 10.4103/0970-1591.173105

Sours: https://www.verywellhealth.com/prostatitis-overview-4582651
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