A study of 1,310 patients evaluated over 16 years for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) showed that pain and urinary symptom patterns and quality of life remained consistent over time. Advances in clinical phenotyping and treatment occurred, leading to a changing clinical picture, particularly with the adoption of multimodal therapy.
Use of next-generation sequencing of the urinary biome of patients with CP/CPPS showed bacteria in 75% of specimens and an average of two types of bacteria per sample, suggesting a potential for culture-driven treatment.
Intraurethral inoculation of two types of laboratory mice with gram-positive bacteria from patients with CP/CPPS induced a pain response that varied by the genetic background of the host animal, suggesting host-pathogen interactions are involved in the development of pain in CP/CPPS.
Trigger-point injection as an adjunct to standard treatment for CP/CPPS was well tolerated and led to symptom improvement in 50% of patients.
Transcutaneous nerve stimulation for refractory CPPS resulted in subjective improvement in 62% of patients, including quality of life and urinary symptoms, and was associated with no adverse events.
Use of a body pain map to characterize CPPS showed extra-abdominal and extrapelvic pain in three of four patients evaluated and was associated with worse quality of life and psychosocial issues, but not worse urinary symptoms.
A randomized trial of CPPS treatment showed that the addition of a phosphodiesterase-type-5 inhibitor to an alpha-blocker and a fluoroquinolone led to greater improvement in symptoms and quality of life than did two-drug therapy.
Almost two-thirds of a group of men with CPPS tested positive for small fiber polyneuropathy (SFPN), adding to evidence of SFPN involvement in CPPS etiology and suggesting alternative treatment strategies, such as intravenous immunoglobulin and immunomodulation.