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What is Prostatodynia?

The term prostatodynia, usually called chronic pelvic pain syndrome (CPPS), is not encouraged in current practice and is used to designate unexplained pelvic pain in men which is associated with irritative voiding symptoms and/or pain located in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria.

 

This term carries the negative historical connotation of being a "wastebasket" designation for a melange of psychosomatic symptoms and suggests that the source of the patient's symptoms invariably lies within the prostate gland itself. Current research has provided evidence of numerous extra-prostatic considerations, including neuropathic and other systemic pathologies.

 

Pontari and Ruggieri's comprehensive 2004 update reviews the numerous pathophysiologic mechanisms implicated as the potential etiology of CPPS. After surveying all of the relevant articles on this topic published from 1966-2003, these researchers reached the following conclusions: The etiology (or etiologies) of CPPS remains unknown.

 

 The number of WBCs (pus cells) found in the prostatic fluid under microscopic examination—long considered the hallmark of this disease process—does not correlate with the degree of pain or with other symptoms experienced by patients with CPPS. Histological signs of inflammation were found in only one third of all patients diagnosed with CPPS who underwent prostatic biopsy, further suggesting an extraprostatic etiology for CPPS. Perhaps CPPS—so-called chronic prostatitis(CP)—is not directly associated with the prostate or with inflammation within it, at least in some cases.

 

Abnormal functioning of the nervous system, at the local level and/or within the CNS, may also play a role in the development of CPPS. For example, a substance known as nerve growth factor (NGF) can cause an increase in the number and the sensitivity of the pelvic nerves that transmit pain. An increase in NGF has been correlated with the development of CPPS symptoms. 

 

Psychological stress and depression have long been associated with CPPS flare-ups. This observation has led some researchers to mistakenly conclude that CPPS is "all in your head” or that such mental stress results in a lower psychological threshold for the same objective degree of pain. More recent data, however, suggest that psychological stress and depression may measurably influence the local production of cytokines in the pelvis, thus directly exacerbating CPPS inflammation. 

 

An academic distinction is currently made as follows:
(1) patients with excess WBCs in their prostatic secretions (chronic nonbacterial prostatitis, class IIIa) and
(2) those with normal prostatic secretions. However, the clinical value of this distinction is now being challenged. The sole parameter is the number of WBCs seen within a smear of prostatic secretions. However, this number may vary widely within the same specimen and even more so from sample to sample taken from the same patient. Furthermore, asymptomatic control patients devoid of any evidence of pelvic pathology have also been found to have a significant number of WBCs in their prostatic secretions. At present, the distinction seems to provide no meaningful differential with respect to either etiology or treatment options.

 

Normal defense mechanisms allow healthy men to render these bacteria harmless as mere microbial "hitchhikers." However, these defense mechanisms may be defective in men with CPPS. This theory helps explain why prolonged courses of antibiotics sometimes provide symptomatic relief for men with CPPS despite the absence of bacteria that are traditionally considered pathogenic. Besides, herbs like the diuretic and anti-inflammatory pill is another choice to do some help for this condition when considering about the antibiotic resistance.

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