Diagnosis of Chronic Pelvic Pain Syndrome

CPPS has always been a common disease bothering urologists, which will have a serious impact on the physical and mental health of patients. For this disease, there are still some problems, such as complicated pathogenic factors, diversified clinical symptoms, controversial diagnosis methods and efficacy standards, and inconsistent treatment courses.

Digital rectal examination

In the digital rectal examination, the prostate is full, enlarged, soft and there will be mild tenderness. In patients with longer duration, the gland will become small, hard and uneven in texture.

Urinalysis

Take a urine sample for analysis before the prostate massage is an auxiliary method to eliminate urinary tract infection and diagnose prostatitis. Some related diseases, such as bacterial infection and malignant tumors of the urogenital system, can be found or excluded.

Expressed prostatic secretion

The microscopic examination of prostatic secretion plays an important role in the diagnosis and differentiation of prostatitis, but it can cause misleading. For example, excessive white blood cells in the prostatic massage fluid may be a false-positive reaction caused by urethral diseases, and the same non-specific infectious diseases of the prostate (such as noninfectious prostatic stones) may also lead to a false-positive reaction.

White blood cells(WBC) in the prostatic fluid were also significantly increased in normal men within hours after sexual intercourse and ejaculation. It is generally believed that the WBC number increases in EPS of patients with chronic bacterial prostatitis and chronic aseptic prostatitis, but not in patients with chronic pelvic pain syndrome.

The correlation between WBC count and symptom severity is not clear. The cytoplasm of macrophages in EPS contains phagocytized lecithin corpuscles or cell fragments, which is the unique manifestation of prostatitis.

Pathogen location examination

The four-cup method is a classical method, but the experiment is complicated, and the operability is limited. This consensus does not recommend the application in daily diagnosis and treatment. It is recommended to use two cup method or PPMT before and after the massage.

The diagnostic accuracy of the latter is more than 96%. Only 8% of CPPS patients were positive in bacterial culture, which was not significantly different from asymptomatic patients. Therefore, it is not necessary for the diagnosis of CPPS.

Cystoscopy

In addition, mild to moderate bladder neck obstruction and trabecula formation could be found.

Examination of the immune response

Studies have shown that both systemic and local immune responses to bacterial infection of the prostate can be produced. However, the value of the detection of antibodies in a prostatic fluid is limited.

However, shorilffe et al. found that the specific antibodies against Chlamydia trachomatis and Ureaplasma urealyticum were significantly increased in the prostatic fluid of nonbacterial prostatitis, suggesting that the detection of antibodies may have some value in the etiological study of CPPS.

Cytology of urine

Although some scholars recommend urine cytology, so far, there is no definite evidence to prove its value in the screening of prostatitis.

Urodynamic examination

The rigid function of the bladder neck and internal sphincter is obviously out of order, which makes the maximum and average flow rate of urine decrease. The urethra of the bladder neck and the prostate near the external sphincter of the urethra can not be completely relaxed, and the maximum closed pressure of urethra will increase during the static period.

The electric silence (normal relaxation) of the external sphincter of the urethra is a typical manifestation of this kind of patient.

Cystourethrography

During urination, bladder neck obstruction, incomplete funnel, urethral stricture at the external sphincter, etc. can occur.

Imaging examination

Transrectal B-ultrasound is a fast and simple method, and its contrast resolution is better than CT and MRI. It is one of the primary screening tests for the diagnosis of prostate diseases.

In order to make a clear diagnosis and differential diagnosis, we can choose semen analysis or bacterial culture, prostate-specific antigen (PSA), urine flow rate, urodynamics, CT, MRI and prostate biopsy.

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