Chronic Prostatitis/Chronic Pelvic Pain Syndrome (eBook)

Preface 6
Table of Contents 8
Contributors 12
Chapter 1 15
Evaluation of the Prostatitis Patient 15
1 Introduction 16
2 Clinical Presentation 17
3 History 17
4 Physical Examination 19
5 Differential Diagnosis of CPPS 20
5.1 Laboratory Studies 20
5.2 Imaging 24
5.3 Voiding Studies 24
5.4 Endoscopy 25
5.5 Miscellaneous Investigations 25
5.5.1 Potassium Sensitivity Test 25
5.5.2 Hydrodistention 26
6 Conclusion 26
References 27
Chapter 2 31
Acute Bacterial Prostatitis 31
1 Introduction 32
2 Epidemiology 32
3 Pathogenesis 33
3.1 Microbiological Factors 33
3.2 Immunology 33
4 Evaluation 35
4.1 Clinical Evaluation 35
4.2 Urine Analysis and Culture 35
4.3 Imaging 36
4.4 Laboratory Investigations 36
4.4.1 Serum Parameters 36
4.4.2 Serum PSA 36
5 Treatment 37
5.1 Antimicrobial Treatment of Acute Prostatitis 37
5.2 Treatment of Prostatic Abscess 38
5.3 Treatment of Urinary Retention 39
5.4 Unusual Infections of the Prostate 39
5.4.1 Tuberculosis 39
5.4.2 Patients With HIV 40
5.4.3 Brucellosis 42
6 Conclusion 42
References 42
Chapter 3 45
Chronic Bacterial Prostatitis 45
1 Introduction 46
2 Epidemiology 46
3 Pathogenesis 46
4 Evaluation 47
4.1 Investigation of Urine Cultures and EPS 47
4.2 Additional Investigations 48
5 Treatment 48
5.1 Antimicrobial Treatment 48
5.1.1 Theoretical Considerations 48
5.1.2 Studies in Volunteers 50
5.1.3 Studies in Patients 51
5.1.4 Duration of Antibiotic Treatment 52
5.2 Additional Treatment 53
5.3 Management of Recurrent UTIs in Men 53
5.3.1 Antimicrobial Treatment 53
5.3.2 Antimicrobial Prophylaxis 53
5.4 Antibiotic Resistance of Fluoroquinolones 54
5.5 Selection of the Appropriate Antimicrobial Drug 54
6 Conclusion 55
References 55
Chapter 4 59
Prostatitis in the Immunocompromised Patient 59
1 Introduction 59
2 Cryptococcus 60
3 Aspergillus 61
4 Viral Prostatitis 62
5 Blastomyces 63
6 Histoplasma 63
7 Coccidioidomycosis 63
8 Candidiasis 64
9 Parasitic Infections of the Prostate 65
10 Bacterial Prostatitis 65
11 Approach to the Patient and Treatment Algorithm 67
References 69
Chapter 5 73
Quality of Life and Economic Impact of Chronic Prostatitis 73
1 Introduction 74
2 Clinical Aspects of Prostatitis 74
2.1 Definition and Prevalence 74
2.2 Diagnosis and Treatment 75
2.3 Health-Related Quality of Life 76
2.4 Quality of Life Impact 76
2.5 Symptoms and Symptom Measures 77
2.6 Disease-Specific Measures of Health 79
2.7 Generic Measures of Health 79
3 Economics:Individual and Social Costs of Prostatitis 80
4 Health Care Utilization for Prostatitis:Results from the Urologic Diseases in America Project 80
4.1 Inpatient Care 80
4.2 Outpatient Care 81
4.2.1 Hospital Outpatient Visits 81
4.2.2 Physician Office Visits 81
4.3 Ambulatory Surgery Procedures 82
4.4 Emergency Room Visits 82
4.5 Economic Impact 83
5 Direct and Indirect Costs 83
6 Conclusion 85
References 86
Chapter 6 91
Antibiotic Therapy in Chronic Prostatitis/Chronic Pelvic Pain Syndrome 91
References 96
Chapter 7 99
Alpha-Blocker Therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome 99
1 Introduction 100
2 Rationale of Alpha-Blocker Therapy in Patients With CP/CPPS 100
2.1 Initial Observations 100
3 Alpha-Blocker Pharmacology in the Lower Urinary Tract 100
4 Data and Debate 101
4.1 Bladder Outflow Obstruction and Disordered Voiding in Prostatitis 101
4.2 Uncontrolled and Small Prospective Studies of Alpha-Blocker Therapy for Patients With Symptoms of Chronic Prostatitis 103
5 Randomized Clinical Trials of Alpha-Blocker Therapy for CP/CPPS 103
5.1 Meta-Analysis of Randomized Clinical Trials Using Alpha-Blockers 103
5.1.1 Limitations 104
5.2 Tamsulosin 105
5.2.1 Comparison of Tamsulosin With Placebo Therapy 105
5.2.1.1 Population 106
5.2.1.2 Study Design 106
5.2.1.3 Results 106
5.2.1.4 Summary 106
5.2.2 Tamsulosin, Ciprofloxacin, Combination Or Placebo Therapy 106
5.2.2.1 Population 107
5.2.2.2 Study Design 107
5.2.2.3 Results 107
5.2.2.4 Summary 108
5.3 Alfuzosin 108
5.3.1 Population 108
5.3.2 Study Design 108
5.3.3 Results 108
5.3.4 Summary 109
5.3.5 Ongoing Studies 109
5.4 Terazosin 109
5.4.1 Population 110
5.4.2 Study Design 110
5.4.3 Results 110
5.4.3.1 Initial Response 110
5.4.3.2 Long-Term Results 110
5.5 Summary 111
6 Current Role of Alpha-Blocker Therapy and Clinical Questions 111
References 112
Chapter 8 115
Phytotherapy and the Prostatitis Syndromes 115
1 Introduction 115
2 Category I (Acute Prostatitis) 116
3 Category II (Chronic Bacterial Prostatitis) 117
4 Category III (Chronic Pelvic Pain Syndrome [CPPS]) 117
5 Phytotherapy for CPPS 118
5.1 Saw Palmetto 118
5.2 Pollen Extracts/Cernilton 118
5.3 Quercetin 119
References 121
Chapter 9 125
Neuromuscular and Psychoactive Treatments for Chronic Prostatitis 125
1 Introduction 126
2 Involvement of the Nervous System in CP/CPPS 126
3 Treatment of Neuropathic Pain in Men With CP/CPPS 128
3.1 Tricyclic Antidepressants 128
3.2 Non-TCAs 129
3.3 Anticonvulsants 129
3.4 Tramadol 131
4 Medications to Treat Muscle Spasticity 131
4.1 Cyclobenzaprine 132
4.2 Tizanidine 132
4.3 Montelukast 133
5 Surgical Therapies for CP/CPPS 133
5.1 Bladder Neck Incision 133
5.2 Neuromodulation 133
6 Conclusion 134
References 134
Chapter 10 139
The Role of Surgery and Minimally Invasive Prostate Therapies in Prostatitis 139
1 Introduction 139
2 Heat Therapy 140
3 Microwaves and Electromagnetic Energy in Bacterial Prostatitis 141
4 Seminal Vesiculography 141
5 Other Surgery 142
6 Conclusion 142
References 142
Chapter 11 145
Physical Therapy for Chronic Prostatitis /Chronic Pelvic Pain Syndrome 145
1 Introduction 145
2 Reframing the Symptoms 146
2.1 Pain 146
2.2 Voiding Dysfunction 147
2.3 Sexual Dysfunction 147
2.4 Muscles, Nerves, and the Pelvic Floor 148
3 Evaluation of Patients With CPPS 151
4 Treatment of the CPPS Patient 153
5 Conclusion 154
References 154
Chapter 12 157
A Biopsychosocial Therapy Model for Chronic Prostatitis/Chronic Pelvic Pain Syndrome 157
1 Introduction 157
2 An Alternative to the Biomedical Model? 159
3 Psychological Comorbidity in CP/CPPS 163
3.1 Depressive and Anxiety Symptoms 163
3.2 Relationship Impact of CP/CPPS 164
3.3 CP/CPPS Quality of Life 165
3.4 The Biopsychosocial CP/CPPS Data 166
4 A Cognitive-Behavioral Symptom Management Program for CP/CPPS? 168
5 Conclusions 172
References 173
Chapter 13 179
Pain Management in Chronic Prostatitis 179
1 Introduction 179
2 Etiology 180
3 Classification 180
4 Symptoms 180
5 Management of Pain in the Prostatitis Syndromes 180
5.1 Nerve Blocks 181
5.1.1 Superior Hypogastric Plexus Block 181
5.1.1.1 Technique 181
5.1.2 Ganglion Impar (Ganglion of Walther) Block 181
5.1.2.1 Technique 182
5.1.3 Pudendal Nerve Block 184
5.1.3.1 Technique 184
5.1.4 Neuromodulation 185
References 187
Chapter 14 189
Sexual Dysfunction and Infertility in Chronic Prostatitis 189
1 Introduction 190
2 Classification and Demographics of Sexual Dysfunction 190
3 Anatomy of Erection 190
4 Physiology of Erection 191
5 Causes of Sexual Dysfunction 191
6 CP/CPPS and Sexual Dysfunction 192
7 CPPS and Premature Ejaculation 193
8 Diagnostic Evaluation of ED 193
9 Therapeutic Management of Sexual Dysfunction 195
10 Infertility and CP/CPPS 199
References 200
Chapter 15 203
Interstitial Cystitis in Men:Diagnosis, Treatment, and Similarities to Chronic Prostatitis 203
1 Introduction 203
2 Definitions and Demographics 204
3 Quality of Life 204
4 Similarities in Clinical Presentation Between IC and CP 205
5 Similarities in Pathogenesis Between IC and CP 207
5.1 Occult Infection 207
5.2 Defective Epithelium 208
5.3 Neurogenic Inflammation 209
5.4 Mast Cell Activation 209
5.5 Autoimmunity 210
6 Diagnosis 210
7 Treatment 213
7.1 Diet Modification 213
7.2 Behavioral Modifications and Physical Therapy 213
7.3 Oral Therapies 214
7.3.1 Pentosan Polysulfate Sodium (PPS) 214
7.3.2 Antihistamines 215
7.3.3 Tricyclic Antidepressants (TCAs) 215
7.3.4 Serotonin/Norepinephrine Reuptake Inhibitors 216
7.3.5 Antispasmodic, Antiseizure, and Muscle Relaxant Medications 216
7.4 Intravesical Therapies 216
7.5 Surgery 217
8 Conclusion 217
References 218
Chapter 16 223
Category IV Prostatitis:Implications for Prostate Cancer Screening, Diagnosis, and Carcinogenesis 223
1 Introduction 223
2 Prevalence 224
3 Pathophysiology 225
4 Impact of Inflammation on PSA 227
5 Impact of Inflammation on Carcinogenesis 228
6 Treating Mildly Elevated PSA Before or Instead of Performing Biopsy 229
7 Risk of Biopsy in the Setting of Prostatitis 230
8 Treatment of Category IV Prostatitis 231
9 Conclusion 231
References 232
Chapter 17 235
The Role of Nanobacteria/Calcifying Nanoparticles in Prostate Disease 235
1 Introduction 236
2 Background/Theoretical Considerations 236
2.1 Corpora Amylacea 237
3 Do Nanobacteria/Calcifying Nanoparticles/Nano-organisms Exist? 237
3.1 History 238
3.2 Properties of NBs 240
4 In Vitro/Histologic Evidence 244
4.1 Genitourinary-Prostate/Testes 244
4.1.1 Preliminary Data 244
4.2 NB Prostate: Histologic 245
4.3 Other Genitourinary (GU) Organ Involvement With NB 245
4.3.1 Kidney 245
4.4 NB Potential Involvement With Disease in Other Organ Systems 246
4.4.1 Cardiovascular 246
4.4.2 Cancer 247
4.4.3 Other Organ Sites 247
5 Nanobacterial Therapy 248
6 Clinical Evidence for Prostatitis Treatment 249
7 What Is Missing? Research Needed 249
8 Conclusion 251
References 251
Chapter 18 259
Strategies for Increasing the Understanding of Chronic Prostatitis/Chronic Pelvic Pain Syndrome 259
1 Introduction 260
2 Development of a Symptom Index 260
3 Burden 261
4 Natural History and Prognosis 262
5 Risk Factors for and Etiology of CP/CPPS 263
6 Risk of Other Urologic Diseases in Men With CP/CPPS 264
7 Defining the Phenotype 264
8 Diagnosis 265
9 Treatment 265
10 Future Research 266
References 267
Chapter 19 273
Chronic Prostatitis/Chronic Pelvic Pain Syndrome:The Past, Present, and Future 273
1 The Traditional Concept of Prostatitis 274
2 An Improved Diagnostic Strategy 274
3 Has Our Traditional Biomedical Model of Therapy Failed? 275
4 Our Understanding of the Etiology of CP/CPPS Is Improving 276
5 The Evolution of CP/CPPS Treatment 276
5.1 Immunomodulation 277
5.2 Neuromodulation 277
5.3 Physical Therapy 277
5.4 Cognitive-Behavioral Therapy (CBT) 277
5.5 Other Exciting Therapeutic Developments 277
6 The Future 278
Chapter 20 279
Therapy for Category III Prostatitis:A Synthesis 279
1 Introduction 279
2 CPPS Is a Syndrome, Not a Disease 280
3 Duration and Chronicity of CPPS Should Influence Approach 280
4 Evidence-Based Medicine and CPPS:Strengths and Limitations 281
5 The Early “Treatment-Naive” Patient 281
6 The Patient with Long Duration and Recalcitrant Symptoms 284
Index 287