Managment, evaluation and differential diagnosis

Below follows an overview of the current management recomendations (1-3) [and personal experience]. The obvious goal of the procedure is to exclude other possible conditions with similar presentation to CPPS.

The standard procedure is to:

• take an anamnesis (ambition varies, but used medications, previous surgery and treatment directed at the lower abdomen and pelvis should be checked for),
• do some tests (PSA, standard blood, urinalysis and presence of STD),
• palpate the prostate and testicles and
• give anti-biotics (e.g. ciprofloxacin), anti-inflammatories and alpha-blockers.

An ambitious urologist may also perform a urography, suprapubic and transrectal ultrasound scans, especially on NIH-I suspicion, and do the NIH-CPSI, IPSS or similar. A Meares-Stamey test is not likely to be performed. If further evaluation is warranted urine cytology and urography / flow rate is recommended.

Some optional procedures are also recommended. These are semen analysis (especially if the patient is young and can be expected to want children), urethral swab (to search for micro-organisms), flow-EMG, cystoscopy (e.g. if IC is suspected) and MRI / CAT-scan / X-rays (especially on suspiscion of cancer). If CPPS is assumed an in-depth evaluation of pain, sexual discomfort, dysuric discomfort, abdominal-pelvic status and muscular tone (“pelvic floor assessment”) should also be made (by palpation).

Conditions to differentiate from (the list is not to be regarded as a complete listing):

• Abdominal wall defects: inguinal or ventral wall hernias, myofascial trigger points.
• Gastrointestinal causes: appendicitis, diverticulitis, constipation, anal fissures, hemorrhoids. [Do notice that constipation may occur in CPPS!]
• Infection: sexually transmitted diseases, chronic bacterial prostatitis, fungal infection.
• Musculoskeletal causes: neoplasm (primary or metastatic), degenerative joint disease of the hips, sacroileitis.
• Neurologic causes: low thoracic or lumbar herniated nucleus pulposis, lumbar stenosis, Parkinson disease, diabetic cystopathy, demyelinating disease.
• Urologic causes: urinary retention, prostatic abcess, renal calculi, varicocele, epididymitis, testicular neoplasm, interstitial cystitis, bladder outlet obstruction, bladder neck hypertrophy, vesical sphincter dyssynergia, prostatic cysts, kidney disease.
• And of course prostate cancer and BPH.

Pituitary disorders were not mentioned in the references.

Do also see discussion on co-morbidities that will follow later.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
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(1) Potts J, Payne RE. Prostatitis: Infection, neuromuscular disorder, or pain syndrome? Proper patient classification is key. Cleveland Clinic Journal of Medicine, vol. 74, suppl 3, May 2007.
(2) Nickel JC. Recommendations for the evaluation of patients with prostatitis. World J Urol 21:75-81, 2003.
(3) Nickel JC, Baranowski AP, Pontari M, Berger RE, Tripp DA. Managment of men diagnosed with CP/CPPS who have failed traditional management. Reviews in Urology 9(2):63-72, 2007.