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Evaluation and Treatment of Chronic Pelvic Pain Syndrome in Men

Evaluation and Treatment of Chronic Pelvic Pain Syndrome in Men

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

The American Urological Association (AUA) is interested in creating a guidance document for the evaluation and treatment of chronic pelvic pain syndrome (CPPS) in men.

Question: What evaluation and treatment strategies can be used for men with CPPS? Does the effectiveness vary by evaluation/ treatment type?

Population of interest:

Men with any of the following:

  • Chronic Prostatitis; especially the more pervasive non-bacterial (NIH type III) form of prostatitis. Chronic Non-Bacterial Prostatitis Type III is also known in the literature as Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS).
  • Chronic Prostatodynia or Prostate Pain Syndrome, which could reflect the non-inflammatory form for chronic prostatitis (Type IIIb specifically).
  • Chronic Orchialgia, Orchidynia, Testalgia, Scrotal Contents Pain, Chronic Scrotal Pain or Chronic Testicular Pain.

Intervention and Comparators:

  • Treatment (see list below) v. treatment
  • Treatment v. placebo
  • Combination of treatments v. treatment
  • Combination of treatments v. placebo

Treatments include:

  • Lifestyle changes (i.e., dietary changes, exercise)
  • Physical therapy
  • Psychotherapy
  • Medications (Alpha adrenergic antagonist, Antibiotics, Pain relievers (NSAIDs), Antidepressants, 5-alpha reductase inhibitor, Onabotulinumtoxin A)
  • Surgical therapy (Transurethral microwave thermotherapy, TURP, Prostatectomy, Transrectal high-intensity focused ultrasound, Transurethral needle ablation of the prostate)
  • Other therapies (Extracorporeal shock wave therapy, Neurologic treatments [i.e., neuromodulation], Acupuncture, Nerve Blocks)

Outcomes: Symptom relief for men with CPPS (UPOINT scores, Physical Exam)

2. Why are you struggling with this issue?

CPPS is the most common urologic disease in men below 50 years old with a worldwide prevalence between 2 and 16%.(1) CPPS has a widely negative impact on quality of life (QoL) that can compare to other diseases such as diabetes mellitus, Crohn's disease, angina, and myocardial infarction. In a study conducted by Collins et al. (2001), it was found patients' mental health is impacted in addition to their physical health.(2)

Additionally, the economic costs associated with this disease surpasses the annual direct costs associated with other common chronic diseases such as peripheral neuropathy, fibromyalgia, lower back pain, and rheumatoid arthritis. The annual direct costs for CPPS are approximately $6,534 (using non-Medicare rates).(1)

In addition to the prevalence of this disease, there is a severe lack of formal evidence-based guidance in this topic area. At present, there is a clinical practice guideline produced by the European Association of Urology (EAU) on CPPS that covers both female and male pelvic pain; encompassing interstitial cystitis/bladder pain syndrome (AUA has a separate guideline on this topic), sexual pain syndrome, myofascial pain syndromes, prostate pain syndrome, scrotal pain syndrome, urethral pain syndrome, vaginal and vulvar pain syndromes and CPPS and prolapse/incontinence mesh.(3) It reviews observational as well as experimental studies and performs a primarily qualitative synthesis of data that covers the epidemiology, pathophysiology, diagnostic evaluation, management and post-treatment follow-up phase. The guideline was first published in 2012.

References

  1. Smith CP: Male chronic pelvic pain: An update. Indian J Urol 2016; 32: 34.
  2. McNaughton Collins M, Pontari MA, O'Leary MP et al: Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med 2001; 16: 656.
  3. Fall M, Baranowski AP, Elneil S et al: EAU guidelines on chronic pelvic pain. Eur Urol 2010; 57: 35.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

CP/CPPS and orchialgia in men is prevalent and proves challenging to manage due to the lack of understanding of its etiology and pathophysiology, and the lack of strong evidence that demonstrates specific treatment efficacy. At this time, there is a lack of evidence-based guidelines specially dedicated to this topic. While there is no "gold standard" for treatment of CPPS, a multidisciplinary and multimodal approach could give patients a better chance of symptom relief.(1,2) There is a current lack of consistency in treatment for CPPS, which would make a guideline specifically dedicated to the treatment of this disease useful amongst the medical community.

There is evidence available to support necessary guidance that would serve to be helpful to practicing urologists as well as primary care practitioners who frequently see patients affected by these conditions should the guidelines committee deduce that this is a clinical area of high importance with a significant need for guidance.

References:

  1. Smith CP: Male chronic pelvic pain: An update. Indian J Urol 2016; 32: 34.
  2. Polackwich AS, Shoskes DA: Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis 2016; 19: 132.

4. When do you need the evidence report?

Fri, 06/30/2023

5. What will you do with the evidence report?

The AUA intends to use this systematic report developed by AHRQ to create an evidence-based guidance document over the next 2–3 years. The creation of an evidence report on this topic would allow the AUA to create a document in a relatively short timeframe as the data collection, extraction and analysis would have already been completed in adherence with the highest standards of systematic review. AUA guidance documents are scientifically rigorous and evidence-based, and with a staff of three full-time professionals and one part-time professional as well as extensive consultant support, the AUA Guidelines Department is well positioned to develop high-quality documents in a timely, efficient and effective manner.

The AUA continues its dedication to providing quality, evidence-based education through the dissemination of pocket guides and other educational products to both urologic specialists and primary care physicians who most commonly treat the patients described herein. Additionally, the AUA Guidelines Department works closely with the Urology Care Foundation, committed to patient education and advocacy, to develop patient guides from its clinical practice guidelines. The development of a guidance document on Male CPPS would enable the AUA to develop additional material with a strong focus on the importance of patient counseling and education, which is essential for a condition that relies heavily on shared decision-making when discussing treatment options.

(Optional) About You

What is your role or perspective? Professional Society

If you are you making a suggestion on behalf of an organization, please state the name of the organization: American Urological Association

May we contact you if we have questions about your nomination? Yes

Title: Guidelines Project Manager

Page last reviewed May 2021
Page originally created May 2021

Internet Citation: Evaluation and Treatment of Chronic Pelvic Pain Syndrome in Men. Content last reviewed May 2021. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/chronic-pelvic-pain-syndrome-men

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