Chronic pelvic pain inflammatory syndrome

Inflammatory syndrome of chronic pelvic pain (VSHTB, category IIIa according to the NIH classification) - an abacterial inflammation of the prostate gland that lasts for more than 3 months, accompanied by periodic pain in the lower abdominal parts, in the perineum, vulva, lumbosacral region and / or urination disorders.

[1], [2], [3], [4], [5], [6]

Epidemiology

This form of the disease accounts for about 65% of all manifest forms of  prostatitis.

[7], [8], [9], [10], [11], [12], [13]

Causes of the inflammatory syndrome of chronic pelvic pain

The presumed etiologic factor of BCCP is bacterial pathogens that can not be detected using modern diagnostic methods. According to single modern studies, in patients with this form of prostatitis, it is possible to detect molecular markers of infectious agents. The effectiveness of trial antibacterial therapy in patients with VCCP also confirms the bacterial nature of the disease.

According to another point of view, the cause of the disease can be urethroprostatic reflux, which causes aseptic inflammation of the prostate gland due to urine entering its ducts.

Pathomorphology in chronic inflammatory abacterial prostatitis reveals lymphohistiocytic infiltration of prostate tissue and its ducts in combination with sclerosis.

[14], [15], [16], [17], [18], [19]

Diagnostics of the inflammatory syndrome of chronic pelvic pain

[20], [21], [22]

Clinical examination

Symptoms of inflammatory syndrome of chronic pelvic pain consists of complaints of pain and dysuric phenomena of a non-permanent nature, arising in a different combination and in varying degrees.

Patients with HCVTB complain of recurring pain in the urethra, perineum, rectum, lower abdomen or in the lumbosacral region, whether or not associated with urination. Patients report a difficulty with the micturition and lethargy of the urine stream, accompanied by a feeling of incomplete emptying of the bladder. Periodically, there are false urge to urinate.

In the anamnesis you can identify episodes of self-medication with antibacterial drugs, frequent immunosuppressive effects (hypothermia, insolation, alcohol abuse).

To assess and subsequently monitor the effectiveness of the treatment, the NIH-CPSI symptom scale is used.

In patients with chronic inflammatory abacterial prostatitis, palpation of the prostate with PID helps to establish an increase in soreness, asymmetry and heterogeneity of the organ tissue.

[23], [24], [25]

Laboratory diagnostics

Laboratory diagnosis of inflammatory syndrome of chronic pelvic pain is based on the results of multiple  urine analyzes. The criterion for the diagnosis of prostatitis in the category of Illa in the 4-glass sample is the increased leukocyte count and the absence of a significant amount of bacteria in the LSR and PM 3. In the case of a 2-cup sample, similar characteristics are noted in the portion of urine obtained after the prostate massage.

All patients are shown a survey aimed at the exclusion of sexually transmitted diseases (examination of a smear from the urethra by polymerase chain reaction).

It is possible to carry out an analysis of the ejaculate (detect pyospermia in the absence of a significant amount of bacteria in the seminal fluid).

Instrumental methods

TRUS is not an obligatory diagnostic method for inflammatory syndrome of chronic pelvic pain due to the absence of typical changes in this form of the disease. The ultrasonographic pattern does not differ significantly from that of a chronic bacterial prostatitis.

Differential diagnosis

Differential diagnosis is performed with a chronic bacterial prostatitis (category II) based on the results of a 4- or 2-glass sample.

Chronic abacterial inflammation of the prostate should be differentiated from chronic urethritis. Differential diagnosis is also performed based on the results of a 4-glass sample.

Differential diagnosis of inflammatory syndrome of chronic pelvic pain and urethritis

Disease	The results of a 4-glass sample (increase of leukocytes / presence of bacteria)
	PM 1	PM 2	SPL	PMZ
VSHTB	- / -	- / -	+/-	+/-
Chronic urethritis	+ / +	- / -	- / -	- / -

VSHTB - inflammatory syndrome of chronic pelvic pain, PM 1 - the first portion of urine, PM 2 - the second portion of urine. PM 3 is the third portion of urine, SPL is the secret of the prostate gland.

In men over the age of 45, prostatitis of category IIIa should be differentiated from prostate cancer and hyperplasia.

Examples of the formulation of the diagnosis

• Inflammatory syndrome of chronic pelvic pain.
• Chronic abacterial inflammatory prostatitis.

Treatment of the inflammatory syndrome of chronic pelvic pain

The goal of treatment is the elimination of inflammation of the prostate gland.

Indications for hospitalization

Treatment of chronic inflammatory abacterial prostatitis is performed on an outpatient basis.

Non-drug treatment

It is advisable to lead an active lifestyle, exclude immunosuppressive effects (hypothermia, insolation). From the diet it is recommended to exclude alcohol, carbonated drinks, spicy, pickled, salty and bitter food.

Medication

Given data on the possible infectious nature of the inflammatory syndrome of chronic pelvic pain, a trial 14-day antibacterial therapy with fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin), tetracyclines (doxycycline) or sulfonamides (sulfamethoxazole / trimethoprim) is performed. With positive dynamics, this treatment continues for another 4-6 weeks.

Together with antibacterial drugs, it is possible to designate non-titerable alpha 1-adrenoblockers (tamsulosin, alfuzosin) in order to reduce the dynamic obstruction of the posterior urethra and prevent possible urethroprostatic reflux.

In complex or monotherapy, it is possible to use herbal preparations on the basis of an extract of the American dwarf palm (Serenoa repena), Cameroon plum (Pygeum africanum) or pollen of various plants (Phleum pratense, Secale cereale, Zea mays).

Prevention

To prevent inflammatory syndrome of chronic pelvic pain, it is necessary to avoid unmotivated therapy or self-medication with antibacterial drugs. It is important to prevent immunosuppressive effects (hypothermia, insolation, alcohol abuse).

[26], [27], [28], [29], [30],

Forecast

Prolonged inflammatory syndrome of chronic pelvic pain can lead to sclerosis of the prostate and infertility. In people with persistent current of this form of the disease, the risk of prostate cancer is increased.

[31], [32]