Inflammatory chronic pelvic pain syndrome

Chronic pelvic inflammatory pain syndrome (CIPPS, category IIIa according to the NIH classification) is a nonbacterial inflammation of the prostate gland that lasts for more than 3 months, accompanied by periodic pain in the lower abdomen, perineum, external genitalia, lumbosacral region and/or urination disorders.

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Epidemiology

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

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Causes inflammatory chronic pelvic pain syndrome.

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

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

Pathologically, in chronic inflammatory abacterial prostatitis, lymphohistiocytic infiltration of the tissue of the prostate gland and its ducts is revealed in combination with foci of sclerosis.

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Diagnostics inflammatory chronic pelvic pain syndrome.

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Clinical examination

Symptoms of inflammatory syndrome of chronic pelvic pain consist of complaints of pain and dysuric phenomena of an inconstant nature, occurring in various combinations and to varying degrees of severity.

Patients with VSHTB complain of periodically occurring pain in the urethra, perineum, rectum, lower abdomen or in the lumbar-sacral region, associated or not associated with urination. Patients note difficulty in urination and a weak urine stream, accompanied by a feeling of incomplete emptying of the bladder. False urges to urinate occur periodically.

The medical history may reveal episodes of self-medication with antibacterial drugs, frequent immunosuppressive effects (hypothermia, insolation, alcohol abuse).

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

In patients with chronic inflammatory abacterial prostatitis, palpation of the prostate gland using PRI allows one to establish enlargement, pain, asymmetry and heterogeneity of the organ tissue.

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Laboratory diagnostics

Laboratory diagnostics of inflammatory syndrome of chronic pelvic pain is based on the results of multiportion urine tests. The criterion for diagnosing category Illa prostatitis when conducting a 4-glass test is an increased content of leukocytes and the absence of a significant number of bacteria in the urine sample and PM 3. In the case of using a 2-glass test, similar characteristics are noted in the urine portion obtained after prostate massage.

All patients are recommended to undergo examination aimed at excluding sexually transmitted diseases (testing of a smear from the urethra using the polymerase chain reaction method).

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

Instrumental methods

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

Differential diagnosis

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

Chronic abacterial inflammation of the prostate should be differentiated from chronic urethritis. Differential diagnostics are also carried out based on the results of the 4-glass test.

Differential diagnosis of inflammatory syndrome of chronic pelvic pain and urethritis

Disease	4-glass test results (increased leukocytes/presence of bacteria)
	PM 1	PM 2	SPZH	Pmz
VSHTB	-/-	-/-	+/-	+/-
Chronic urethritis	+/+	-/-	-/-	-/-

ICPPS - inflammatory chronic pelvic pain syndrome, PM 1 - first portion of urine, PM 2 - second portion of urine. PM 3 - third portion of urine, SPZh - prostatic secretion.

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

Examples of diagnosis formulation

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

Treatment inflammatory chronic pelvic pain syndrome.

The goal of treatment is to eliminate inflammation of the prostate gland.

Indications for hospitalization

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

Non-drug treatment

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

Drug treatment

Given 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 administered. If the dynamics are positive, the indicated treatment is continued for another 4-6 weeks.

In combination with antibacterial drugs, non-titratable alpha1-adrenergic blockers (tamsulosin, alfuzosin) may be prescribed to reduce dynamic obstruction of the posterior urethra and prevent possible urethroprostatic reflux.

In combination or monotherapy, it is possible to use herbal preparations based on the extract of American fan-leaved (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).

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Forecast

Long-term inflammatory syndrome of chronic pelvic pain can lead to prostate sclerosis and infertility. People with persistent course of this form of the disease have an increased risk of developing prostate cancer.

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