Chronic Prostatitis/Chronic Pelvic Pain Syndrome Current Clinical Urology Urologic Robotic Surgery, edited by Jeffrey A. Stock, Michael P. Esposito, and Vincent Lanteri, 2008 Genitourinary Pain and Inflammation: Diagnosis and Management, edited by Jeannette M. Potts, 2008 Prostate Biopsy: Indications, Techniques, and Complications, edited by J. Stephen Jones, 2008 Chronic Prostatitis/Chronic Pelvic Pain Syndrome, edited by Daniel A. Shoskes, 2008 Female Urology: A Practical Clinical Guide, edited by Howard Goldman and Sandip P. Vasavada, 2007 Urinary Stone Disease: The Practical Guide to Medical and Surgical Management, edited by Marshall L. Stoller and Maxwell V. Meng, 2007 Peyronie’s Disease: A Guide to Clinical Management, edited by Laurence A. Levine, 2006 Male Sexual Function: A Guide to Clinical Management, Second Edition, edited by John J. Mulcahy, 2006 Advanced Endourology: The Complete Clinical Guide, edited by Stephen Y. Nakada and Margaret S. Pearle, 2005 Oral Pharmacotherapy of Male Sexual Dysfunction: A Guide to Clinical Management, edited by Gregory A. Broderick, 2005 Urological Emergencies: A Practical Guide, edited by Hunter Wessells and Jack W. McAninch, 2005 Management of Prostate Cancer, Second Edition, edited by Eric A. Klein, 2004 Essential Urology: A Guide to Clinical Practice, edited by Jeannette M. Potts, 2004 Management of Benign Prostatic Hypertrophy, edited by Kevin T. McVary, 2004 Pediatric Urology, edited by John P. Gearhart, 2003 Laparoscopic Urologic Oncology, edited by Jeffrey A. Cadeddu, 2004 Essential Urologic Laparoscopy: The Complete Clinical Guide, edited by Stephen Y. Nakada, 2003 Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Follow-Up, edited by Culley C. Carson, III, 2002 Male Sexual Function: A Guide to Clinical Management, edited by John J. Mulcahy, 2001 Prostate Cancer Screening, edited by Ian M. Thompson, Martin I. Resnick, and Eric A. Klein, 2001 Bladder Cancer: Current Diagnosis and Treatment, edited by Michael J. Droller, 2001 Office Urology: The Clinician’s Guide, edited by Elroy D. Kursh and James C. Ulchaker, 2001 Voiding Dysfunction: Diagnosis and Treatment, edited by Rodney A. Appell, 2000 Management of Prostate Cancer, edited by Eric A. Klein, 2000 Chronic Prostatitis/Chronic Pelvic Pain Syndrome Edited by Daniel A. Shoskes, MD Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Editor Daniel A. Shoskes, MD Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, Ohio Series Editor Eric A. Klein, MD Professor of Surgery Cleveland Clinic Lerner College of Medicine Head, Section of Urologic Oncology Glickman Urological and Kidney Institute Cleveland, OH ISBN: 978-1-934115-27-5 e-ISBN: 978-1-59745-472-8 Library of Congress Control Number: 2007938048 © 2008 Humana Press, a part of Springer Science + Business Media, LLC All rights reserved. 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The publisher makes no warranty, express or implied, with respect to the material contained herein. Cover illustration: Chapter 1, Fig. 2B Printed on acid-free paper 10 9 8 7 6 5 4 3 2 1 springer.com Preface Prostatitis is a clear enigma within urology; a group of conditions that is at once extremely common, poorly understood, inadequately treated, and under-researched. When I developed a research interest in the conditions about ten years ago, a careful read of the literature to date was quite surprising. The classification system was based upon the “4-glass test,” which was designed to help localize bacterial infec- tions and had never been validated for other use. There was no validated symptom score. There was not a single randomized placebo-controlled trial using symptoms as an outcome. The condition was clearly a “wastebasket of urology.” When speak- ing at academic meetings, I seldom failed to get a laugh adding “…and I’m not the most junior member of the faculty” to my introduction. Ten years later, much has changed. National Institutes of Health funding support has brought new investigators into the field. We now have a classification system based upon clinical syndromes rather than etiology (which is still unknown). Outcomes research has improved our understanding of the incidence, quality of life impact, and economic impact. We have a validated symptom score that appears to adequately measure both symptom severity and response to therapy. Randomized placebo-controlled trials are now the rule rather than the exception. Established dogma on the investigation, therapy and indeed the prostatic origin for many men with “chronic prostatitis” is being challenged. The purpose of this book is to review the state of the art in prostatitis combining practical clinical recommendations with cutting-edge clinical research, basic science, and questions for the future. We have assembled a diverse international group of contributors that includes urologists (academic, primary care, and front- line private practice), scientists, psychologists, pain specialists, and directors from the National Institute of Health. Chapters cover general evaluation of the prostatitis patient; the approach to acute prostatitis; chronic bacterial prostatitis and chronic pelvic pain syndrome; evidence behind individual therapies; and ancillary topics such as erectile dysfunction, infertility, the link between chronic prostatitis and prostate cancer; male interstitial cystitis; and the potential etiologic role of calcify- ing nanoparticles. We conclude with reviews of where we have come from and where we may be going and a practical summary chapter of therapy for chronic pelvic pain syndrome based upon established data and clinical experience. v vi Preface It is my sincere hope that readers can find novel approaches in this text to help their patients. I also hope that in another ten years, we will be able to marvel at how much more has been accomplished and how the suffering of men with prostatitis has been eased. Daniel A. Shoskes, MD Contents Preface. v Contributors . ix Chapter 1 Evaluation of the Prostatitis Patient . 1 Carvell T. Nguyen and Daniel A. Shoskes Chapter 2 Acute Bacterial Prostatitis . 17 Kurt G. Naber, Florian M. E. Wagenlehner, and Wolfgang Weidner Chapter 3 Chronic Bacterial Prostatitis . 31 Wolfgang Weidner, Florian M. E. Wagenlehner, and Kurt G. Naber Chapter 4 Prostatitis in the Immunocompromised Patient . 45 Alain J. Duclos Chapter 5 Quality of Life and Economic Impact of Chronic Prostatitis . 59 Elizabeth A. Calhoun, Anna M. S. Duloy, and J. Quentin Clemens Chapter 6 Antibiotic Therapy in Chronic Prostatitis/Chronic Pelvic Pain Syndrome. 77 Russell Blair Egerdie Chapter 7 Alpha-Blocker Therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome. 85 Shaun Wen Huey Lee, Men Long Liong, Kah Hay Yuen, Yee Vonne Liong, and John N. Krieger vii viii Contents Chapter 8 Phytotherapy and the Prostatitis Syndromes. 101 Daniel A. Shoskes Chapter 9 Neuromuscular and Psychoactive Treatments for Chronic Prostatitis . 111 Michel Pontari Chapter 10 The Role of Surgery and Minimally Invasive Prostate Therapies in Prostatitis . 125 Jonathan Bergman and Scott I. Zeitlin Chapter 11 Physical Therapy for Chronic Prostatitis /Chronic Pelvic Pain Syndrome. 131 Jeannette M. Potts Chapter 12 A Biopsychosocial Therapy Model for Chronic Prostatitis/Chronic Pelvic Pain Syndrome . 143 Dean A. Tripp Chapter 13 Pain Management in Chronic Prostatitis . 165 Amgad Abdu, Samer Narouze, and Nagy A. Mekhail Chapter 14 Sexual Dysfunction and Infertility in Chronic Prostatitis. 175 Lawrence S. Hakim Chapter 15 Interstitial Cystitis in Men: Diagnosis, Treatment, and Similarities to Chronic Prostatitis . 189 Jonathan D. Kaye and Robert M. Moldwin Chapter 16 Category IV Prostatitis: Implications for Prostate Cancer Screening, Diagnosis, and Carcinogenesis . 209 J. Stephen Jones Chapter 17 The Role of Nanobacteria/Calcifying Nanoparticles in Prostate Disease . 221 Jeffrey A. Jones, Neva Ciftcioglu, and David McKay Chapter 18 Strategies for Increasing the Understanding of Chronic Prostatitis/Chronic Pelvic Pain Syndrome . 245 John W. Kusek and Leroy M. Nyberg Contents ix Chapter 19 Chronic Prostatitis/Chronic Pelvic Pain Syndrome: The Past, Present, and Future . 259 J. Curtis Nickel Chapter 20 Therapy for Category III Prostatitis: A Synthesis . 265 Daniel A. Shoskes Index . 273 Contributors Amgad Abdu, MD Pain Management Center, The Cleveland Clinic, Cleveland, OH Jonathan Bergman, MD Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA Elizabeth A. Calhoun, PhD University of Illinois at Chicago, Chicago, IL Neva Ciftcioglu, PhD Nanobac Pharmaceuticals,