Chronic Pelvic Pain Syndrome in Men – Part I

The typical CPPS patient is a young–to–middle-aged man who will visit the urologist (a specialized doctor in conditions of the urinary system) complaining primarily of erectile dysfunction. Since CPPS symptoms are similar in men with chronic bacterial prostatitis and those where bacteria can not be found, a US National Institutes of Health (NIH) collaborative panel has proposed the Chronic Prostatitis Symptom Index (NIH-CPSI) in order to facilitate history taking and to establish a more uniform standard. This index is calculated using 9 questions that contain 21 items used to assess patient history in a standardized and quantifiable format. The questionnaire addresses four classes of symptoms: pain, problems with urination, impact of symptoms on life and activity, and quality of life. The NIH describes 4 categories of prostatitis as follows (note that type III below refers to CPPS):

Type I – Acute bacterial prostatitis;
Type II – Chronic bacterial prostatitis;
Type III – Chronic abacterial prostatitis, ie, chronic pelvic pain syndrome (CPPS) categorized as either type IIIa (inflammatory CPPS) or type IIIb (noninflammatory CPPS)
Type IV – Asymptomatic inflammatory prostatitis

In the next paper, I will continue with physical examination, investigations and treatment approaches.

Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)
Director, Comprehensive Pain Program,
Senior Investigator, Krembil Neuroscience Centre
Toronto Western Hospital,
Chair ACTION Ontario

Keywords: pain