A simplified algorithm for management of CP/CPPS and associated entities: A summary table for general urologists

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 25% urology clinic visits. Due to significant overlap with other conditions, CP/CPPS is frequently misdiagnosed and inadequately managed. Therefore, we provided a simplified diagnostic and treatment approach to CP/CPPS by subdividing it into distinct subcategories.

We systematically reviewed the published literature about CP/CPPS and its "associated entities", including interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, male accessory gland Inflammation, and Chlamydia trachomatis infection. We applied the UPOINTS system to differentiate CP/CPPS phenotypes, using male accessory gland inflammation solely to flag potential inflammatory-pelvic pain overlap.

The review yielded an evidence base of 140 articles pertaining to CP/CPPS treatment antibiotics, α-blockers, anti-inflammatory drugs, phytotherapeutics, neuromodulators, physical therapy, local blocks, injections, and minimal invasive treatments. CP/CPPS, interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, and C trachomatis infection, and developed type-specific, step-by-step diagnostic and therapeutic algorithms. The proposed treatment model includes physiotherapy, minimally invasive options, and innovative interventions.

Dividing CP/CPPS into 6 distinct subtypes offers clinicians more targeted guidance when selecting appropriate diagnostic tools and therapeutic interventions. Sperm analysis is recommended for patients with a history of infertility, painful ejaculation, or hematospermia, whereas pyospermia warrants investigation using semen cultures, polymerase chain reaction testing, and transrectal ultrasound. Ct-infection should be ruled out in young patients with prostatitis-like symptoms, burning micturition, "penile tip irritation," and a thick urethral discharge. Patients over 50 years of age who have failed conventional therapy may require cystoscopy. Transrectal ultrasound can help rule out clustered prostatic calcifications, especially in older, overweight patients with a persistently elevated International Prostate Symptom Score and an increased white blood cell count in postprostatic massage urine. This approach is recommended for guiding CP/CPPS treatment.