Clinical phenotypes and treatment patterns in men with chronic pelvic pain: a tertiary referral cohort

Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have heterogeneous symptoms and variable responses to treatment. We sought to identify clinical and treatment factors associated with pain improvement. Specifically, which presenting features and management strategies are associated with clinically meaningful reductions in pain among men with CP/CPPS?

We performed a retrospective review of men evaluated for chronic pelvic or genitourinary pain by a single specialist from February 2023 to July 2025. Patients were included based on ICD codes for pelvic pain, genitourinary pain, or chronic prostatitis. Demographics, presenting symptoms, and initial and most recent visual analog scale (VAS) pain scores were collected. Intervention types were compared by analyzing VAS scores before and after receiving an intervention.

157 men were included, of which 103 had follow-up VAS data. The median follow up was 277 days and median symptom duration prior to presentation was 24 months. Diffuse pelvic pain was the most common phenotype (51.6%). The mean baseline and most recent VAS scores were 3.4 and 2.1, respectively. The greatest improvements were associated with penile block (- 3.8), spermatic cord block (- 2.6), and hydrodistension with cautery of ulcers (- 2.6). Cystoscopy was performed in 26.8% of patients. While often non-diagnostic (31%), cystoscopy frequently diagnosed inflammatory lesions (31%) and BPH (19%).

Most patients with CP/CPPS experienced clinically meaningful pain reduction following subspecialist evaluation. Diffuse pain without clear triggers is common. Greater improvement with nerve blocks and treatment of Hunner's lesions supports a phenotype-driven approach. However, studies are needed to isolate and validate treatment effects.