Recognizing CPPS as multifactorial a big step forward.

[Anonymous]

Recognizing CPPS as multifactorial a big
step forward.

Anthony J. Schaeffer 04/01/2001 Urology
Times

A number of articles in this issue of Urology
Times discuss the growing body of evidence
that our patients who suffer from chronic
pelvic pain clearly comprise a heterogenous
population with diverse etiologies for their
symptoms. A movement to change the
terminology itself for the condition from the
very specific "chronic prostatitis" to the
broader "chronic pelvic pain syndrome"
(CPPS) indicates that the urologic
community has begun to embrace this
concept.

Current research is directed at pinpointing--
or in some cases, ruling out--the causes of
the pain and voiding symptoms that
characterize CPPS. Studies are examining
the role of inflammation, infectious disease,
pelvic muscle tension, and autoimmunity,
among other factors. Early therapeutic
trials, although not yet reproducible,
suggest possible benefits of anti-
inflammatory drugs, antimicrobials,
antioxidant phytotherapeutic agents, and
physical therapy. But the results of these
studies also make it clear that no single
treatment is effective in the face of a
multifactorial condition. Even the role of
inflammation itself in CPPS has been called
into question (see article, page 1).
Ultimately, we should strive to select out
men with a given etiology and tailor a
treatment modality accordingly. We have
not reached this point, and empiric therapy
cannot be considered unreasonable just yet.
However, patients who do not respond to
early, empiric treatment require a detailed
analysis that includes, at the very least, a
thorough search for inflammation
throughout the urinary tract and then a
similar search for bacteria. Consider
examining the pelvic muscles for tone and
tenderness as well. This approach may help
you identify a specific problem area that
would suggest a more directed course of
therapy.

For many of you who are frustrated by an
inability to treat CPPS effectively and are
anxiously awaiting more definitive data,
there is good news to report. Multicenter
studies under the umbrella of the NIH-
funded Chronic Prostatitis Collaborative
Network are systematically tackling this
problem. An initial effort has led to an
effective clinical assessment measure, the
Chronic Prostatitis Symptoms Index, which
is now scientifically validated. Results of the
Network's longitudinal studies, some of
which will be presented at the upcoming
AUA annual meeting, should shed some
light on possible etiologies of this condition.
And this summer will mark the launch of the
first full-fledged, double-blind clinical trial
examining potential treatment arms.

These efforts show that we are heading in
the right direction. And by realizing that
CPPS is not a homogenous condition,
researchers have taken the important step
of focusing on more individualized
treatment strategies.

Anthony J. Schaeffer, MD, a member of the
Urology Times editorial council, is professor
and chairman of the department of urology
at Northwestern University Medical School,
Chicago.

[John Garst]

In article <0a25f2e8d1fdddca...@remailer.privacy.at>,
Anonymous <nob...@remailer.privacy.at> wrote:

...

> For many of you who are frustrated by an
> inability to treat CPPS effectively and are
> anxiously awaiting more definitive data,
> there is good news to report. Multicenter
> studies under the umbrella of the NIH-
> funded Chronic Prostatitis Collaborative
> Network are systematically tackling this

> problem....

I look forward to more useful "good news."