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Meta-Analysis
. 2024 Mar;211(3):341-353.
doi: 10.1097/JU.0000000000003820. Epub 2023 Dec 18.

Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature

Emily S Barker  1 , Kimberley Chiu  2 , Victoria L Brown  2   3 , Haidy Morsy  2   4 , Lauren H Yaeger  5 , Arya Catna  3 , Ratna Pakpahan  3 , Robert Moldwin  6 , Barbara Shorter  7 , Jerry L Lowder  2   3 , H Henry Lai  8   9 , Siobhan Sutcliffe  2   3
Affiliations
Meta-Analysis

Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature

Emily S Barker et al. J Urol. 2024 Mar.

Abstract

Purpose: We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research.

Materials and methods: We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals.

Results: Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms.

Conclusions: Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.

Keywords: bladder pain syndrome; chronic pelvic pain syndrome; chronic prostatitis; interstitial cystitis; symptom exacerbation.

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Conflict of interest statement

Conflict of interest disclosures:

Emily S. Barker: None

Kimberley Chiu: None

Victoria L. Brown: None

Haidy Morsy: None

Lauren S. Yaeger: None

Arya Catna: None

Ratna Pakpahan: None

Robert Moldwin:

Abbvie Pharmaceuticals, PI and consultant

Ironwood Pharmaceuticals, PI and consultant

Kuste Pharmaceuticals, PI and consultant

Trigone Pharmaceuticals, Consultant

Vaneltix Pharmaceuticals, PI

Barbara Shorter: None

Jerry L. Lowder: Expert witness

Henry L. Lai: None

Siobhan Sutcliffe: None

Figures

Figure 1:
Figure 1:
PRISMA flow diagram for the systematic review of urologic chronic pelvic pain syndrome symptom flares
See this image and copyright information in PMC

References

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