Male Chronic Pelvic Pain: AUA Guideline: Part II Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Abstract

Purpose: This Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part II of a three-part series focusing on treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A challenge for clinicians treating these patients is the necessity to address symptoms and etiologies outside of the usual urologic evaluation. Consequently, recommended treatment utilizes a multimodal/multidisciplinary approach that is highlighted through discussion of referral to other specialists and allied health professionals while continuing to manage urologic symptoms. For discussion of patient evaluation and treatment of chronic scrotal content pain, refer to Parts I and III of this series.

Materials and methods: The systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024.

Results: The Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for the treatment of patients with CP/CPPS, which may include lifestyle modification, behavioral therapy, pharmacologic and phytotherapeutic options, and procedural intervention.

Conclusions: We usually think of pain in response to tissue injury that resolves with healing. We now know that pain can also derive from neurologic origins. Effective treatment of CP/CPPS will require better understanding of what is causing persistence of the pain in addition to further testing of therapies under investigation to establish a role in patient care.