Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is of considerable interest in clinical urology. During the past decade, several new approaches have been made to discover its aetiology and pathophysiological mechanisms and to develop treatment modalities. The aetiology of CPPS has remained unresolved. Bacterial, chemical, urodynamic and immunological aetiologies have been suggested, but none of these has been conclusively proven. The histopathological changes in CP and CPPS are relatively well known, but the pathophysiological changes that lead to chronic inflammation and prolonged symptoms are still poorly understood. This review proposes an additional approach to the pathophysiology of CPPS. The concept of prostate tissue pressure is introduced as an objectively measurable parameter in evaluating the inflammatory process in CPPS. Chronic pain due to neurogenic inflammation and altered mast cell function is also discussed.

Assessment of Perigenital Sensitivity and Prostatic Mast Cell Activation in a Mouse Model of Neonatal Maternal Separation

“…Patients with CP/CPPS have variant etiology that largely does not involve previous infection of or direct injury to the prostate [1][2][3] . Despite this fact, published models of CP/CPPS have incorporated direct or indirect inflammation of the prostate to induce hypersensitivity of the perigenital region and/or mast cell activation.…”

“…These syndromes are often comorbid and share many characteristics in that they have no associated pathology or identified underlying etiology, although dysfunction within the immune system, central nervous system, and peripheral nervous system has been shown to contribute towards the maintenance and progression of these disorders [1][2][3] . Patients with chronic pelvic pain are more likely to present with symptoms of additional, non-pelvic-related functional pain disorders and mood disorders, including anxiety, depression, and panic disorder [4][5][6] , which has been associated with altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis [7][8][9][10] .…”

Mast cells in endometriosis: guilty or innocent bystanders?

“…However, their role in several other pathologies associated with chronic pelvic pain (e.g., irritable bowel syndrome, interstitial cystitis, chronic pelvic pain syndrome and chronic prostatitis) [34,35], especially their role as pain mediators, has been analyzed in more detail. For example, in a murine model of interstitial cystitis it has been shown that the disease-associated pain is MC-dependent [36].…”

Chronic prostatitis/chronic pelvic pain syndrome is associated with previous colonoscopy

“…[4][5][6][7][8]22,23 Previous studies suggested that patients who received colonoscopy, with or with a polypectomy, were complicated with transient bacteremia in approximately 4% of procedures, with a range of 0-25%. 14,24 Therefore, colonoscopy complicated with bacteremia may represent a potential risk factor for CP/CPPS.…”

“…A combination of alterations to the nervous system with endocrine, psychosocial, or immunological abnormalities leads to the chronic state of CP/CPPS. 4,[7][8][9][10] Colonoscopy is a common procedure for diagnosing a wide range of conditions and symptoms, including chronic abdominal or pelvic pain, neoplasms, and colitis. Numerous studies indicated that the colonoscopic examination itself may induce abdominal pain and transient bacterial infections.…”