Diagnosis of Chronic Pelvic Pain Syndrome

Chronic pelvic pain syndrome may be caused by an unknown pathogenic microorganism, a noninfectious disease, or tension myalgia of the pelvis, which is not related to the prostate itself. Although CPPS is often intermittent, its symptoms usually exist for a long time (at least three months).

 

The purpose of diagnosis is to exclude the specific diseases of pelvic pain, such as infection, tumor, etc. Once the obvious pathogenic factors are eliminated, there is no need to repeatedly or excessively concentrate on further identifying the pathogenic factors.

 

1. Physical examination

 

The results of physical examination vary greatly, which is not enough for the diagnosis of chronic prostatitis. Some patients show severe anal sphincter spasm, while some patients show moderate or severe tenderness when palpating the prostate. Some patients' tenderness areas are scattered in the pelvic floor area rather than the prostate.

 

2. EPS and VB

 

According to the new classification method, CPPS can be divided into two types of Ⅲ A and Ⅲ B with or without leukocytes in EPS, VB, or semen. Meares Stamey's four cup method is the location diagnosis of bacterial infection in the lower urinary tract, but less than 5% of urologists use this method in real life.

 

The reason is that this method is tedious, time-consuming, and expensive, sometimes it is difficult to take out EPS, and there are often false-negative and false-positive results. Nevertheless, the four-cup method is still regarded as the gold standard for the diagnosis of prostatitis.

 

In order to simplify the examination, Nick et al. proposed the pre and post-massage test (PPMT), namely, bacterial culture and microscopic examination of urine before and after prostate massage. Compared with the four-cup method, the specificity and sensitivity of the two cup method were 91%.

 

3. Ultrasonic examination

 

Transrectal of ultrasound(TRUS) can be used in the diagnosis of chronic prostatitis. Although there are many abnormalities in the TURS prostate image of CPPS patients, TRUS and automatic analysis of prostate ultrasound image prove that TRUS has a high sensitivity for the diagnosis of CPPS, but the specificity is low, so TRUS can not diagnose CPPS.

 

Some people use color Doppler ultrasound to find the characteristic hypoechoic area in the peripheral zone of the prostate and isolated capsule vessels in CPPS patients, but the sensitivity and specificity of this sign are not detected.

 

4. Urodynamic examination

 

For CPPS patients with significant lower urinary tract symptoms, the urodynamic examination should be considered. Studies have shown that most of the patients have rigid dysfunction of the bladder neck and the prostate urethra, that is, the internal sphincter, which reduces the flow rate of urine, makes the urethra of the bladder neck and the prostate near the external sphincter of the urethra unable to relax completely.

 

And the maximum closed pressure of the urethra also increases abnormally at rest. During urination, the electric silence (normal relaxation) of the external sphincter of the urethra is a typical manifestation of this kind of patient, and the bladder has no inhibitory contraction and is not normal. Therefore, the urine flow rate should be taken as the routine examination of CPPs patients to obtain the information of abnormal urination.

 

5. Special inspection

 

It includes cystourethroscopy, CT, and MRI, if necessary，Electromyography(EMG) is also an optional CPP assistant examination.

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