Chronic Pelvic Pain Syndrome (CPPS): New Insights and Therapeutic Approaches

So InamuraJapan Speaker Chronic Pelvic Pain Syndrome (CPPS): New Insights and Therapeutic Approaches Chronic Pelvic Pain Syndrome (CP/CPPS) is a complex condition characterized by a combination of pelvic pain or discomfort and lower urinary tract symptoms (LUTS), including both storage and voiding issues. The pathophysiology is multifaceted, often originating from prostatic inflammation which contributes to both LUTS and pelvic pain. The condition is frequently exacerbated by the involvement of neurogenic inflammation and central sensitization, which can cause pain to spread and amplify, creating a negative spiral of symptoms that significantly impairs patients' quality of life (QOL). This presentation reviews the current understanding of CP/CPPS pathophysiology and outlines therapeutic options. In general, treatment primarily relies on conventional drug therapies such as α1 blockers, anti-inflammatory agents, neuropathic medications, phosphodiesterase 5 inhibitors (PDE5 inhibitors), and phytotherapeutics. These treatments aim to manage symptoms by improving bladder outlet obstruction (BOO), suppressing inflammation, enhancing pelvic blood flow, and modulating pain signals. While various treatment options exist, their effectiveness varies significantly among individuals, underscoring the need for a patient and individualized approach to find a suitable regimen. Furthermore, emerging treatments such as Extracorporeal Shockwave Therapy (ESWT) have shown significant promise in improving pain and QOL and are recommended in international guidelines. In conclusion, effective management of CP/CPPS requires consideration of its complex mechanisms, including prostatic inflammation, neurogenic inflammation, and central sensitization. A patient, trial-and-error approach is essential to identify the most effective treatment for each individual.