Clinical assessment and management of patients with National Institutes of Health categories IIIA and IIIB chronic prostatitis/chronic pelvic pain syndrome

Chronic pelvic pain syndrome in men is characterized by lower urinary tract symptoms consisting of pelvic pain, variable urinary symptoms, and sexual dysfunction. Chronic pelvic pain syndrome is different from chronic prostatitis, in which an identifiable bacterial infection or a positive bacterial culture can be obtained. Chronic pelvic pain syndrome affects approximately 7% of men and causes significant morbidity, disability, and cost. The assessment of men with chronic prostatitis/chronic pelvic pain syndrome involves a cascade of diagnostic steps, including an evaluation of the clinical presentation, physical examination, evaluation of urine and expressed prostatic secretions, special examination of the seminal plasma, and a search for common bacteria and uncommon pathogens. Cystoscopy, urodynamics, and medical imaging studies may provide valuable information for patients with predominantly urinary symptoms. Histopathological examination of prostatic biopsy samples may also be beneficial.