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Zhang J, Wang H, Guo L. Investigating the brain functional abnormalities underlying pain hypervigilance in chronic neck and shoulder pain: a resting-state fMRI study. Neuroradiology 2024; 66:1353-1361. [PMID: 38296904 DOI: 10.1007/s00234-024-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/07/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE To investigate pain hypervigilance in individuals suffering from chronic neck and shoulder pain (CNSP) and its underlying brain mechanism. METHODS The evaluation of pain vigilance was conducted through the utilization of pain vigilance and awareness questionnaires. Voxel-wise regional homogeneity (ReHo) from 60 CNSP patients and 60 healthy controls (HCs) using resting-state fMRI data. Voxel-wise two-sample T-test was conducted to reveal the ReHo variations between CNSP and HC. Correlation analyses were utilized to reveal the connection between brain abnormalities and medical measurements. Furthermore, a mediation analysis was conducted to elucidate the pathway-linking changes in brain function with medical measurements. RESULTS Our present study revealed three main findings. Firstly, patients with CSNP demonstrated a heightened vigilance of pain in comparison to healthy adults, a common occurrence among individuals with chronic pain conditions. Secondly, we observed brain abnormalities in various brain regions in CSNP patients, and these alterations were associated with the extent of pain vigilance. Lastly, the pain hypervigilance impact on the severity of pain was found to be controlled by regional neural activity in the anterior cingulate cortex (ACC) in subjects with CSNP. CONCLUSION Our findings suggested that long-term repetitive nociceptive input caused by chronic pain further aggravates the pain intensity by impairing the vigilance-related pain processing within the anterior cingulate cortex in CNSP patients.
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Affiliation(s)
- Jiyang Zhang
- Radiology Department, Tianjin Hospital, Tianjin University, Jiefang Nan Road 406, Hexi District, Tianjin, 300211, People's Republic of China
| | - Hao Wang
- Radiology Department, Tianjin Hospital, Tianjin University, Jiefang Nan Road 406, Hexi District, Tianjin, 300211, People's Republic of China
| | - Lin Guo
- Radiology Department, Tianjin Hospital, Tianjin University, Jiefang Nan Road 406, Hexi District, Tianjin, 300211, People's Republic of China.
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Teng Z, Jin C, Wang S, Han Z, Zhang Y, Wang Y. Predicting surgical efficacy and diagnosing histological inflammation: the clinical significance of prostate exosome proteins in benign prostatic hyperplasia. Transl Androl Urol 2024; 13:930-939. [PMID: 38983479 PMCID: PMC11228684 DOI: 10.21037/tau-23-655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/25/2024] [Indexed: 07/11/2024] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) among the aging male population. Recent studies have shown that histological inflammation (HI) plays a significant role in BPH, with prostatic exosomal protein (PSEP) identified as a potential biomarker for prostate diseases. Therefore, this study aimed to explore the effect of HI on LUTS in patients with BPH, and to further explore the clinical value of PSEP as a diagnostic biomarker of BPH complicated with HI and whether PSEP could be used as an index to predict the improvement of LUTS after operation. Methods This study was an open-label, cohort study. The study enrolled all patients who were clinical diagnosed as BPH with LUTS and prepared to receive operation of the prostate at the Department of Urology of the Second Hospital of Hebei Medical University. International Prostate Symptom Score (IPSS) were used to evaluate the LUTS of the BPH. And the enrolled patients were divided into four groups, including none, mild HI, moderate HI, and severe HI, based on postoperative pathological results. Then the relationships between HI and IPSS, the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), as well as PSEP were analyzed. Simple and multiple linear regression analyses were performed on the preoperative IPSS and the difference of IPSS before and after surgery was examined. SPSS software version 26 was used for statistical analysis and Prism 9.0 was used to make violin plots. Results A total of 69 patients were enrolled in the study. The violin plot results indicated IPSS and NIH-CPSI scores exhibited significant increases in correlation with the severity levels of HI (P<0.001; P<0.001). Among BPH patients with total prostate-specific antigen (t-PSA) levels higher than 4.0 ng/mL, a significant correlation was observed between PSEP levels and HI (P=0.04). Besides, simple and multiple linear regression analysis showed that HI (P<0.001) or PSEP (P=0.03) was significantly associated with IPSS and improvement of LUTS, assessed by postoperative and preoperative IPSS differences. Conclusions The study indicated that IPSS and PSEP (when t-PSA >4 ng/mL) were correlated with the severity of HI in patients with BPH. PSEP was linearly correlated with IPSS and the degree of reduction in IPSS after surgery. Consequently, PSEP may serve as a promising predictor for assessing surgical efficacy and diagnosing the severity of HI in patients with BPH.
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Affiliation(s)
- Zhihai Teng
- Department of Urology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenggen Jin
- Department of Urology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Song Wang
- Department of Urology, Hengshui People’s Hospital, Hengshui, China
| | - Zhenwei Han
- Department of Urology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanping Zhang
- Department of Urology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaxuan Wang
- Department of Urology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
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Hu Y, Ma J, Chen B, Pang J, Liang W, Wu W. The Duration of Chronic Pain Can Affect Brain Functional Changes of the Pain Matrix in Patients with Chronic Back Pain: A Resting-State fMRI Study. J Pain Res 2024; 17:1941-1951. [PMID: 38828086 PMCID: PMC11141710 DOI: 10.2147/jpr.s457575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This study was conducted to explore the differences in functional changes in the pain matrix in patients with chronic back pain (CBP) at different stages and identify whether these brain changes were related to the pain duration. Patients and Methods In this study, 29 healthy individuals and 54 patients with CBP were recruited. According to the pain duration, 25 patients (3 to 12 months) were divided into the CBP-S group and 29 patients (≥ 24 months) were divided into the CBP-L group. All subjects completed clinical pain-related measurement and functional magnetic resonance imaging (fMRI) scans. Moreover, the amplitude of low-frequency fluctuation (ALFF), functional connectivity (FC), and correlation analysis were conducted in this study. Results Compared with healthy controls, patients in the CBP-L group showed significantly decreased ALFF in the left precuneus. In the FC analysis, patients in the CBP-S and CBP-L groups showed significantly decreased FC in several regions in the bilateral orbitofrontal cortices (OFC) and the left ventral posterior insula. Moreover, there were significant differences in the FC between the left hyper granular insula and the probabilistic area in OFC in pairwise group comparisons. The correlation analysis results demonstrated that pain duration was correlated with these functional brain changes, and the ANCOVA results revealed that pain intensity and pain interference scores did not affect the FC analysis results. Conclusion There are different changes in the pain neural matrix in patients with chronic pain at different stages. Furthermore, the pain duration is related to brain functional changes.
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Affiliation(s)
- Yingxuan Hu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Junqin Ma
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Bingmei Chen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jiahui Pang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Wen Wu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
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Lackner JM, Clemens JQ, Radziwon C, Danforth TL, Ablove TS, Krasner SS, Vargovich AM, O’Leary PC, Marotto T, Naliboff BD. Cognitive Behavioral Therapy for Chronic Pelvic Pain: What Is It and Does It Work? J Urol 2024; 211:539-550. [PMID: 38228093 PMCID: PMC10939861 DOI: 10.1097/ju.0000000000003847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/10/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE Urologic chronic pelvic pain syndrome (UCPPS), which encompasses interstitial cystitis/bladder pain syndrome in women and men and chronic prostatitis/chronic pelvic pain syndrome in men, is a common, often disabling urological disorder that is neither well understood nor satisfactorily treated with medical treatments. The past 25 years have seen the development and validation of a number of behavioral pain treatments, of which cognitive behavioral therapy (CBT) is arguably the most effective. CBT combines strategies of behavior therapy, which teaches patients more effective ways of behaving, and cognitive therapy, which focuses on correcting faulty thinking patterns. As a skills-based treatment, CBT emphasizes "unlearning" maladaptive behaviors and thoughts, and replacing them with more adaptive ones that support symptom self-management. MATERIALS AND METHODS This review describes the rationale, technical procedures, and empirical basis of CBT. RESULTS While evidence supports CBT for treatment-refractory chronic pain disorders, there is limited understanding of why or how CBT might work, for whom it is most beneficial, or the specific UCPPS symptoms (eg, pain, urinary symptoms) it effectively targets. This is the focus of EPPIC (Easing Pelvic Pain Interventions Clinical Research Program), a landmark NIH trial examining the efficacy of low-intensity, home-based CBT for UCPPS relative to a nonspecific comparator featuring self-care recommendations of AUA guidelines. CONCLUSIONS Systematic efforts to increase both the efficiency of CBT and the way it is delivered (eg, home-based treatments) are critical to scaling up CBT, optimizing its therapeutic potential, and reducing the public health burden of UCPPS.
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Affiliation(s)
- Jeffrey M. Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | | | - Christopher Radziwon
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Teresa L. Danforth
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY
| | - Tova S. Ablove
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY
| | - Susan S. Krasner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
- Department of Anesthesiology, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo NY
| | - Alison M. Vargovich
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Patricia C. O’Leary
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Tracy Marotto
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY
| | - Bruce D. Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Medicine and Biobehavioral Sciences, UCLA, Los Angeles, CA
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McBenedict B, Petrus D, Pires MP, Pogodina A, Arrey Agbor DB, Ahmed YA, Castro Ceron JI, Balaji A, Abrahão A, Lima Pessôa B. The Role of the Insula in Chronic Pain and Associated Structural Changes: An Integrative Review. Cureus 2024; 16:e58511. [PMID: 38770492 PMCID: PMC11103916 DOI: 10.7759/cureus.58511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Chronic pain affects a substantial portion of the global population, significantly impacting quality of life and well-being. This condition involves complex mechanisms, including dysfunction of the autonomic nervous system, which plays a crucial role in pain perception. The insula, a key brain region involved in pain processing, plays a critical role in pain perception and modulation. Lesions in the insula can result in pain asymbolia, where pain perception remains intact but emotional responses are inappropriate. The insula is anatomically and functionally divided into anterior and posterior regions, with the posterior insula processing nociceptive input based on intensity and location before relaying it to the anterior insula for emotional mediation. Understanding the insula's intricate role in pain processing is crucial, as it is involved in encoding prediction errors and mediating emotional dimensions of pain perception. The focus of this review was on synthesizing existing literature on the role of the insula in chronic pain and associated structural changes. The goal was to integrate findings from various sources to provide a comprehensive overview of the topic. The search strategy included a combination of Medical Subject Headings (MeSH) and relevant keywords related to insula and chronic pain. The following databases were surveyed: PubMed, Embase, Scopus, and Web of Science. We identified a total of 2515 articles, and after following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline based on eligibility criteria, 46 articles were used to synthesize this review. Our study highlights the pivotal role of the insula in chronic pain processing and associated structural changes, integrating findings from diverse studies and neuroimaging investigations. Beyond mere pain sensation, the insula contributes to emotional awareness, attention, and salience detection within the pain network. Various chronic pain conditions reveal alterations in insular activity and connectivity, accompanied by changes in gray matter volume and neurochemical profiles. Interventions targeting the insula show promise in alleviating chronic pain symptoms. However, further research is needed to understand underlying mechanisms, which can aid in developing more effective therapeutic interventions for pain.
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Affiliation(s)
| | - Dulci Petrus
- Family Health, Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, NAM
| | | | - Anna Pogodina
- Medicine and Surgery, University of Buckingham, Buckingham, GBR
| | | | - Yusuf A Ahmed
- Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Jose Ittay Castro Ceron
- Academic Medicine, Institute of Health Sciences, Autonomous University of the State of Hidalgo, Pachuca, MEX
| | - Aishwariya Balaji
- General Practice, Government Kilpauk Medical College and Hospital, Chennai, IND
| | - Ana Abrahão
- Public Health, Fluminense Federal University, Niterói, BRA
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Messelink B, Flink I, Dos Santos A, Adamse C. Chronic pelvic pain; more than just the bladder. Curr Opin Urol 2024; 34:69-76. [PMID: 37823725 DOI: 10.1097/mou.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Chronic pelvic pain is much of a burden to those who suffer from it. Additionally, in many patients medical doctors, such as urologists are unable to identify a cause or clear pathology that can explain the pain. Still numerous patients and doctors keep on searching for a cause, focussing particularly on the pelvic organs. Lots of diagnostics and treatment methods are used but often without success. In recent years, we have gained increased insight into the mechanisms of pain and adapted the terminology accordingly. RECENT FINDINGS Two aspects of chronic pelvic pain have gained more attention. First, the myofascial aspects, especially the role of the pelvic floor muscles in maintaining the pain and as a therapeutic option. Second, the role of the brain and the psychological aspects intertwine with the pain and its consequences also open up for alternative management options. In terminology chronic pain is now included in the ICD-11, a historical change. Introducing chronic primary pain (no cause found) helps us to look away from the organ and deal with the patient as a whole human being. SUMMARY The findings reported here are helpful for your daily practice. Looking from a broad perspective gives the patient the feeling of being seen and heard. Working together in a multidisciplinary team makes your work easier and gives more satisfaction. VIDEO ABSTRACT http://links.lww.com/COU/A44.
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Affiliation(s)
- Bert Messelink
- Medical Centre Leeuwarden, Department of Urology, Leeuwarden, The Netherlands
| | - Ida Flink
- Karlstad University, Karlstad, Sweden
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Guan X, Lao Y, Wang J, Wang Y, Bai Y, Li X, Liu S, Li Z, Li F, Dong Z. The methodological quality assessment of systematic reviews/meta-analyses of chronic prostatitis/chronic pelvic pain syndrome using AMSTAR2. BMC Med Res Methodol 2023; 23:281. [PMID: 38012566 PMCID: PMC10680214 DOI: 10.1186/s12874-023-02095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This study aimed to assess the methodological quality of the systematic reviews/meta-analyses (SRs/MAs) of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) using A Measurement Tool to Assess systematic Reviews (AMSTAR2) and to explore the potential influencing factors. METHODS PubMed, EMBASE and Cochrane Library databases were searched for relevant studies. AMSTAR2 was used for evaluating the methodological quality of eligible SRs/MAs. Differences between methodological characteristics of SRs/MAs were compared using chi-square tests. The intra-class correlation coefficient (ICC) was used to assess reviewer agreement in the pre-experiment. Multivariate regression analysis was used to identify potential factors affecting methodological quality. RESULTS A total of 45 SRs/MAs were included. After AMSTAR2 evaluation, only two (4.4%) of 45 SRs/MAs were moderate, three (6.7%) were rated as low quality, and the remainder 40 (88.9%) were rated as critically low quality. Among the 16 items of AMSTAR2, item 3 and item 10 had the poorest adherence. Item 4 received the most significant number of "Partial Yes" responses. Univariable analysis indicated that there were significant differences in methodological quality in SRs between different continents (P = 0.027) as well as between preregistered SRs and those that were not (P = 0.004). However, in multivariate analysis, there was no significant association between methodological quality and the following research characteristics: publication year, continent, whether reporting followed Preferred Reporting Items for Systematic Reviews (PRISMA), preregistration, funding support, randomized controlled trials (RCT) enrollment, whether SR was published in the Cochrane Database of Systematic Reviews (CDSR), and whether with meta-analysis. Additionally, subgroup analysis based on interventional SRs/MAs showed that continent was independently associated with the methodological quality of SRs/MAs of CP/CPPS via univariable and multivariate analysis. CONCLUSIONS Our study demonstrates that the methodological quality of SRs/MAs of CP/CPPS was generally poor. SRs/MAs of CP/CPPS should adopt the AMSTAR2 to enhance their methodological quality.
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Affiliation(s)
- Xin Guan
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yongfeng Lao
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jian Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yanan Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yanan Bai
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaolong Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shuai Liu
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zewen Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Fuhan Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhilong Dong
- Second Clinical Medical College, Lanzhou University, Lanzhou, China.
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
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Xiao G, Weng M, Wang P. Transcutaneous electrical nerve stimulation combined with levofloxacin and tamsulosin for patients with chronic prostatitis: clinical efficacy and changes in serum factors. Am J Transl Res 2023; 15:5267-5275. [PMID: 37692965 PMCID: PMC10492048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To analyze the effects of transcutaneous electrical nerve stimulation (TENS) combined with levofloxacin (0.1 g, twice daily) and tamsulosin (0.2 mg, once daily) on clinical efficacy and serum factors in patients with chronic prostatitis (CP). METHODS A retrospective analysis was conducted on 105 patients with CP who received treatment at Hangzhou Lin'an District Hospital of Traditional Chinese Medicine from February 2020 to December 2022. Among them, 47 patients received levofloxacin and tamsulosin were included in a drug group (DG), and 58 patients received additional TENS therapy (frequency: 1/4/1 Hz+80/120/80 Hz; pulse width: 270/230/270 μs+120/80/120 μs; waveform: square and continuous waveforms) were included in a joint group (JG). The changes in the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), international prostate symptom score (IPSS), and the levels of inflammatory and pain-causing factors were compared between the two groups before and after treatment. The clinical efficacy was compared between the two groups after treatment. Moreover, the incidence of adverse reactions was compared between the two groups. RESULTS After treatment, the scores of NIH-CPSI and IPSS, and the levels of IL-6, CRP, TNF-α, IL-1β, 5-hydroxytryptamine, substance P, and dynorphin in the JG were obviously lower than those in the DG (P<0.001). The clinical response rate in the DG was obviously lower than that in the JG (P=0.006, Table 2). There was no difference in total incidence of adverse reactions between the two groups (P=0.801). CONCLUSION Compared to medication alone (levofloxacin and tamsulosin), the combination of TENS with levofloxacin and tamsulosin can reduce the levels of inflammatory and pain-causing factors in patients, and improve the efficacy. Importantly, it has been observed that this combination therapy does not lead to an increase in adverse reactions and is considered to be safe for patients.
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Affiliation(s)
- Guohu Xiao
- Department of Surgical, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
| | - Minjie Weng
- Department of Surgical, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
| | - Ping Wang
- Operating Room, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
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Graziani A, Grande G, Martin M, Ferraioli G, Colonnello E, Iafrate M, Dal Moro F, Ferlin A. Chronic Prostatitis/Chronic Pain Pelvic Syndrome and Male Infertility. Life (Basel) 2023; 13:1700. [PMID: 37629557 PMCID: PMC10455764 DOI: 10.3390/life13081700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined as urologic pain or discomfort in the pelvic region, associated with urinary symptoms and/or sexual dysfunction, lasting for at least 3 of the previous 6 months. The rate of symptoms related to prostatitis has a mean prevalence of 8-8.2%. CP/CPPS is most frequent in men younger than 50 years, among whom it is the most common urologic diagnosis. In the last decades, many studies have been published on CP/CPPS and its association with male infertility. The pathophysiologic relation between CP/CPPS and male infertility involves several aspects, which are not well studied yet. A reduction in semen parameters has been demonstrated in patients with CP/CPPS, and several mechanisms have been proposed to represent putative pathophysiological links between CP/CPPS and infertility, including male accessory gland inflammation, metabolic syndrome, inflammatory bowel disease, HPV co-infection and autoimmunity. In light of this evidence, a multidisciplinary approach is advocated for patients with known CP/CPPS, and particular attention is needed for male patients of infertile couples in order to evaluate male accessory glands correctly. In addition, it is advisable that future studies dealing with the treatment of CP/CPPS take into consideration all the different pathophysiological aspects implicated.
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Affiliation(s)
- Andrea Graziani
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Michel Martin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Giordana Ferraioli
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Elena Colonnello
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Chair of Endocrinology and Medical Sexology (ENDOSEX), University of Tor Vergata, 00133 Rome, Italy
| | - Massimo Iafrate
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
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