2046 CHRONIC PELVIC PAIN SYNDROME: BACK TO THE BRAIN

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20122046 CHRONIC PELVIC PAIN SYNDROME: BACK TO THE BRAIN Livio Mordasini, Christian Weisstanner, George N. Thalmann, Roland Wiest, and Thomas M. Kessler Livio MordasiniLivio Mordasini Bern, Switzerland More articles by this author , Christian WeisstannerChristian Weisstanner Bern, Switzerland More articles by this author , George N. ThalmannGeorge N. Thalmann Bern, Switzerland More articles by this author , Roland WiestRoland Wiest Zuerich, Switzerland More articles by this author , and Thomas M. KesslerThomas M. Kessler Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2210AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic pelvic pain syndrome (CPPS) impairs the life of millions of men worldwide and represents a serious economic problem for every health care system. There is a large number of purported therapeutic approaches but the effectiveness is very limited. Treatment of CPPS is a challenge and the ideal therapy remains to be elucidated. Growing evidence supports the presence of central pathomechanisms involved in CPPS maintaining pain perception in spite of excessive anti-microbial and anti-inflammatory therapies. We therefore assessed brain morphology in men with CPPS and compared it to a cohort of age-matched healthy volunteers. METHODS We investigated a consecutive series of 20 men with treatment refractory CPPS. Inclusion criteria were National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score ≥ 15 and failed pharmacological therapy with alpha-blockers, tetracyclines, and nonsteroidal anti-inflammatory drugs. We employed neuroimaging using voxel-based morphometry (VBM), investigated and compared regional brain volume and density of men with CPPS and of a cohort of age-matched healthy volunteers. RESULTS Mean age of the 20 patients was 42 years (standard deviation (SD) ± 14.34) with a mean NIH-CPSI total score of 28 (SD ± 6.36) and pain index of 6 (SD ± 1.93) on a visual analogue scale, respectively. Highly significant differences (p < 0.0001 for gray matter (GM), T = 3.1 for white matter (WM)) were found between patients with CPPS and healthy controls with a substantial reduction regarding regional GM and WM volume in right anterior cingulate cortex in patients with CPPS. CONCLUSIONS Substantial volume reduction in the anterior cingulate cortex in patients with CPPS suggests an essential role of this brain region involved in emotional pain processing. Central pathomechanisms of CPPS may be responsible for the often unsatisfactory results of conventional treatments focused on peripheral dysfunction. Thus, the anterior cingulated cortex may be a promising target for the development of new therapies for CPPS. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e825-e826 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Livio Mordasini Bern, Switzerland More articles by this author Christian Weisstanner Bern, Switzerland More articles by this author George N. Thalmann Bern, Switzerland More articles by this author Roland Wiest Zuerich, Switzerland More articles by this author Thomas M. Kessler Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...