Chronic Pelvic Pain Syndrome Research Articles

Chronic Pelvic Pain Syndrome among women - challenge in diagnostics and management. Current literature review

Introduction and purpose:
 Chronic Pelvic Pain Syndrome (CPPS) is characterized as intermittent or constant pain located in the lower abdomen or pelvis, persisting continuously for at least 6 months [1]. Reports on the prevalence of chronic pelvic pain indicate the occurrence of this condition at a level of 5.7–26.6% in women of reproductive age. However, only a third of women suffering from chronic pelvic pain, seek medical care [2].
 Clinical picture of CPPS consists of various patterns and symptoms, often as the intersection of the multiple systems, which additionally complicates and delays the diagnostic process.
 The aim of this review is to summarize existing literature about the diagnostics and management of Chronic Pelvic Pain Syndrome among women and create an awareness about the challenges which this condition poses for healthcare professionals. 
 A brief description of the state of knowledge:
 Chronic Pelvic Pain Syndrome is a multifaceted condition and the pathophysiology of it has not yet been comprehensively studied. Clinical picture often involves dysfunctions in pelvic floor, urinary tract, or gastrointestinal system. Treatment involves a multidisciplinary approach including non-pharmacological and pharmacological interventions.
 Summary (conclusions):
 Chronic Pelvic Pain is a complex condition involving symptoms affecting the psychological, gastrointestinal, musculoskeletal systems. The most successful treatment approach emphasizes the role of collaboration among a diverse team of specialists such as gynecologists, gastroenterologists, psychiatrists, psychologists, and physiotherapists. More research focused on multimodal strategies in management of the CPP is needed to match patients most effectively with the most suitable combination of treatment and reduce the systemic consequences of chronic pain.

Hypertension and urologic chronic pelvic pain syndrome: An analysis of MAPP-I data

BackgroundUrologic chronic pelvic pain syndrome (UCPPS), which includes interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis (CP/CPPS), is associated with increased voiding frequency, nocturia, and chronic pelvic pain. The cause of these diseases is unknown and likely involves many different mechanisms. Dysregulated renin-angiotensin-aldosterone-system (RAAS) signaling is a potential pathologic mechanism for IC/BPS and CP/CPPS. Many angiotensin receptor downstream signaling factors, including oxidative stress, fibrosis, mast cell recruitment, and increased inflammatory mediators, are present in the bladders of IC/BPS patients and prostates of CP/CPPS patients. Therefore, we aimed to test the hypothesis that UCPPS patients have dysregulated angiotensin signaling, resulting in increased hypertension compared to controls. Secondly, we evaluated symptom severity in patients with and without hypertension and antihypertensive medication use.MethodsData from UCPPS patients (n = 424), fibromyalgia or irritable bowel syndrome (positive controls, n = 200), and healthy controls (n = 415) were obtained from the NIDDK Multidisciplinary Approach to the Study of Chronic Pelvic Pain I (MAPP-I). Diagnosis of hypertension, current antihypertensive medications, pain severity, and urinary symptom severity were analyzed using chi-square test and t-test.ResultsThe combination of diagnosis and antihypertensive medications use was highest in the UCPPS group (n = 74, 18%), followed by positive (n = 34, 17%) and healthy controls (n = 48, 12%, p = 0.04). There were no differences in symptom severity based on hypertension in UCPPS and CP/CPPS; however, IC/BPS had worse ICSI (p = 0.031), AUA-SI (p = 0.04), and BPI pain severity (0.02). Patients (n = 7) with a hypertension diagnosis not on antihypertensive medications reported the greatest severity of pain and urinary symptoms.ConclusionThis pattern of findings suggests that there may be a relationship between hypertension and UCPPS. Treating hypertension among these patients may result in reduced pain and symptom severity. Further investigation on the relationship between hypertension, antihypertensive medication use, and UCPPS and the role of angiotensin signaling in UCPPS conditions is needed.

Validation of a simple body map to measure widespread pain in urologic chronic pelvic pain syndrome: A MAPP Research Network study.

In patients with urologic chronic pelvic pain syndrome (UCPPS), the presence of widespread pain appears to identify a distinct phenotype, with a different symptom trajectory and potentially different response to treatment than patients with pelvic pain only. A 76-site body map was administered four times, at weekly intervals, to 568 male and female UCPPS participants in the MAPP Network protocol. The 76 sites were classified into 13 regions (1 pelvic region and 12 nonpelvic regions). The degree of widespread pain was scored from 0 to 12 based on the number of reported nonpelvic pain regions. This continuous body map score was regressed over other measures of widespread pain, with UCPPS symptom severity, and with psychosocial variables to measure level of association. These models were repeated using an updated body map score (0-12) that incorporated a threshold of pain ≥ 4 at each site. Body map scores showed limited variability over the 4 weekly assessments, indicating that a single baseline assessment was sufficient. The widespread pain score correlated highly with other measures of widespread pain and correlated with worsened UCPPS symptom severity and psychosocial functioning. Incorporating a pain severity threshold ≥4 resulted in only marginal increases in these correlations. These results support the use of this 13-region body map in the baseline clinical assessment of UCPPS patients. It provides reliable data about the presence of widespread pain and does not require measurement of pain severity, making it relatively simple to use for clinical purposes.

Ecological momentary assessment of pelvic pain and urinary urgency variability in urologic chronic pelvic pain syndrome and their association with illness impact and quality of life: Findings from the multidisciplinary approach to the study of chronic pelvic pain symptom patterns study.

This study tested the hypothesis that ecological momentary assessment (EMA) of pelvic pain (PP) and urinary urgency (UU) would reveal unique Urologic Chronic Pelvic Pain Syndrome (UCPPS) phenotypes that would be associated with disease specific quality of life (QOL) and illness impact metrics (IIM). A previously validated smart phone app (M-app) was provided to willing Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) participants. M-app notifications were sent 4-times daily for 14 days inquiring about PP and UU severity. A clustering algorithm that accounted for variance placed participants into PP and UU variability? clusters. Associations between clusters and QOL and IIM were then determined. A total of 204 participants enrolled in the M-app study (64% female). M-app compliance was high (median 63% of surveys). Cluster analysis revealed k = 3 (high, low, none) PP clusters and k = 2 (high, low) UU clusters. When adjusting for baseline pain severity, high PP variability, but not UU variability, was strongly associated with QOL and IIM; specifically worse mood, worse sleep and higher anxiety. UU and PP clusters were associated with each other (p < 0.0001), but a large percentage (33%) of patients with high PP variability had low UU variability. PP variability is an independent predictor of worse QOL and more severe IIM in UCPPS participants after controlling for baseline pain severity and UU. These findings suggest alternative pain indices, such as pain variability and unpredictability, may be useful adjuncts to traditional measures of worst and average pain when assessing UCPPS treatment responses.

Thermosensitive hydrogel with emodin-loaded triple-targeted nanoparticles for a rectal drug delivery system in the treatment of chronic non-bacterial prostatitis

BackgroundThe complex etiology and pathogenesis underlying Chronic Non-Bacterial Prostatitis (CNP), coupled with the existence of a Blood Prostate Barrier (BPB), contribute to a lack of specificity and poor penetration of most drugs. Emodin (EMO), a potential natural compound for CNP treatment, exhibits commendable anti-inflammatory, anti-oxidant, and anti-fibrosis properties but suffers from the same problems as other drugs.MethodsBy exploiting the recognition properties of lactoferrin (LF) receptors that target intestinal epithelial cells (NCM-460) and prostate epithelial cells (RWPE-1), a pathway is established for the transrectal absorption of EMO to effectively reach the prostate. Additionally, hyaluronic acid (HA) is employed, recognizing CD44 receptors which target macrophages within the inflamed prostate. This interaction facilitates the intraprostatic delivery of EMO, leading to its pronounced anti-inflammatory effects. A thermosensitive hydrogel (CS-Gel) prepared from chitosan (CS) and β-glycerophosphate disodium salt (β-GP) was used for rectal drug delivery with strong adhesion to achieve effective drug retention and sustained slow release. Thus, we developed a triple-targeted nanoparticle (NPs)/thermosensitive hydrogel (Gel) rectal drug delivery system. In this process, LF, with its positive charge, was utilized to load EMO through dialysis, producing LF@EMO-NPs. Subsequently, HA was employed to encapsulate EMO-loaded LF nanoparticles via electrostatic adsorption, yielding HA/LF@EMO-NPs. Finally, HA/LF@EMO-NPs lyophilized powder was added to CS-Gel (HA/LF@EMO-NPs Gel).ResultsCellular assays indicated that NCM-460 and RWPE-1 cells showed high uptake of both LF@EMO-NPs and HA/LF@EMO-NPs, while Raw 264.7 cells exhibited substantial uptake of HA/LF@EMO-NPs. For LPS-induced Raw 264.7 cells, HA/LF@EMO-NPs can reduce the inflammatory responses by modulating TLR4/NF-κB signaling pathways. Tissue imaging corroborated the capacity of HA/LF-modified formulations to breach the BPB, accumulating within the gland's lumen. Animal experiments showed that rectal administration of HA/LF@EMO-NPs Gel significantly reduced inflammatory cytokine expression, oxidative stress levels and fibrosis in the CNP rats, in addition to exerting anti-inflammatory effects by inhibiting the NF-κB signaling pathway without obvious toxicity.ConclusionThis triple-targeted NPs/Gel rectal delivery system with slow-release anti-inflammatory, anti-oxidant, and anti-fibrosis properties shows great potential for the effective treatment of CNP.Graphical

Cognitive Behavioral Therapy for Chronic Pelvic Pain: What Is It and Does It Work?

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. This review describes the rationale, technical procedures, and empirical basis of CBT. 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. 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.

The Protective Effects of Bushen Daozhuo Granule on Chronic Non-bacterial Prostatitis.

Background: Chronic non-bacterial prostatitis (CNP), one of the most common chronic diseases in urology, leads to pain in the prostate and dysuria, critically affecting the physical or mental health of patients. However, there are no standard treatment approaches for the treatment of CNP in the clinic. Although the clinical application of Bushen Daozhuo granule (BSDZG) offers hope to CNP patients in China, the mechanisms of BSDZG in treating CNP are still not entirely clear. Hence, we aimed to investigate the novel therapeutic mechanisms of BSDZG on CNP. Methods: In this study, we first assayed the prostate index of rats and then determined the anti-inflammatory and anti-apoptotic effects of BSDZG on CNP in vivo and in vitro by employing ELISA kits and TUNEL staining. Next, we investigated whether the anti-inflammatory and anti-apoptotic mechanisms of BSDZG on prostate protein-induced rats and lipopolysaccharide (LPS) induced RWPE-1 cells were related to the AKT, p38 MAPK, and NF-κB pathways with the help of Western blot. Finally, the influence of BSDZG on the interaction between the p38 MAPK and NF-κB pathway in LPS-induced RWPE-1 cells was explored by adopting dehydrocorydaline (DHC, p38 MAPK activator) with the help of ELISA kits and Western blot. Results: In vivo, BSDZG effectively reduced the prostate index. In vivo and in vitro, BSDZG dramatically declined the level of two pro-inflammatory cytokines, TNF-α and IL-1β, as well as the apoptosis rate. Moreover, in vivo and in vitro, BSDZG memorably upregulated the expression level of p-AKT, and substantially downregulated the expression level of p-p38 MAPK and NF-κB2. The activation of p38 MAPK significantly reversed the moderation effects of BSDZG on the level of TNF-α and IL-1β, as well as the expression level of p-p38 MAPK and NF-κB2 in vitro. Conclusion: To sum up, the in vivo and in vitro therapeutic mechanisms of BSDZG on CNP were reflected as the anti-inflammation and anti-apoptosis that was formed by inhibiting the level of pro-inflammatory cytokines, TNF-α and IL-1β, to regulate the AKT, p38 MAPK, and NF-κB pathways, and the anti-inflammatory effect of BSDZG was realized by suppressing the p38 MAPK pathway to inhibit the downstream NF-κB pathway.

Сравнительный анализ микробиоты секрета простаты у больных хроническим абактериальным простатитом категории IIIа и IIIб

Numerous studies have established that chronic prostatitis/ chronic pelvic pain syndrome ( CP/CPPS) is the focus of attention of the global medical community, because it is the most common type of disease, the treatment of which has largely unsatisfactory results. Purpose of the work: to conduct a comparative analysis of the microbiota of prostate secretions in patients with CP/CPPS IIIa and IIIb using mass spectrometry of microbial markers (MSMM). Material and methods. A prospective comparative study was conducted from 2018 to 2023 at the SM-Clinic medical center. 205 patients with prostatitis-like symptoms and 70 males who applied for a screening examination with no complaints at the age of 25 to 50 years were selected. The subjects were divided into three groups: group 1 – patients with CP/CPPS category IIIa, group 2 ( n = 85) patients with CP/CPPS category IIIb with clinical manifestations of chronic prostatitis and group 3 ( n = 70) – without clinical manifestations prostatitis/control group. A study of the microbiota of prostate secretions was carried out using gas chromatograph mass spectrometer "Maestro" (LLC "Interlab", Russia). Results. The results of statistical analysis showed that the level of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and the control group, was significantly higher ( p = 0.0020 ; p &lt; 0.0001; p &lt; 0.0001; p = 0.0254; p = 0.0254). It was revealed that in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and healthy people, there was a significant increase in the total load of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses . When analyzing the relationship between the absolute number of microorganisms, it was revealed that an increase in the level of many microorganisms is associated with an increase in the probability of detecting a leukocyte level ≥10. An analysis of the relationship between the occurrence of individual microorganisms and leukocyte values in prostate secretions ≥10 showed that an increase in the indicators of many microorganisms, compared with the control group, increased the chances of having a leukocyte level ≥10 several times. Conclusion. Identification of microbial associations in prostate secretions using the MSMM method and an increase in the total load of microorganisms in patients with CP/CPPS IIIa, compared with CP/CPPS IIIa and the control group, suggests the role of infection in a certain part of patients with CP/CPPS IIIa, which dictates the need to change the view of the urologist in the diagnosis and treatment strategy of these patients

Research progress on the relationship between chronic prostatitis/chronic pelvic pain syndrome and the microbiota of the reproductive system.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common pelvic pain syndrome in males, seriously affecting patients' quality of life. For a long time, CP/CPPS has been considered a complex and variable disease, and its pathogenesis remains incompletely understood. Currently, CP/CPPS is believed to be a group of diseases characterized by pelvic pain or discomfort, urinary abnormalities, and other symptoms, each with its unique etiology, clinical characteristics, and outcomes, likely resulting from the action of pathogens or (and) certain non-infectious factors. Traditionally, CP/CPPS was thought to be unrelated to bacterial infections. However, in recent years, with the development of microbiology and the advancement of high-throughput sequencing technology, an increasing number of studies have suggested that microorganisms in the reproductive system may play an important role in the pathogenesis of CP/CPPS. The unique characteristics of CP/CPPS, such as its refractory nature and tendency to recur, may be closely related to the microbiota and their biological functions in the reproductive system. The relationship between CP/CPPS and reproductive system microorganisms is one of the current hot topics in microbiology and urology, receiving considerable attention from scholars in recent years and making a series of new advances. Through this review, we will comprehensively explore the relationship between CP/CPPS and reproductive system microorganisms, and look forward to future research directions, aiming to provide new ideas and methods for clinical diagnosis and treatment, thereby improving the treatment outcomes and quality of life of CP/CPPS patients.

Cannabidiol Alleviates Chronic Prostatitis and Chronic Pelvic Pain Syndrome via CB2 Receptor Activation and TRPV1 Desensitization.

This study elucidates the mechanism of the physiological effect of cannabidiol (CBD) by assessing its impact on lipopolysaccharide (LPS)-induced inflammation in RWPE-1 cells and prostatitis-induced by 17β-estradiol and dihydrotestosterone in a rat model, focusing on its therapeutic potential for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). RWPE-1 cells were stratified in vitro into three groups: (1) controls, (2) cells with LPS-induced inflammation, and (3) cells with LPS-induced inflammation and treated with CBD. Enzyme-linked immunosorbent assays and western blots were performed on cellular components and supernatants after administration of CBD. Five groups of six Sprague-Dawley male rats were assigned: (1) control, (2) CP/CPPS, (3) CP/CPPS and treated with 50 mg/kg CBD, (4) CP/CPPS and treated with 100 mg/kg CBD, and (5) CP/CPPS and treated with 150 mg/kg CBD. Prostatitis was induced through administration of 17β-estradiol and dihydrotestosterone. After four weeks of CBD treatment, a pain index was evaluated, and prostate tissue was collected for subsequent histologic examination and western blot analysis. CBD demonstrated efficacy in vivo for CP/CPPS and in vitro for inflammation. It inhibited the toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) pathway by activating the CB2 receptor, reducing expression of interleukin-6, tumor necrosis factor-alpha, and cyclooxygenase-2 (COX2) (p<0.01). CBD exhibited analgesic effects by activating and desensitizing the TRPV1 receptor. CBD inhibits the TLR4/NF-κB pathway by activating the CB2 receptor, desensitizes the TRPV1 receptor, and decreases the release of COX2. This results in relief of inflammation and pain in patients with CP/CPPS, indicating CBD as a potential treatment for CP/CPPS.

Non-Invasive Radiofrequency Hyperthermia Attenuates HMGB1/TLR4/NF-κB Inflammatory Axis in a Chronic Prostatitis/Chronic Pelvic Pain Syndrome Rat Model.

The primary goal of this study is to evaluate the effect of the non-invasive radiofrequency hyperthermia (RFHT) device on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) rat model and investigate the underlying mechanism. In this study, Sprague-Dawley rats were randomly distributed into three groups: (1) normal control group, (2) CP/CPPS group, and (3) RFHT group. CP/CPPS rat models were induced by 17β-estradiol and dihydrotestosterone for 4 weeks and RFHT was administered for 5 weeks after model establishment. During RFHT administration, core body temperatures were continuously monitored with a rectal probe. After administering RFHT, we assessed pain index for all groups and collected prostate tissues for Western blot analysis, immunofluorescence, and immunohistochemistry. We also collected adjacent organs to the prostate including urinary bladder, testes, and rectum for safety assessment via H&E staining along with a terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling assay. After administering RFHT, pain in rats was significantly alleviated compared to the CP/CPPS group. RFHT reduced high-mobility group box 1 (HMGB1) expression and improved inflammation by downregulating subsequent proinflammatory cytokines through inhibition of the toll-like receptor 4 (TLR4)-nuclear factor kappa B (NF-κB) pathway. In prostate-adjacent organs, no significant histological alteration or inflammatory infiltration was detected. The area of cell death also did not increase significantly after RFHT. In conclusion, RFHT demonstrated anti-inflammatory effects by inhibiting the HMGB1-TLR4-NF-κB pathway in CP/CPPS rat models. This suggests that RFHT could serve as a safe and promising therapeutic strategy for CP/CPPS.

Multi-pharmacological treatment for young subfertile males with chronic prostatitis/chronic pelvic pain syndrome.

This study evaluated the effectiveness of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) treatments using multiple pharmaceutical agents that could simultaneously preserve or enhance fertility capability. This was a single-center-based, randomized controlled study, whereas the final analysis evaluated a total 350 CP/CPPS patients (age range, 28-40 years) and 50 patients were randomly allocated to each therapeutic group, with a 1:1 ratio. The therapeutic groups consist of tadalafil (group 1, 5 mg daily), L-carnitine (group 2, 2 g daily), Serenoa repens extract (group 3, 320 mg daily), group 4 (tadalafil+L-carnitine), group 5 (tadalafil+S. repens), group 6 (L-carnitine+S. repens), and group 7 (tadalafil+L-carnitine+S. repens). The treatment outcomes at 3 months post-therapy were analyzed. At 3 months post-therapy, the mean total sperm motility was significantly improved in all groups. A normal morphology improvement was observed in L-carnitine receiving groups. The mean total score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the mean International Prostate Symptom Score (IPSS) showed the greatest reduction in intensity in group 7. Logistic regression analyses showed that group 5 and group 7 were significantly associated with improvements in total IPSS and total NIH-CPSI scores at 3 months post-therapy. Group 7 was a significant predictor for improving total sperm motility, leukocytospermia and normal form of sperm. Tadalafil, carnitine, and S. repens combination therapy could be considered a feasible treatment option for CP/CPPS males with subfertility.

Meta-analysis of the effectiveness and safety of magnetic stimulation for chronic pelvic pain.

To systematically assess the effectiveness and safety of magnetic stimulation (MS) for treating chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) through a meta-analysis. A comprehensive search of databases including PubMed, The Cochrane Library, EMbase, VIP, Web of Science, WanFang, China Biology Medicine disc (CBMdisc), and China National Knowledge Internet (CNKI) databases was conducted to retrieve randomized controlled trials (RCTs) on MS interventions for CPPS from inception to the present. The search employed keywords such as "MS", "CPPS", and "prostatitis". Data analysis was performed using RevMan 5.4 software, focusing on NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), maximal urinary flow rate (Qmax), and international index of erectile function-5 (IIEF-5) score. Eight RCTs involving 636 patients were included. Our meta-analysis revealed that extracorporeal MS significantly reduced NIH-CPSI scores [MD = -6.65; 95% CI (-8.15, -5.15), P < 0.00001] and improved Qmax [MD = 2.98; 95% CI (1.36, 4.59), P = 0.0003] compared to the control group. Although a trend toward improved IIEF-5 scores was observed [MD = 0.81; 95% CI (-0.34, 1.95), P = 0.17], the results were not significant. MS is effective in alleviating clinical symptoms and enhancing Qmax in patients with CP/CPPS.

Gut microbiome: a novel preventive and therapeutic target for prostatic disease.

The human gut microbiome (GM) impacts various physiological processes and can lead to pathological conditions and even carcinogenesis if homeostasis is disrupted. Recent studies have indicated a connection between the GM and prostatic disease. However, the underlying mechanisms are still unclear. This review aims to provide a summary of the existing information regarding the connection between the GM and various prostatic conditions such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), benign prostatic hyperplasia (BPH), and prostate cancer (PCa). Furthermore, the review aims to identify possible pathogenic mechanisms and suggest potential ways of targeting GM to prevent and treat prostatic disease. Due to the complexity of the mechanism between GM and prostatic diseases, additional research is required to comprehend the association between the two. This will lead to more effective treatment options for prostatic disease.

Хронический простатит, ассоциированный с герпесвирусами

The most common microorganisms are herpesviruses, which are capable of infecting many organs and systems, including reproductive organs (due to their biological properties) causing in some cases the occurrence of infertility and life-threatening generalized infections. Among the many herpesviruses, there are 9 that are transmitted from humans: herpes simplex viruses types 1 and 2, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, herpes viruses types 6, 7, 8, as well as macacine herpesvirus 1. In recent decades, there has been intensive research into their role in damage to the male reproductive system, including the prostate gland. The authors attempted to assess the possible association of herpesviruses with symptoms of chronic prostatitis and infertility, for which a search was conducted in the Pubmed database for the following search query: human papillomavirus, Epstein-Barr virus, cytomegalovirus, herpes virus 1, 2, 6, sexual transmission, sperm, prostatitis. Epidemiological studies concerning the possible association of herpesviruses with chronic prostatitis (CP) / chronic pelvic pain syndrome (CPPS) symptoms in young men have shown that viruses can enter the genital organs through sexual contact or a systemic route. However, some of them do not damage the male reproductive system organs, but rather affect sperm cells, leading to infertility. Despite the contradictory isolated studies, most of them indicated the role of herpesviruses in the damage to the male reproductive system, including the prostate gland, with spermatogenesis disorder and infertility occurrence. Thus, patients with CP/CPPS should be examined for the herpesvirus detection, since atypical, uncultivated, intracellular, as well as viral pathogens (along with typical pathogens) can play a role in the prostatitis progression. KEYWORDS: herpesviruses, Epstein-Barr virus, cytomegalovirus, herpes simplex virus type 1, herpes simplex virus type 2, human herpesvirus type 6, human papillomavirus, chronic prostatitis, infertility. FOR CITATION: Kadyrov Z.A., Ramishvili Sh.V., Stepanov V.S., Ignatiev A.V., Mashaneishvili Sh.G. Chronic prostatitis associated with herpesviruses. Russian Medical Inquiry. 2024;8(4):221–227 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-6.

CD8 T cells are dispensable for experimental autoimmune prostatitis induction and chronic pelvic pain development.

Chronic Pelvic Pain Syndrome or Chronic Prostatitis (CPPS/CP) is the most prevalent urologic affliction among young adult men. It is a challenging condition to treat, which significantly decreases patient quality of life, mostly because of its still uncertain aetiology. In that regard, an autoimmune origin is a prominent supported theory. Indeed, studies in patients and in rodent models of Experimental Autoimmune Prostatitis (EAP) have provided compelling evidence suggesting a key role of CD4 Th1 cells in disease pathogenesis. However, the implication of other prominent effectors of the immune system, such as CD8 T cells, has yet to be studied. We herein analyzed the induction of prostatitis and the development of chronic pelvic pain in EAP using CD8 T cell-deficient animals. We found similarly elevated PA-specific immune responses, with high frequencies of specific IFNg+CD4+ and IL17+CD4+ T cells in prostate draining lymph nodes from PA-immunized either CD8 KO or wild type animals with respect to controls. Moreover, these peripheral immune responses were paralleled by the development of significant chronic pelvic pain, and accompanied by prostate histological lesions, characterized by hemorrhage, epithelial cell desquamation, marked periglandular leukocyte infiltration, and increased collagen deposition in both, PA-immunized CD8 KO and wild type animals. As expected, control animals did not develop prostate histological lesions. Our results indicate that CD8 T cells do not play a major role in EAP pathogenesis and chronic pelvic pain development. Moreover, our results corroborate the previous notion that a CD4 Th1 associated immune response drives the induction of prostate tissue inflammation and the development of chronic pelvic pain.

The histological prevalence of prostatitis at Potchefstroom Hospital: a cross-sectional study.

prostatitis is defined as a clinical condition caused by acute or chronic infectious diseases, chronic pelvic pain syndrome, or asymptomatic inflammation of the prostate gland. We conducted a study to determine the prevalence of histological prostatitis in patients with prostatic diseases at Potchefstroom Hospital. we conducted a cross-sectional study based on the review of histology report from 1st January 2015 to 31st December 2019 coupled to clinical information of patients. A total of 362 cases with complete histopathology report were included in the study. Chi-square and Fisher exact test were used to test statistical significance with a p-value of 0.05 deemed to be significant. over a total number of 362 patients, the mean age was 69.82±7.9 years. The overall prevalence of prostatitis on histology was 158 (43.65%). Chronic prostatitis was predominant and commonly associated with BPH or PCa in 142 cases (39.23%) on histopathology report, while acute prostatitis was found in 16 patients (4.42%). We further found prostate cancer in 178 patients (49.17%), BPH in 163 (45.03%). The study shows that 41 cases (23.3%) of prostate cancer were associated with prostatitis, and 96 cases (58.9%) of BPH were also associated with prostatitis on histology. The difference was statistically significant p < 0.001. The study revealed that in BPH with prostatitis the median PSA was 15 ng/ml (IQR 9-24), while in BPH without prostatitis the median PSA was 11ng/ml (IQR 7-16). (p < 0.017). This means that prostatitis increases PSA in patients with BPH. However, the presence of prostatitis did not significantly influence the PSA value in patients with prostate cancer. this study showed that close to half of the histology examined had signs of prostatitis. Chronic prostatitis was more frequent on histology done in our sample. BPH was strongly associated with prostatitis. Prostatitis contributed to a higher PSA values in patients with BPH and did not influence the PSA value in PCa.

Эндометриоз. Обзор клинического протокола под разным углом зрения (дискуссия)

Endometriosis is a common disease characterized by the tissue similar in morphology and function to the endometrium outside the uterine cavity. The review presents a historical background, an overview of the theories concerning the endometriosis pathogenesis, a description of the clinical picture, diagnostic issues and a discussion concerning the clinical recommendations of the Ministry of Health of the Russian Federation on the patient management with endometriosis, which are currently in force. To date, the etiology and pathogenesis of this disease have not been fully clarified, and the development of this pathology is still debated. Endometriosis has significant adverse health outcomes and negatively affects the life quality of patients. Endometriosis-associated infertility contributes to a decrease in fertility, having an adverse impact on the country's economy. The disease clinical debut may be a menstrual disorder, abnormal uterine bleeding, infertility, the development of chronic pelvic pain syndrome, manifested by dyspareunia, dyschezia, dysmenorrhea. The progress of medicine in this area is associated with an individual patient management, where an improvement a woman's life quality, therapy and overcoming infertility, reducing the frequency of relapses and minimizing surgical interventions are highlighted Properly selected individual therapy leads to a decrease in the incidence of endometriosis clinical manifestation, which has a beneficial effect on personal, social, demographic and economic indicators. KEYWORDS: endometriosis, endometrium, endometrial pathogenesis, endometrial disease, endometriosis treatment, clinical recommendations, endometriosis-associated infertility. FOR CITATION: Dobrokhotova Yu.E., Markova E.A., Khlynova S.A., Narimanova M.R. Endometriosis. Сlinical protocol review from different angles (discussion). Russian Journal of Woman and Child Health. 2024;7(2):89–97 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-1.

Унилатеральная гибридная хирургическая реконструкция тазового дна. Модифицированная лоскутная методика

Sacrospinous fixation is one of the most studied treatments for pelvic organ prolapse (POP), but the prevention of implantrelated complications remains unresolved. To isolate the mesh materials from the incision line and to prevent the development of chronic pelvic pain syndrome due to rigid fixation, a modification of hybrid pelvic floor reconstruction was performed, where a U-shaped vascularized vaginal flap acts as the main fixation point of the mesh implant. Objective. To study the efficacy and safety of a modified flap technique for unilateral hybrid pelvic floor surgical reconstruction. Patients and methods. A database of 128 case histories was generated. Inclusion criteria: apical anterior prolapse (POP-Q: Ba, C ≥ 0), hybrid pelvic floor surgical reconstruction using mesh endoprosthesis and vascularized vaginal flap performed between May 2020 and September 2022. The variables under study included POP stage, results of the PFDI-20, PISQ-12, and ICIQ-SF questionnaires, intraoperative complications. Patients who underwent surgery were invited for consultation. The following parameters were evaluated: POP stage, presence of mesh erosion, de novo dyspareunia, de novo chronic pelvic pain, de novo functional disorders (an overactive or atonic bladder, stress urinary incontinence (SUI), defecation disorders), repeat surgeries for POP and SUI. The PFDI-20, PISQ-12, and ICIQ-SF questionnaires were filled in. Satisfaction with treatment was assessed using the PGI-I scale. Four patients underwent contrast-enhanced magnetic resonance imaging of the pelvic organs. Results. The results showed a significant improvement in the quality of life after surgery in 113 (96.6%) cases. Only 3 (2.6%) patients had persistent POP symptoms. Of the 117 patients with baseline moderate or severe urinary incontinence, 45 (38.5%) showed improvement in 41 (91.1%) cases. Assessment of the quality of sexual life showed improvement in 27 (77.1%) of 35 patients, and 4 patients returned to sexual activity after surgery. Satisfaction with the results of treatment was noted in 109 (93.2%) patients. Conclusion. Flap modification for unilateral hybrid pelvic floor surgical reconstruction is an effective and safe method of preventing the development of implant-related complications in the correction of POP. Key words: pelvic organ prolapse, mesh implant, vaginal flap

Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature.

We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research. We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals. Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms. Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.