Defining the Urologic Chronic Pelvic Pain Syndromes: A New Beginning

In December 2007 The NIDDK held its first workshop on urologic chronic pelvic pain. It was concluded that future research studies need to be conducted that will:

a) incorporate the basic diagnostic symptoms of the significant concurrent co-morbid disorders into the urologic diagnostic protocols;
b) explore, in more detail, the relationship between these co-existing disorders; and
c) develop diagnostic protocols that will allow disease identification by the generalist physician and not limit it to an organ-specific specialist.

The follow-up workshop was held in Bethesda, MD on June 16th and 17th with guest participants from Europe, Asia, and North America and was open to the public and patient organizations. Its purpose was to assemble a group of international experts in urology, gastroenterology, internal medicine, rheumatology, epidemiology, behavioral science and other disciplines with a goal to re-characterize the two most common urologic chronic pelvic pain syndromes, interstitial cystitis (IC) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The meeting was seen as a prelude to the “Multidisciplinary Approach to Pelvic Pain (MAPP) multicenter program, set to begin later this summer. Centers for the MAPP have not been officially announced.

While no conclusions were reached, several interesting papers led to wide ranging discussions on the following topics:

* Is the perception of chronic pelvic pain organ and gender specific?
* Would a questionnaire need to be gender specific?
* Are the current definitions too restrictive?
* What is the relationship between urologic pelvic pain syndromes and the other chronic pelvic pain syndromes?
* Is the relationship an epiphenomenon or do these relationships provide a clue to common pathophysiology?

Andrew Baranowski from Queen Square in London examined the issue of classification. He discussed the classification of bladder pain syndrome put forth by the European Society for the Study of Interstitial Cystitis which classifies patients based on whether or not they had bladder endoscopy or bladder biopsy - and the findings of each procedure. He noted that classification should allow appropriate (best) assessment and management of the condition in its own right and for the patient as a whole. It should provide a platform for future research and be usable for all stakeholders: the practicing physician, researcher, patient, support groups, and reimbursement agencies. A good classification system employing phenotype, terminology, and taxonomy allows logical patient flexibility in the system, enables development within the system, and enables logical empirical and generic treatments to be employed.

Quentin Clemens from the University of Michigan discussed perceptions of urologic pelvic pain. He noted that patients may manifest symptoms from more than one, what he termed “afferent neurourology disorders”: BPS, CP/CPPS, overactive bladder, “bladder hypersensitivity disorder”, orchalgia, and chronic epididymitis. These disorders are common and may have similar patterns in men and women. They may be a part of a systemic disease complex. In one study he noted, only 19% of patients with new onset symptoms of prostatitis had symptoms three months later (Clemens, et.al., J. Urol, Dec. 2005). Interestingly, he cited research indicating that while “prostatitis” may account for 2 million office visits per year, 38% of primary care providers, when presented with a vignette of a man with CPPS, indicated that they had never seen such a patient. Dr. Clemens is currently working on a condition-specific instrument. He concluded that anatomic differences and possible gender differences in how pain is experienced make it necessary to have gender specific terms in any such instrument.