الفهرس 
Chronic Pelvic Pain SyndromeOnly 14 pages are availabe for public view
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Abstract
Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is a clinical syndrome characterized by pain in the perineum, pelvis, suprapubic area, or external genitalia, causing a variable degree of voiding and ejaculatory disturbance. Currently, the exact etiology of CP/CPPS is not completely understood, and the optimal management of CP/CPPS remains unknown. In a primary-care setting in which QOL was measured, a worse QOL was associated with greater pain and urinary symptoms, and that pain was more robustly associated with worse QOL compared to urinary symptoms. Pain intensity and urinary symptoms were independent predictors of QOL, with pain intensity representing the strongest predictor. These findings are highly suggestive that pain relief could significantly alleviate the overall symptoms of the condition.
Chronic prostatitis (CP) is a common disease among adult men. It can result in male infertility mainly by alternating the semen quality, volume, pH, component, viscosity and liquefaction. There seems to be a strong association between CP and semen delayed liquefaction. Researches on the mechanism of semen delayed liquefaction resulting from CP mainly focus on the proteolytic ferment, plasminogen activator, prostate acid phosphatase, tissue factor, lack of zinc, and pH. Analysis of the data on etiology and pathogenesis of inflammatory processes in prostate including acute and chronic prostatitis as well as chronic pelvic pain syndrome is presented. It has been noted that about 50% of men of fertile age had clinical signs of chronic prostatitis at least once in life and that more than 60% of admissions to urologists in outpatient practices are related with clinical signs of chronic prostatitis. An appreciable decrease in quality of life similar to that due to myocardial infarction or Crohn’s disease is observed in patients with chronic prostatitis. Prostatitis often has a chronic cyclic course with exacerbation and remission phases. Not rarely the disease has primary chronic course--without an apparent beginning as acute prostatitis. This leads to late diagnostics and difficulties with identification of etiologic factor, which commonly is a conditionally pathogenic microorganisms and mixed infections. Such difficulties can be a reason for inadequate treatment and complications of chronic prostatitis such as abscess, paraprostatitis, impotence, and infertility.
Male genital tract inflammations constitute an important factor of male subfertility in which different mediators are discussed damaging sperm membranes. As acrosome reaction (AR) is ultimately a membrane function. The imbalance between reactive oxygen species (ROS) production and total antioxidant capacity (TAC) in seminal fluid indicates oxidative stress and is correlated with male infertility. A composite ROS-TAC score may be more strongly correlated with infertility than ROS or TAC alone.
Prostatitis has been associated with abnormal semen parameters and may be the cause of infertility in some patients. Sperm antibodies and impaired sperm motility have been observed in the semen of patients with prostatitis. More recently, seminal oxidative stress has been detected in patients with prostatitis or accessory gland infection. Oxidative stress is the result of elevated Reactive Oxygen Species (ROS) or depressed Total Anti-oxidant Capacity, or both. Granulocytes, in prostatic fluid may be responsible for the generation of ROS, which are known to impair sperm function. Abnormal levels of ROS, however, have also been detected in the absence of leucocytospermia. Several investigators have observed significant oxidative stress in the semen or prostatic fluid from patients with bacterial and abacterial forms of prostatitis, comparable with levels reported in men with recognized infertility. Whether prostatitis is a risk factor for infertility or not, remains controversial. Therefore, the role of seminal oxidative stress as either the result of prostatic inflammation or the cause of infertility is likewise debatable, but plausible.
The optimal response to the limited symptom-relief profile of biomedical treatment options for the patients suffering from CP/CPPS is to continue to critically evaluate novel biomedical treatments. But we must also develop and investigate physical therapy and biopsychosocial approaches to managing individual patient symptoms. The new management model presented in this article should bring hope for CP/CPPS providers and refractory patients.
Chronic prostatitis patients presented important alterations in semen quality parameters and up-regulated expression of Omi/HtrA2 mRNA and proteins in the spermatozoa.
Male infertility is a common clinical condition that affects about 15% of the couples in Europe which amounts to approximately 50,000 men per year in Germany. Among these patients, about 12% suffers from male genital tract inflammations, which constitute an important and potentially curable factor of male sub-fertility. Various inflammation-dependent alterations of the ejaculate have been identified. During the last three decades, a causative role of male urogenital tract inflammations on ejaculate quality and, subsequently, on fertility has been controversially discussed. Particularly in chronic prostatitis, most reports have not relied on generally accepted classification proposals. Nevertheless, even those studies that have done so give conflicting results. While some authors have found an alteration of basic ejaculate parameters like sperm density, motility, or morphology, others have not.