Chronic prostatitis /chronic pelvic pain syndrome: A misnomer?

Introduction. Chronic prostatitis /chronic pelvic pain syndrome (CP/CPPS) specifically the NIH-category IIIb, usually presents with chronic pelvic discomfort and intermittent pelvic pain for ≥3 months without identifiable infection and inflammation. Voiding disturbances and sexual dysfunction may accompany pain. There is a wide variety in the duration and severity of symptoms. The pathophysiology of this entity is poorly understood. In this retrospective study, we reviewed the medical records of 286 patients diagnosed with CP/CPPS to investigate the natural history of this disease. Material and Methods. The clinical cohort consisted of patients with CP symptoms for at least 3 months who were diagnosed with CP/CPPS at presentation or during follow-up from 01/2009 to 12/2025. In all cases, the Meares & Stamey or the similar “3-glass” tests and imaging studies of the urogenital system were performed. Individuals with proven neurological disorders and anatomical abnormalities of the urinary tract, as well as immunosuppressed patients, were excluded from the study, as these conditions can affect treatment and alter study outcomes. Results: 563 visits from 286 patients with prostatitis-like symptoms, in which initial investigation and/or follow-up diagnosed CP/CPPS, were reviewed. The 60.8% (176) of these 286 patients presented with a single set of CP-like symptoms, assessed at up to three visits (first visit, a second visit in case of treatment failure, and a follow-up visit). Almost half of them (44.8%/78 patients) were found to suffer from diseases other than prostatitis. Treatment failed in 35 out of the 96 patients with confirmed CP/CPPS. At the second visit, 15 (16.6%) of these 35 patients were identified as having a type of CP different from CP/CPPS, initially assessed. The remaining 39.2% (110 out of 286 patients) had recurring episodes of CP-like symptoms assessed or confirmed in a course of 4-18 visits. Most of them (almost 90%) were initially diagnosed with bacterial prostatitis (also known as NIH category II) followed by disease-free periods or clinical recurrence (shifts to CP/CPPS) and/or microbiological recurrence (relapses or reinfections). Conclusions. A considerable number of CP/CPPS patients (almost 40%) experience a relatively long remitting and relapsing clinical course characterised by disease-free periods and transitions between different CP classes. CP is probably a single disease characterised by a variety of clinical manifestations and variability of microbiological findings.