UropathogenicEscherichia coliInduces Chronic Pelvic Pain

ABSTRACTChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating syndrome of unknown etiology often postulated, but not proven, to be associated with microbial infection of the prostate gland. We hypothesized that infection of the prostate by clinically relevant uropathogenicEscherichia coli(UPEC) can initiate and establish chronic pain. We utilized anE. colistrain newly isolated from a patient with CP/CPPS (strain CP1) and examined its molecular pathogenesis in cell culture and in a murine model of bacterial prostatitis. We found that CP1 is an atypical isolate distinct from most UPEC in its phylotype and virulence factor profile. CP1 adhered to, invaded, and proliferated within prostate epithelia and colonized the prostate and bladder of NOD and C57BL/6J mice. Using behavioral measures of pelvic pain, we showed that CP1 induced and sustained chronic pelvic pain in NOD mice, an attribute not exhibited by a clinical cystitis strain. Furthermore, pain was observed to persist even after bacterial clearance from genitourinary tissues. CP1 induced pelvic pain behavior exclusively in NOD mice and not in C57BL/6J mice, despite comparable levels of colonization and inflammation. Microbial infections can thus serve as initiating agents for chronic pelvic pain through mechanisms that are dependent on both the virulence of the bacterial strain and the genetic background of the host.

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Microbiota of Chronic Prostatitis/Chronic Pelvic Pain Syndrome are Distinct from Interstitial Cystitis/Bladder Pain Syndrome

10.1101/2021.03.04.21252926 ◽

2021 ◽

Author(s):

Bryan White ◽

Michael Welge ◽

Loretta Auvil ◽

Matthew Berry ◽

Colleen Bushell ◽

...

Keyword(s):

Interstitial Cystitis ◽

Pelvic Pain ◽

Chronic Prostatitis ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Unknown Etiology ◽

Pelvic Pain Syndrome ◽

Bladder Pain

Urologic chronic pelvic pain syndrome patients include men chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and patients, mainly women, with interstitial cystitis/bladder pain syndrome (IC/BPS or IC). CP/CPPS is marked by severe chronic pelvic pain of unknown etiology that is differentially associated with prostatic inflammation. Microbes are known to modulate sensory responses, and microbiota are increasingly understood to drive normal biological processes and pathogenesis, including inflammation. Recent studies have linked fecal dysbiosis with chronic pelvic pain in IC/BPS, suggesting a role for microbiota in modulating UCPPS pain. Similarly, dysbiosis has been reported in CP/CPPS patients, but the relationship between with the dysbiosis of IC/BPS patients is unclear. Here, we characterized the fecal microbiota of men with CP/CPPS and women and men with IC/BPS. Similar to recent reports, we identified fecal dysbiosis in men with CP/CPPS relative to healthy controls among specific phyla and overall differences in diversity and richness. Interestingly, we also observed differences between CP/CPPS microbiota and IC/BPS microbiota that were not likely due to sex differences. These findings suggest that CP/CPPS is marked by changes in the gut microbiome, but these changes differ from IC/BPS. Taken together, UCPPS appears associated with distinct dybioses among CP/CPPS and IC/BPS, raising the possibility of distinct contributions to underlying pelvic pain mechanisms and/or etiologies.

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Treatment of patients with chronic pelvic pain syndrome: result of single-center follow up study

Herald Urology ◽

10.21886/2308-6424-2018-6-4-27-35 ◽

2019 ◽

Vol 6 (4) ◽

pp. 27-35

Author(s):

V. A. Kruglov ◽

F. R. Asfandiyarov ◽

S. N. Vybornov ◽

K. S. Seyidov

Keyword(s):

Neuropathic Pain ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pain Therapy ◽

Prostate Gland ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Perineal Region ◽

Inflammatory Changes

Introduction. Chronic pelvic pain syndrome is an urgent and widely discussed problem in the medical community. Despite the efforts made by a wide range of specialists, there is currently no universally accepted universal approach to the diagnosis and treatment of this condition. The article provides a description and results of applying its own approach to the management of patients with chronic pelvic pain syndrome.Purpose of research. The aim of the work was to improve the practical results of treatment of patients suffering from chronic pelvic pain syndrome.Materials and methods. The results of the examination and treatment of 46 men aged from 26 to 57 years are presented. The leading complaint of the patients was the long-term pain in the pelvic and / or perineal region. According to the survey results, 43.5% of patients showed signs of inflammation in the prostate gland, 56.5% showed no symptoms. Patients with proven inflammatory changes in the prostate gland were divided into two groups: the first group received the “standard” therapy of chronic prostatitis (antibiotics, prostate-tropic drugs, microcirculation and immunocorrection enhancers, physiotherapy), in the second group the patients received the “standard” treatment in combination with myofascial blockades and neuropathic pain therapy. Patients without inflammatory changes in the prostate were combined into a third group and received only myofascial blockade and neuropathic pain therapy.Results. Pain in chronic pelvic pain syndrome is most often localized in the perineal region and in the inguinal zones, while the presence or absence of a proven inflammatory component in the prostate gland does not significantly affect the localization and degree of pain, nor the assessment of quality of life. The pelvic myofascial syndromes are detected in the majority of patients with CPPS and their targeted correction in the framework of complex therapy has a positive effect on the results of patient treatment.Conclusions. Correction of musculo-tonic disorders in chronic pelvic pain syndrome was accompanied by a statistically significant reduction in pain on a 10-point numerical rating scale for pain, a decrease in the I-PSS index.

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