{"paper_id":"2296bb0a-e239-45b0-8a06-14f407583889","body_text":"Abstract\nPurpose\nMen with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have heterogeneous symptoms and variable responses to treatment. We sought to identify clinical and treatment factors associated with pain improvement. Specifically, which presenting features and management strategies are associated with clinically meaningful reductions in pain among men with CP/CPPS?\nMethods\nWe performed a retrospective review of men evaluated for chronic pelvic or genitourinary pain by a single specialist from February 2023 to July 2025. Patients were included based on ICD codes for pelvic pain, genitourinary pain, or chronic prostatitis. Demographics, presenting symptoms, and initial and most recent visual analog scale (VAS) pain scores were collected. Intervention types were compared by analyzing VAS scores before and after receiving an intervention.\nResults\n157 men were included, of which 103 had follow-up VAS data. The median follow up was 277 days and median symptom duration prior to presentation was 24 months. Diffuse pelvic pain was the most common phenotype (51.6%). The mean baseline and most recent VAS scores were 3.4 and 2.1, respectively. The greatest improvements were associated with penile block (− 3.8), spermatic cord block (− 2.6), and hydrodistension with cautery of ulcers (− 2.6). Cystoscopy was performed in 26.8% of patients. While often non-diagnostic (31%), cystoscopy frequently diagnosed inflammatory lesions (31%) and BPH (19%).\nConclusion\nMost patients with CP/CPPS experienced clinically meaningful pain reduction following subspecialist evaluation. Diffuse pain without clear triggers is common. Greater improvement with nerve blocks and treatment of Hunner’s lesions supports a phenotype-driven approach. However, studies are needed to isolate and validate treatment effects.\nSimilar content being viewed by others\nData availability\nThe data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to the inclusion of sensitive patient information, the data are not publicly available and are stored on a secure institutional server.\nReferences\nAmerican Urological Association. Male chronic pelvic pain: AUA Guideline. American Urological Association website. Published 2022. Updated 2023. Accessed December 29, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain\nSmith C (2016) Male chronic pelvic pain: an update. Indian J Urol 32(1):34. https://doi.org/10.4103/0970-1591.173105\nRees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG) (2015) Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int 116(4):509–525. https://doi.org/10.1111/bju.13101\nFranz J, Kieselbach K, Lahmann C, Gratzke C, Miernik A (2023) Chronic primary pelvic pain syndrome in men. Dtsch Arztebl Int 120(29–30):508–518. https://doi.org/10.3238/arztebl.m2023.0036\nHuang J, Shah N, Bailon R, Trammel S (2023) Chronic penile pain: a poorly researched and managed life-debilitating condition. Cureus 15(12):e49776. https://doi.org/10.7759/cureus.49776\nChiarioni G, Asteria C, Whitehead WE (2011) Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol 17(40):4447–4455. https://doi.org/10.3748/wjg.v17.i40.4447\nLeslie SW, Sajjad H, Siref LE. Chronic testicular pain and orchalgia. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.\nClemens JQ, Erickson DR, Varela NP, Lai HH (2022) Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 208(1):34–42\nEAU Guidelines on Chronic Pelvic Pain-Introduction-Uroweb. Uroweb - European Association of Urology. https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/introduction\nWagenlehner FME, Naber KG, Bschleipfer T, Brähler E, Weidner W (2009) Prostatitis and male pelvic pain syndrome. Dtsch Ärztebl Int. https://doi.org/10.3238/arztebl.2009.0175\nDoiron RC, Nickel JC (2018) Management of chronic prostatitis/chronic pelvic pain syndrome. Can Urol Assoc J 12(6S3):S161–S163. https://doi.org/10.5489/cuaj.5325\nHao D, Yurter A, Chu R et al (2022) Neuromodulation for management of chronic pelvic pain: a comprehensive review. Pain Ther 11(4):1137–1177. https://doi.org/10.1007/s40122-022-00430-9\nYang CC (2013) Neuromodulation in male chronic pelvic pain syndrome: rationale and practice. World J Urol 31:767–772. https://doi.org/10.1007/s00345-013-1066-7\nMyles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A (2017) Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 118(3):424–429. https://doi.org/10.1093/bja/aew466\nLevin D, Van Florcke D, Schmitt M, Kendall LK, Patel A, Doan LV, Kirpekar M (2024) Fluoroscopy-guided transgluteal pudendal nerve block for pudendal neuralgia: a retrospective case series. J Clin Med 13(9):2636. https://doi.org/10.3390/jcm13092636\nSimon DP, Bajic P, Lynch KM, Levine LA (2021) Spermatic cord block series as a minimally invasive therapy for chronic scrotal content pain. J Urol 206(3):725–732. https://doi.org/10.1097/JU.0000000000001777\nQiu Y, Hu AM, Liu J, Du GZ (2016) Dorsal penile nerve block for rigid cystoscopy in men: study protocol for a randomized controlled trial. Trials 17(1):147. https://doi.org/10.1186/s13063-016-1281-9\nDolendo I, Chen A, Bresee C, Pacheco JAC, De Hoedt A, Kim J, Freedland S, Anger JT (2025) Sex differences in cystoscopic findings among veterans with interstitial cystitis. Neurourol Urodyn 44(8):1602–1606. https://doi.org/10.1002/nau.70142\nUeda M, Sengiku A, Kono J, Negoro H, Saito R, Yoshimura N, Ogawa O, Ueda T (2019) Low bladder capacity is an important predictor for comorbidity of interstitial cystitis with Hunner’s lesion in patients with refractory chronic prostatitis/chronic pelvic pain syndrome. Int J Urol 26(Suppl 1):53–56. https://doi.org/10.1111/iju.13975\nKim SH, Oh SJ (2014) Nonspecific genitourinary pain improves after prostatectomy using holmium laser enucleation of prostate in patients with benign prostatic hyperplasia: a prospective study. PLoS ONE 9(6):e98979. https://doi.org/10.1371/journal.pone.0098979\nLai HH, Pontari MA, Argoff CE et al (2025) Male chronic pelvic pain: aua guideline: Part I evaluation and management approach. J Urol. https://doi.org/10.1097/JU.0000000000004564\nCurtis Nickel J, Baranowski AP, Pontari M, Berger RE, Tripp DA (2007) Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol 9(2):63–72\nSandhu J, Tu HYV (2017) Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res 6:F1000 Faculty Rev-1747. https://doi.org/10.12688/f1000research.10558.1\nGreig J, Mak Q, Furrer MA, Sahai A, Raison N (2023) Sacral neuromodulation in the management of chronic pelvic pain: a systematic review and meta-analysis. Neurourol Urodyn 42(4):822–836. https://doi.org/10.1002/nau.25167\nHoang Roberts L, Vollstedt A, Volin J, McCartney T, Peters KM (2021) Initial experience using a novel nerve stimulator for the management of pudendal neuralgia. Neurourol Urodyn 40(6):1670–1677. https://doi.org/10.1002/nau.24735\nMykoniatis I, Pyrgidis N, Sokolakis I, Sountoulides P, Hatzichristodoulou G, Apostolidis A, Hatzichristou D (2021) Low-intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis. BJU Int 128(2):144–152. https://doi.org/10.1111/bju.15335\nBirowo P, Rangganata E, Rasyid N, Atmoko W (2020) Efficacy and safety of extracorporeal shockwave therapy for the treatment of chronic non-bacterial prostatitis: a systematic review and meta-analysis. PLoS ONE 15(12):e0244295. https://doi.org/10.1371/journal.pone.0244295\nSamplaski MK, Li J, Shoskes DA (2012) Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. J Urol 188(5):1788–1793. https://doi.org/10.1016/j.juro.2012.07.036\nAuthor information\nAuthors and Affiliations\nContributions\nA.K. and E.W. wrote the main manuscript text. A.K., E.W., and J.U. performed data collection and data analysis. A.K., E.W., and J.U. performed literature review. A.K., E.W., B.Z., and K.P. were responsible for project conceptualization. B.Z. and K.P. performed critical revision of manuscript drafts.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare no competing interests. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nKennedy, A.J., Weitzman, E., Um, J. et al. Clinical phenotypes and treatment patterns in men with chronic pelvic pain: a tertiary referral cohort. Int Urol Nephrol (2026). https://doi.org/10.1007/s11255-026-05189-y\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s11255-026-05189-y","source_license":"CC0","license_restricted":false}