Clinical phenotypes and treatment patterns in men with chronic pelvic pain: a tertiary referral cohort

Purpose Men 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?

We 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.

157 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%).

Most 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. Similar content being viewed by others Data availability The 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.

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J Urol 188(5):1788–1793. https://doi.org/10.1016/j.juro.2012.07.036 Author information Authors and Affiliations Contributions A.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. Corresponding author Ethics declarations Conflict of interest The 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. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer 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. About this article Cite this article Kennedy, 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 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11255-026-05189-y