[Painful ejaculation]. / L'éjaculation douloureuse.

OBJECTIVE: To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). MATERIAL AND METHODS: Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. RESULTS: PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. CONCLUSION: The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.

Proposal for a predictive model of erectile function after permanent (125)I prostate brachytherapy for localized prostate cancer.

To determine the risk factors for EDin men treated by prostate brachytherapy (PB) for localized prostate cancer and to propose a model to predict post-implant erectile function. Out of a series of 270 sexually active men treated by PB, 241 (89%) (mean age=66 years (range, 43-80)) accepted to participate in a mail-based study on erectile function. The risk factors for erectile dysfunction were determined by regression analysis and a predictive model was proposed. The performance of the model was determined in this population and subsequently verified in a population of 50 men treated by PB in another treatment center. The risk factors for ED after PB were age, the pre-implant IIEF score and prostate volume. In the studied population, the final model to predict a post-treatment IIEF-5 score, using these factors, had a sensitivity of 69% and a specificity of 68% associated to an area under the ROC curve (AUC) of 0.75. The same performance was obtained in another treatment center. Age, pre-implant IIEF-5 score and prostate volume may be used to predict post-implant erectile function in patients treated by PB.

[Orgasm after curietherapy with permanent iodine-125 radioimplants for localized prostate cancer]. / Orgasme après curiethérapie de prostate par implants permanents d'iode 125 pour cancer localisé de la prostate.

OBJECTIVES: Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. PATIENTS AND METHODS: In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). RESULTS: After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P=0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P=0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P<0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n=31) before implantation (P=0.0001). CONCLUSION: Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm.

[Female partners confronted with erectile dysfunction. A series of 137 patients]. / La femme face à la dysfonction érectile de son partenaire. À propos de 137 patients.

AIM: To assess the behavior of female partners of patients consulting for erectile dysfunction (ED) and the impact of ED on their sex life. MATERIAL: One hundred and thirty seven men (mean age 57.4 ears), consulting for the first time because of ED and having a stable relationship with a single woman for more than six months, completed various questionnaires: IIEF, grounds for the possible absence of their partner during the consultation, attitude of the latter confronted with ED. The partners (mean age 54 years) have been invited to complete a questionnaire ISL (Index of Sexual Life) regarding their sexual life during the four last weeks. Seventy-nine (58%) have responded. RESULTS: Most often, the ED was severe (49%) and has evolved for more than one year (64%). The relationship has lasted for more than ten years for 77% of couples. Moreover, 43% of men declared that their partner had encouraged them to consult but 76% consulted alone the first time. According to the patients, the most frequent grounds for absence of their partner were: "she was occupied" (58%), "we did not think of it" (24%), "we did not know that it was possible" (15%). According to the patients, confronted with ED their partner was disappointed (29%), vexed (27%), frustrated (17%), accepting (15%) but the most often understanding (77%). The ISL scores were impaired in the different categories (sexual drive, sexual life satisfaction, general life satisfaction). According to ISL, 41% of women indicated that sexual intercourse was "a few times, almost never" or never satisfactory for them. Moreover, 45% found sexual intercourse "fairly enjoyable, enjoyable, or very enjoyable" but 41% did not feel an orgasm during vaginal penetration. Additionally, 44% remained "moderately or very satisfied" with their sexual relationship and 54% with their overall sex life. CONCLUSION: Few women attended the first consultation of ED because, according to the patients, usually they were not free. According to the patients, confronted with ED their partner was sometimes vexed, disappointed, frustrated but more often remained understanding. The analysis of the questionnaires ISL completed by the female partners shown that ED affected their sexuality but about half of them remained satisfied with their sexual relationship and overall sex life.

[Chronic pelvic pain in urology: a nationwide questionnaire survey among French urologists]. / Douleurs pelvipérinéales chroniques en urologie: enquête auprès des urologues français.

OBJECTIVE: To know the opinion of French urologists concerning the importance of pelvic and perineal pain syndromes in their clinical activity, their management, self-admitted knowledge and training needs concerning this situation. MATERIAL AND METHODS: Eight hundred and seventy-eight urologists exercising in France, all French Urology Association (AFU) members, have been asked to fill in an online questionnaire concerning their daily management of chronic pelvic and perineal pain syndromes. RESULTS: Three hundred and fifty-two urologists answered (response rate 40%). For about 20%, chronic pelvic and perineal pain syndromes took up more than 5% of consult activity. More than half took care of between 20 and 100 new cases of chronic pelvic and perineal pain every year. More than two thirds deemed their knowledge concerning chronic pelvic and perineal pain fair to insufficient. Three quarters of urologists would like to benefit from an opinion from another specialist for more than one out of four patients. More than 56% deemed that the organization of their daily consult activity was inadequate for the management of this type of patient. Most of them deemed useful to develop additional specific training programs. CONCLUSION: This survey shows that pelvic and perineal pain syndromes are frequent in daily urological consult activity, despite the fact that urologists feel they lack in training and organization to manage properly these diseases.

[Anatomy and physiology of chronic pelvic and perineal pain]. / Anatomophysiologie des douleurs pelvipérinéales chroniques.

OBJECTIVE: To determine the mechanisms involved in the regulation of pelvic and perineal pain. MATERIAL AND METHODS: Description of the anatomical pathways mediating nociceptive transmission and the physiological mechanisms of pain control. RESULTS: The pelvis and perineum do not have the same innervation. The pelvis is innervated by the sympathetic nervous system, while the perineum is innervated by the somatic nervous system via sacral nerve roots (and the pudendal nerve) and the thoracolumbar sympathetic nervous system. Systems of regulation of nociceptive messages are present at all levels of the nervous system. Two of these systems are essential: one situated in the dorsal horns of the spinal cord (gate control) and another supraspinal system (descending inhibitory system). Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas, especially involving memory and emotion. CONCLUSION: Excessive nociceptive stimulation must be clearly distinguished from dysfunction of pain control systems (for example neuropathic pain). The definition of pain: "unpleasant sensory and emotional experience related to a real or potential tissue lesion or described in terms of such a lesion" clearly indicates that not all pain is inevitably related to a persistent and visible cause. Convergence phenomena identified between nerve pathways of the various systems and pelvic organs account for the possible diffusion of visceral nociceptive messages and interactions between organs. A good knowledge of anatomy is essential to understand the patient's description of the pain, and a good knowledge of the modalities of pain control is essential to correctly adapt treatment strategies (drugs, neurostimulation, psycho-behavioural therapy, etc.).

[Evaluation of chronic pelvic and perineal pain]. / Évaluation des douleurs pelvipérinéales chroniques.

OBJECTIVE: To describe the tools allowing evaluation of chronic pelvic and perineal pain and to define their indications. MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either Medical subject heading (MeSH) keywords (pelvic pain, pain measurement, prostatitis, quality of life) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Various rating scales and questionnaires constitute useful tools for clinical evaluation of the patient's chronic pain. They cannot replace clinical interview and cannot be used to establish a diagnosis. The main clinical assessment tools include severity scales, body diagrams, descriptive assessment (sensory and affective), evaluation of the impact on sleep, activities of daily living, quality of life and behaviour and assessment of mood and anxiety. In addition to these general tools, specific questionnaire have been developed in the fields of interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome. These specific questionnaires are designed for evaluation of the severity of symptoms, assessment of the disability related to the symptoms and the impact on quality of life, and follow-up of the course of symptoms and the response to treatment. CONCLUSION: Rapid and easy to use tools are essential in routine clinical practice. The recommended assessment tools are VAS (visual analogue scale) or numerical severity scales, body diagrams and brief questionnaires such as the Questionnaire sur la Douleur de Saint-Antoine (QDSA) (Saint-Antoine pain questionnaire) or Questionnaire Concis sur les Douleurs (QCD) (validated French translation of the Brief Pain Inventory).

[Chronic pelvic pain: epidemiology and economic impact]. / Épidémiologie et aspects économiques des douleurs pelvipérinéales chroniques.

OBJECTIVE: To combine epidemiological and health economics data concerning urological chronic pelvic pain syndromes. MATERIAL: Review of articles concerning this topic in the Medline (PubMed) database, chosen according to their scientific relevance. RESULTS: Prevalences are about 10,000/100,000 for chronic pelvic pain syndrome/chronic prostatis, 239 to 306/100,000 for bladder pain syndrome/interstitial cystitis, 15,000 to 20,000/100,000 for post-vasectomy testis and epididymis pain, 14,000/100,000 concerning deep female dyspareunia, 1000 to 9000/100,000 for male ejaculation or orgasma-related pain, 15,000 to 21,000/100,000 for female chronic pelvic pain, of which one third is related to endometriosis. Little has been published about the frequency of other chronic pelvic and perineal pain syndromes. The financial impact is comparable to other more frequent chronic diseases, with costs definitely above what the prevalences would have led to believe. CONCLUSION: The frequency of pelvic disease association, their predisposing factors, common environments and comordities suggest a possible common origin. This epidemiological data highlights the benefit of a multidisciplinary approach of chronic pelvic and perineal pain. This could lead to a better understanding of involved mechanisms, and ultimately treatment options.

[Definitions, classifications and terminology of chronic pelvic and perineal pain]. / Définitions, classifications et lexique des douleurs pelvipérinéales chroniques.

OBJECTIVE: To review the definitions and classifications of chronic pelvic and perineal pain and to describe the concepts of chronic pelvic and perineal pain syndrome and the global diagnostic and aetiopathogenic approach. MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (classification, complex regional pain syndrome, fibromyalgia, myofascial pain syndrome, neuralgia, pelvic pain, postoperative pain, prostatitis, referred pain, syndrome) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Chronic pelvic and perineal pain does not only consist of symptoms localized to an anatomical region present for 3 to 6 months, but also constitutes a distinct, complex, multidimensional disease entity, comprising psychological, organic and psychosomatic phenomena, called chronic pelvic and perineal pain syndromes. These syndromes are responsible for disability, impaired quality of life, and induce considerable health care consumption and sick leave. They alter the patient's personality and affect his or her behaviour, sex life, family life, social life and work life. The usual clinical approach to these syndromes, looking for an organ or tissue disease responsible for pain, is negative. The approach to this type of pain must be much more global and consists of looking for disturbances of the regulation of pelvic and perineal nociceptive messages and dysfunction of the organ or structure concerned. CONCLUSION: The current definitions and classifications of chronic pelvic and perineal pain comprise the concepts of syndrome, functional disease and global approach and differ from the strict organ-based context and the classical medical approach (infectious, inflammatory, metabolic, endocrine) in order to focus pain syndromes on the pain itself and the associated symptoms.

[Medicolegal aspects of chronic pelvic and perineal pain]. / Aspects médicolégaux des douleurs pelvipérinéales chroniques.

OBJECTIVE: To review the medicolegal aspects of chronic pelvic and perineal pain. MATERIAL AND METHODS: The literature and the French Public Health Code were reviewed. The review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (forensic medicine, legislation, pelvic pain, postoperative pain) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Chronic pelvic and perineal pain raises a number of medicolegal issues: pain management is required by law, chronic pelvic and perineal pain can be a complication of certain surgical procedures and may be the subject of patient complaints, certain medical or surgical treatments of chronic pelvic and perineal pain do not have a marketing authorisation or scientific validation with a high level of evidence, which can have medicolegal implications. The French law of 4 March 2002 concerning patient rights and quality of the health care system defines a number of legal obligations. All physicians must comply with good professional practices as defined by the code of medical ethics and scientific knowledge. All surgeons are required to provide the patient with honest, clear and appropriate information about the risks of a proposed operation, especially about the possible risk of pain. It is also advised to provide the patient with a written document. All physicians must subscribe a professional civil liability insurance policy. Contraceptive vasectomy, that may be complicated by pain, is a particular case, subject to the French law of 4 July 2001, which requires the surgeon to provide the patient with written information and requires the patient to confirm his request for vasectomy in writing after a 4-month period of reflection. CONCLUSION: The field of chronic pelvic and perineal pain comprises numerous and major medicolegal implications, requiring compliance with good clinical practice and legislation, especially the French law of 4 March 2002 concerning patient rights and quality of the health care system.

[Integration of chronic pelvic pain to the accreditation and professional practice assessment procedures]. / Intégration des douleurs pelvipérinéales chroniques dans la démarche d'accréditation et d'évaluation des pratiques professionnelles.

OBJECTIVE: To list available actions in order to optimize urological care of patients suffering from chronic pelvic and perineal pain, based on guidelines for accreditation and professional practice assessment. MATERIAL AND METHODS: Legislative texts concerning accreditation and PPA, as well as professional recommendations concerning chronic pains have been consulted. RESULTS: Professional practice assessment of chronic pelvic and perineal pain is hampered by the lack of specific professional guidelines. Urological management of chronic pelvic and perineal pain can only be optimized if initial and continued training is strengthened. Furthermore, current professional structures implemented for professional practice assessment and accreditation processes (staff, multi-disciplinary meetings, morbidity-mortality reviews) should be applied in a more systematic way to pelvic chronic pain by urologists. CONCLUSION: The need for improvement in the management of chronic pelvic pain is felt in the urological field, and should lead to developing means of evaluating professional practices, a goal to which the French Urology Association has committed itself.

[Clinical interview and clinical examination of patients with chronic pelvic and perineal pain]. / Interrogatoire et examen clinique d'un patient ayant des douleurs pelvipérinéales chroniques.

INTRODUCTION: Patients with chronic pelvic and perineal pain sometimes report major complaints with no objective value that help to "validate" this pain other than by the patient's own interpretation of the pain. The purpose of this article is to describe the essential elements of the clinical interview and clinical examination in the diagnostic approach to patients with chronic pelvic and perineal pain. PATIENTS AND METHODS: A review of the literature and a description of our experience was performed to describe the clinical interview and clinical examination of patients with chronic pelvic and perineal pain. RESULTS: Clinical interview of the patient is designed to define the characteristics of the pain: mode of installation, topography, irradiation, type, remission, nocturnal waking, and aggravating or limiting factors. It must also look for associated clinical signs: urinary, gastrointestinal, gynaecological, sexual, cutaneous and neurological. The intensity of the pain is evaluated on an analogue scale. A complete clinical examination of the pelvis and perineum must be performed looking for an organic cause: neurological, dermatological, urogenital, spinal, myofascial and sympathetic nervous system. Digital rectal and vaginal (pelvic) examinations play an important role in the detection of trigger points. CONCLUSION: A well-conducted clinical interview and clinical examination can help to elucidate a large proportion of cases of chronic pelvic and perineal pain and are an essential in part of the diagnostic approach.

[Electrophysiological studies of chronic pelvic and perineal pain]. / Explorations électrophysiologiques des douleurs pelvipérinéales chroniques.

OBJECTIVE: To describe electrophysiological studies, what they investigate, and their contribution and limitations in the assessment of pelvic and perineal pain. MATERIAL AND METHOD: Description of the electrophysiological techniques generally used to evaluate somatic nerves of the pelvic and perineal region (analytical electromyography, nerve conduction velocities, reflexology), their applications and the difficulties of interpretation. RESULTS: Electrophysiological studies can demonstrate signs in favour of peripheral neuropathy, specify the axonal and/or demyelinating type of lesion, and provide topographic arguments on the type of trunk or nerve root involved (pudendal nerve, sacral nerve roots, ilioinguinal or iliohypogastric nerve, genitofemoral nerve, obturator nerve). CONCLUSION: Electrophysiological studies require a technically skilled operator and can provide a better understanding of some types of pain, but are not sufficiently sensitive and specific. The conclusions of electrophysiological study reports must be closely correlated with clinical findings.

[The doctor-patient relationship in chronic pelvic and perineal pain]. / La relation médecin-malade dans les douleurs pelvipérinéales chroniques.

OBJECTIVE: To analyse the doctor-patient relationship from the patient's point of view and from the doctor's point of view. MATERIAL AND METHODS: Experience of a chairman of a chronic pelvic and perineal pain patient association (AFAP-NP) and experience of doctors specialized in chronic pelvic and perineal pain. RESULTS: Management of a patient with chronic pelvic and perineal pain requires knowledge and understanding of the patient's trajectory disease, the history of the disease and the patient's hopes and disappointments, and evaluation of the patient's personality and family, social and work environment. CONCLUSION: As pain is an emotional experience, the type of doctor-patient relationship determines the quality of subsequent management. A number of basic principles should be applied: believe the patient, avoid making the patient feel responsible for failure, avoid overestimating the secondary benefits, avoid making the patient passive and dependent, learn to reinterpret the patient's symptoms, ask "how" does the pain persist rather than "why", clearly define the patient's demand and adapt management to realistic and accessible objectives.

[Impact of chronic pelvic pain on sexual functions and fertility]. / Retentissement sur la sexualité et la fertilité des douleurs pelvipérinéales chroniques.

OBJECTIVE: To summarize current knowledge on prevalence, characteristics and ethiopathogenical hypothesis concerning sexuality and fertility dysfunctions in patients with chronic pelvic pain. MATERIAL AND METHODS: Review of articles published on this subject in the Medline (PubMed) database, selected according to their scientific relevance. RESULTS: In the male subject, most frequent sexual dysfunctions are erectile dysfunction and ejaculation disturbance (premature ejaculation, painful ejaculation). Chronic epididymal and testicular pain has a negative impact on the quality of sexual intercourse and satisfaction of both partners. Association between lower urinary tract symptoms--frequent in the event of chronic pelvic pain syndrome--and sexual dysfunction has been proved. Change in spermatic parameters exists in the event of chronic pelvic pain syndrome, but their impact on male fertility has not yet been established. In the female subject, sexual dysfunction is less studied. However, effect of chronic pelvic and perineal pain on female patient sexuality cannot be ignored, as they can affect all components of the sexual cycle. There is no data published on the link between infertility and chronic pelvic and perineal pain in the female subject. CONCLUSIONS: Allowing to the frequency of sexual dysfunction and its impact on quality of life, sexual function assessment must be a part of every consultation for chronic pelvic and perineal pain.

[Symptomatic approach to chronic pudendal pain]. / Approche symptomatique des douleurs pudendales chroniques.

INTRODUCTION: Pudendal neuralgia is a recently identified and now clearly recognized clinical entity. This chronic disabling pain is due to a pelviperineal tunnel syndrome. MATERIAL AND METHODS: Review of the literature based on a Medline search of articles devoted to this subject. RESULTS: The diagnosis is purely clinical, based on simple consensual criteria (Nantes Criteria): pain situated in the anatomical territory of the pudendal nerve, worse on sitting, not usually waking the patient at night, not accompanied by any objective perineal sensory loss with a positive anaesthetic block of the pudendal nerve at the ischial spine. CONCLUSION: The diagnosis of pudendal neuralgia is straightforward when the patient's symptoms remain confined to these diagnostic criteria, which are all essential for the diagnosis. However, the patient often presents associated urinary, anorectal, sexual, neuromuscular and hypersensitization signs, which can complicate the diagnostic approach and therapeutic management.

[Diagnostic approach to chronic bladder pain]. / Approche symptomatique des douleurs vésicales chroniques.

INTRODUCTION: Painful bladder syndrome is defined as chronic pelvic pain present for more than 6 months, causing discomfort perceived as being related to the bladder and accompanied by a persistent and strong urge to urinate or urinary frequency. The purpose of this article is to review the diagnostic approach to painful bladder syndrome. PATIENTS AND METHODS: A comprehensive review of the literature was performed by searching Pubmed for articles on the diagnostic approach to painful bladder syndrome. RESULTS: Painful bladder syndrome was initially defined by pain related to bladder filling, but now refers to pain related to the bladder accompanied by urinary symptoms (persistent urge or frequency). The diagnosis of painful bladder syndrome is based on clinical interview and a bladder diary. Cystoscopy under general anaesthesia is an essential examination to confirm the diagnosis. Cystoscopy classically demonstrates glomerulations of the bladder mucosa and Hunner's ulcers and simultaneously allows bladder biopsies and bladder hydrodistension, which are the first steps in the management of painful bladder syndrome. The other complementary investigations: imaging, urodynamic assessment, laboratory work-up, cytology are not essential at diagnosis but are useful for the differential diagnosis, as painful bladder syndrome remains a diagnosis of exclusion. CONCLUSION: The diagnosis of painful bladder syndrome is primarily clinical, but is confirmed by cystoscopy in the operating room under anaesthesia with bladder biopsies and a brief trial of hydrodistension.

[Symptomatic approach to chronic prostatitis/chronic pelvic pain syndrome]. / Approche symptomatique des douleurs "prostatiques" chroniques et du syndrome douloureux pelvien chronique.

OBJECTIVE: To review the diagnosis and pathogenesis of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS). MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (microbiology, pelvic pain, prostatitis) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Chronic bacterial prostatitis is a chronic, recurrent bacterial infection of the prostate, accounting for about 5 to 10% of all cases of chronic prostatitis (CP). CPPS is nonbacterial genitourinary pelvic pain present for at least 3 months, sometimes associated with sexual and voiding disorders. Although the prostate does not appear to be involved in all cases of chronic pelvic pain in men, the term CP usually remains associated with CPPS (CP/CPPS). CP/CPPS has a negative impact on quality of life. The precise pathogenesis of CP/CPPS has not been elucidated, but prostatic infection and inflammation could be involved, not as direct causes, but as initiating factors of a neurological hypersensitization phenomenon. Evaluation of CP/CPPS comprises clinical interview completed by the National Institutes of Health-Chronic Prostatitis Symptom Index questionnaire (NIH-CPSI), physical examination, urine culture and uroflowmetry combined with determination of the post-voiding residual volume. The other investigations are optional and are designed to exclude other urological diagnoses. The Meares-Stamey four-glass test should be abandoned in favour of a simplified test comprising urine analysis before and after prostatic massage. However, the indications for this test are limited to patients in whom chronic bacterial prostatitis is suspected or with bacteriuria on urine culture. CONCLUSION: Chronic bacterial prostatitis represents only about 5 to 10% of all cases of CP. The usual terminology of chronic non-bacterial prostatitis has been replaced by the term CPPS or CP/CPPS in men, in order to situate this disease in a broader context not exclusively related to the prostate. Despite its prevalence and its impact on quality of life and sexuality, CP/CPPS remains poorly known and continues to raise diagnostic problems.

[Symptomatic approach to chronic urethral pain]. / Approche symptomatique des douleurs urétrales chroniques.

OBJECTIVE: To describe the clinical features, pathogenesis and differential diagnosis of urethral pain syndrome. MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (urethra, pain) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Urethral pain syndrome is defined as recurrent urethral pain usually occurring during micturition, but sometimes unrelated to micturition, accompanied by daytime frequency and nocturia, in the absence of documented infection or another clinically apparent disease. The cause of this syndrome is unclear, but it could correspond to an early form of interstitial cystitis/painful bladder syndrome. Urethral pain syndrome is a diagnosis of exclusion and, in a patient presenting with urethral pain and voiding disorders, various more common and more clearly defined organ or tissue diseases must be excluded by a urological and gynecological work-up (especially genital tract and urinary tract infection, urethral stricture, bladder tumor, urethral tumor, hyperactive bladder, low urinary tract or distal ureteric stones). CONCLUSION: The cause of urethral pain syndrome is unclear. This syndrome remains a diagnosis of exclusion in patients with urethral pain and voiding disorders.