Chronic prostatitis/chronic pelvic pain syndrome

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of the painful areas and there remains to be consensus on where the optimal location of the spinal cord this treatment should be aimed. As the innervation of the pelvic region is from the sacral nerve roots, previous treatments have been aimed at this region; however pain pathways seem to elude treatment solely directed at the level of the spinal cord (perhaps via the sympathetic nervous system) leading to failures. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results. A newer form of spinal cord stimulation called dorsal root ganglion stimulation (DRG) has shown a great deal of promise for treating pelvic pain due to its ability to affect multiple parts of the nervous system simultaneously – it is particularly effective in patients with "known cause" (i.e. post surgical pain, endometriosis, pudendal neuralgia, etc.).

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there were short term improvements in symptoms and few adverse effects, but the medium terms results are unknown, and the results are difficult to generalize due to low quality of the studies. Physical activity may slightly reduce physical symptoms of chronic prostatitis but may not reduce anxiety or depression. Transrectal thermotherapy, where heat is applied to the prostate and pelvic muscle area, on its own or combined with medical therapy may cause symptoms to decrease slightly when compared with medical therapy alone. However, this method may lead to transient side effects. Alternative therapies like prostate massage or lifestyle modifications may or may not reduce symptoms of prostatitis.

57: 774:(a calcium-leaching antibiotic with anti-inflammatory effects, used here to kill the "pathogens"), and half had significant improvement in symptoms. Scientists have expressed strong doubts about whether nanobacteria are living organisms, and research in 2008 showed that "nanobacteria" are merely tiny lumps of abiotic limestone. 403:

For CP/CPPS patients, analysis of urine and expressed prostatic secretions for leukocytes is debatable, especially due to the fact that the differentiation between patients with inflammatory and non-inflammatory subgroups of CP/CPPS is not useful. Serum PSA tests, routine imaging of the prostate, and

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There are no definitive diagnostic tests for CP/CPPS. It is a poorly understood disorder, even though it accounts for 90–95% of prostatitis diagnoses. CP/CPPS may be inflammatory (Category IIIa) or non-inflammatory (Category IIIb), based on levels of pus cells in expressed prostatic secretions (EPS),

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Neuromodulation has been explored as a potential treatment option for some time. Traditional spinal cord stimulation, also known as dorsal column stimulation has been inconsistent in treating pelvic pain: there is a high failure rate with these traditional systems due to the inability to affect all

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also appears to be helpful in decreasing prostate symptoms without the impact of negative side effects but the decrease may only last while treatment is continued. As of 2018 use of extracorporeal shockwave therapy had been studied as a potential treatment for this condition in three small studies;

572:) including intrarectal digital massage of the pelvic floor, physical therapy to the pelvic area, and progressive relaxation therapy to reduce causative stress. A device, that is typically placed in the rectum, has also been created for use together with relaxation. This process has been called the 467:

A distinction is sometimes made between "IIIa" (Inflammatory) and "IIIb" (Noninflammatory) forms of CP/CPPS, depending on whether pus cells (WBCs) can be found in the expressed prostatic secretions (EPS) of the patient. Some researchers have questioned the usefulness of this categorisation, calling

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In the general population, chronic pelvic pain syndrome occurs in about 0.5% of men in a given year. It is found in men of any age, with the peak incidence in men aged 35–45 years. However, the overall prevalence of symptoms suggestive of CP/CPPS is 6.3%. The role of the prostate was questioned in

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which is present in the central nervous system. This means that regardless of the route of administration (oral versus rectal/intra-vaginal), the drug will still need to travel to the central nervous system to work and is no more or less effective when given in this capacity. Research shows this

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Extraprostatic abdominal/pelvic tenderness is present in >50% of patients with chronic pelvic pain syndrome but only 7% of controls. Healthy men have slightly more bacteria in their semen than men with CPPS. The high prevalence of WBCs and positive bacterial cultures in the asymptomatic control

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Chronic Prostatitis Symptom Index (NIH-CPSI) – with the female homologue of each male anatomical term used on questionnaires for female participants – (2) the International Prostate Symptom Score (IPSS), and (3) additional questions on pelvic pain. The prevalence of

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without evidence of urinary tract infection, lasting longer than 3 months, as the key symptom. Symptoms may wax and wane. Pain can range from mild to debilitating. Pain may radiate to the back and rectum, making sitting uncomfortable. Pain can be present in the perineum, testicles, tip of penis,

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Penna G, Mondaini N, Amuchastegui S, Degli Innocenti S, Carini M, Giubilei G, et al. (Feb 2007). "Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia".

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Treatment with antibiotics is controversial. A review from 2019 indicated that antibiotics may reduce symptoms. Some have found benefits in symptoms, but others have questioned the utility of a trial of antibiotics. Antibiotics are known to have anti-inflammatory properties and this has been

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UCPPS is a term adopted by the network to encompass both IC/BPS and CP/CPPS, which are proposed as related based on their similar symptom profiles. In addition to moving beyond traditional bladder- and prostate-specific research directions, MAPP Network scientists are investigating potential

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cells (dead white blood cells or WBCs), whereas in the non-inflammatory form no pus cells are present. Recent studies have questioned the distinction between categories IIIa and IIIb, since both categories show evidence of inflammation if pus cells are ignored and other more subtle signs of

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suppositories are a controversial treatment for CPPS – proponents believe that by delivering the medication in a closer proximity to the area of pain that better relief can be achieved. This has never been substantiated in any research and this hypothesis is invalid due to the fact that

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Experimental tests that could be useful in the future include tests to measure semen and prostate fluid cytokine levels. Various studies have shown increases in markers for inflammation such as elevated levels of cytokines, myeloperoxidase, and chemokines.

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symptoms suggestive of CPPS in this selected population was 5.7% in women and 2.7% in men, placing in doubt the role of the prostate gland. New evidence from 2008 suggests that the prevalence of CP/CPPS is much higher in teenage males than once suspected.

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population raises questions about the clinical usefulness of the standard Meares–Stamey four-glass test as a diagnostic tool in men with CP/CPPS. By 2000, the use of the four-glass test by American urologists was rare, with only 4% using it regularly.

304:(11KDHT), an 11-oxo form of DHT with the same potency. The relationship between steroid serum levels and CP/CPPS suggests that deficiencies in the enzyme CYP21A2 may lead to increased biosynthesis of 11-oxo androgens and androgens biosynthesized via a 598:

Other non-drug treatments that have been evaluated for this condition include acupuncture, extracorporeal shockwave therapy, programs for physical activity, transrectal thermotherapy and a different set of recommendations regarding lifestyle changes.

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One theory is that CP/CPPS is a psychoneuromuscular (psychological, neurological, and muscular) disorder. The theory proposes that anxiety or stress results in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of

658:(TNF), which coincidentally are the same cytokines found to be elevated in the semen and EPS of men with chronic prostatitis. The UPOINT diagnostic approach suggests that antibiotics are not recommended unless there is clear evidence of infection. 4374:

Leskinen MJ, Vainionp R, Syrjnen S, et al. (2003). "Herpes simplex virus, cytomegalovirus, and papillomavirus DNA are not found in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer".

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Clemens, J Quentin, Meenan, Richard T, O'Keeffe Rosetti, Maureen C, Gao, Sara Y, Calhoun, Elizabeth A (Dec 2005). "Incidence and clinical characteristics of National Institutes of Health type III prostatitis in the community".

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Marszalek M, Wehrberger C, Temml C, Ponholzer A, Berger I, Madersbacher S (April 2008). "Chronic Pelvic Pain and Lower Urinary Tract Symptoms in Both Sexes: Analysis of 2749 Participants of an Urban Health Screening Project".

709:(BTA) may cause a large decrease in prostatitis symptoms. If BTA is applied to the muscles of the pelvis, it may not lead to the reduction of symptoms. For both of these procedures, there may be no associated side effects. 669:) is questionable in men with CPPS and may increase side effects like dizziness and low blood pressure. A 2006 meta-analysis found that they are moderately beneficial when the duration of therapy was at least three months. 332:

began to group IC/PBS (Interstitial Cystitis & Painful Bladder Syndrome)and CP/CPPS under the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS). Therapies shown to be effective in treating IC/PBS, such as

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Nickel J, Tripp D, Chuai S, Litwin M, McNaughton-Collins M, Landis J, et al. (Jan 2008). "Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome".

308:, that contribute to the development of CP/CPPS. Non-classical congenital adrenal hyperplasia (CAH) resulting from CYP21A2 deficiency is typically considered asymptomatic in men. However, non-classical CAH could be a 2492:

Weidner W, Anderson RU (2007). "Evaluation of acute and chronic bacterial prostatitis and diagnostic management of chronic prostatitis/chronic pelvic pain syndrome with special reference to infection/inflammation".

624:

A number of medications can be used which need to be tailored to each person's needs and types of symptoms (according to UPOINTS, S = sexual: e.g. erectile dysfunction, ejaculatory dysfunction, postorgasmic pain).

801:. For HSV, the evidence is weaker still, and there is only one reported case, and the causative role of the virus was not proven, and there are no reports of successful treatments using antiviral drugs such as 5460: 808:

Due to the concomitant presence of bladder disorders, gastrointestinal disorders and mood disorders, research has been conducted to understand whether CP/CPPS might be caused by problems with the hypothetical

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Leskinen M, Kilponen A, Lukkarinen O, Tammela T (Aug 2002). "Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study".

472: 2580:

Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, Propert KJ (2003). "Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls".

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and flower pollen extract have been studied in small clinical trials. A 2019 review found that this type of therapy may reduce symptoms of CPPS without side effects, but may not improve sexual problems.

2005:

du Toit T, Swart AC (2020). "The 11β-hydroxyandrostenedione pathway and C11-oxy C21 backdoor pathway are active in benign prostatic hyperplasia yielding 11keto-testosterone and 11keto-progesterone".

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Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, et al. (May 2020). "A Comprehensive Review of the Diagnosis, Treatment, and Management of Urologic Chronic Pelvic Pain Syndrome".

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The bacterial infection theory was shown to be unimportant in a 2003 study which found that people with and without the condition had equal counts of similar bacteria colonizing their prostates.

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relationships between UCPPS and other chronic conditions that are sometimes seen in IC/PBS and CP/CPPS patients, such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome.

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Shoskes DA, Landis JR, Wang Y, Nickel JC, Zeitlin SI, Nadler R (August 2004). "Impact of post-ejaculatory pain in men with category III chronic prostatitis/chronic pelvic pain syndrome".

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in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer. The reports implicating CMV must be interpreted with caution, because in

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Khadra A, Fletcher P, Luzzi G, Shattock R, Hay P (May 2006). "Interleukin-8 levels in seminal plasma in chronic prostatitis/chronic pelvic pain syndrome and nonspecific urethritis".

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Lee JC, Muller CH, Rothman I, et al. (February 2003). "Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls".

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Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G (March 2017). "Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis".

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Shoskes DA, Nickel JC, Dolinga R, Prots D (2009). "Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity".

2442:"Nerve growth factor level in the prostatic fluid of patients with chronic prostatitis/chronic pelvic pain syndrome is correlated with symptom severity and response to treatment" 4161:

Shoskes DA, Thomas KD, Gomez E (2005). "Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience".

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probably leads to a decrease in prostatitis symptoms when compared with standard medical therapy but may not reduce sexual problems. When compared with a simulated procedure,

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may not lead to side effects and may reduce symptoms for men with CPPS. However, these medicines probably don't improve sexual problems or symptoms of anxiety and depression.

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A classification system called "UPOINT" was developed by urologists Shoskes and Nickel to allow clinical profiling of a patient's symptoms into six broad categories:

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McNaughton Collins M, Fowler F, Elliott D, Albertsen P, Barry M (Mar 2000). "Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?".

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Chronic pelvic pain syndrome is difficult to treat. Initial recommendations include education regarding the condition, stress management, and behavioral changes.

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in their EPS when compared with controls; therefore measurement of these cytokines could be used to diagnose category III prostatitis. A 2010 study found that

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He L, Wang Y, Long Z, Jiang C (Dec 2009). "Clinical Significance of IL-2, IL-10, and TNF-alpha in Prostatic Secretion of Patients With Chronic Prostatitis".

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The star of Monty Python and "A Fish Called Wanda" has been diagnosed with prostatitis, the inflammation of the prostate gland and is undergoing treatment.

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In 2006, Chinese researchers found that men with categories IIIa and IIIb both had significantly and similarly raised levels of anti-inflammatory cytokine

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Another proposal is that it may result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems.

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Anderson RU, Wise D, Nathanson NH (October 2018). "Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder – A Meta-analysis".

5177: 3374:"Psychological therapies for chronic pelvic pain: systematic review of randomized controlled trials: Psychological therapies for chronic pelvic pain" 1981: 5854: 1771: 1700: 3861:"The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials" 5110: 1656:"Letter to the editor regarding the article "Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome"" 5849: 2902:

Hruz P, Danuser H, Studer UE, Hochreiter WW (2003). "Non-inflammatory chronic pelvic pain syndrome can be caused by bladder neck hypertrophy".

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Pasqualotto F, Sharma R, Potts J, Nelson D, Thomas A, Agarwal A (Jun 2000). "Seminal oxidative stress in patients with chronic prostatitis".

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Sant GR, Kempuraj D, Marchand JE, Theoharides TC (2007). "The mast cell in interstitial cystitis: role in pathophysiology and pathogenesis".

882: 218:, abdominal pain, constant burning pain in the penis, and frequency may all be present. Frequent urination and increased urgency may suggest 146: 490:

Older terms for this condition are "prostatodynia" (prostate pain) and non-bacterial chronic prostatitis. These terms are no longer in use.

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are not recommended. Treatment may also include a program of "paradoxical relaxation" to prevent chronic tensing of the pelvic musculature.

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but these subcategories are of limited use clinically. In the inflammatory form, urine, semen, and other fluids from the prostate contain

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Potts J, Payne RE (May 2007). "Prostatitis: Infection, neuromuscular disorder, or pain syndrome? Proper patient classification is key".

4831:"Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome" 4999: 5053: 5030: 3283: 1203: 856:, protocols aimed at quieting the pelvic nerves through myofascial trigger point release, anxiety control and chronic pain therapy. 841: 777:

The evidence supporting a viral cause of prostatitis and chronic pelvic pain syndrome is weak. Single case reports have implicated

3905:"Therapeutic Intervention for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/ CPPS): A Systematic Review and Meta-Analysis" 604: 5844: 3317: 2968: 2227:

Dimitrakov J, Dimitrakova E (2009). "Urologic chronic pelvic pain syndrome – looking back and looking forward".

837: 767: 581: 5020: 4494:

McKay TC, Albala DM, Sendelbach K, Gattuso P (1994). "Cytomegalovirus prostatitis. Case report and review of the literature".

5072: 5255: 5230: 3614:"Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration" 1792:

Theoharides TC, Cochrane DE (2004). "Critical role of mast cells in inflammatory diseases and the effect of acute stress".

725:

Therapies that have not been properly evaluated in clinical trials although there is supportive anecdotal evidence include

5823: 5623: 4056:"Management of Men Diagnosed With Chronic Prostatitis/Chronic Pelvic Pain Syndrome Who Have Failed Traditional Management" 2131:

Theoharides T, Whitmore K, Stanford E, Moldwin R, O'Leary M (Dec 2008). "Interstitial cystitis: bladder pain and beyond".

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improves voiding, reduces urological pain and improves quality of life in patients with chronic non-bacterial prostatitis.

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method of delivery takes longer to achieve peak effect, lower bioavailability and lower peak serum plasma concentration.

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as most chronic pain conditions, psychotherapy might be helpful in its management regardless its direct impact on pain.

5204: 3342: 2530:"Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study" 692:

probably help to reduce prostatitis symptoms in men with CPSS and don't appear to cause more side effects than when a

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Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Tirapegui FI, et al. (2019-10-06). Cochrane Urology Group (ed.).

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some protocols focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as

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Schaeffer AJ (2003). "Editorial: Emerging concepts in the management of prostatitis/chronic pelvic pain syndrome".

939: 351:

The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network has found that CPPS and

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A 2016 review suggested that although the peripheral nervous system is responsible for starting the condition, the

292:

11-oxygenated steroids (pregnanes) are presumed to be precursors to potent androgens. Specifically, steroids like

833: 786: 689: 305: 3742:

Anothaisintawee T, Attia, J, Nickel, JC, Thammakraisorn, S, Numthavaj, P, McEvoy, M, et al. (Jan 5, 2011).

4874: 3744:"Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis" 428: 244: 182: 1333:

Luzzi GA (2002). "Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management".

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Research has been conducted to understand how chronic bladder pain affects the brain, using techniques like

699: 274: 5818: 5169: 4170: 3099: 2377: 2311: 2140: 2057: 1966: 1895: 893: 259: 84: 4656:

Shoskes D, Katz E (Jul 2005). "Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome".

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Rempe S, Hayden JM, Robbins RA, Hoyt JC (30 November 2007). "Tetracyclines and Pulmonary Inflammation".

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Theoharides TC, Kalogeromitros D (2006). "The critical role of mast cells in allergy and inflammation".

655: 484: 406: 219: 155: 141: 89: 5745: 262:(CNS) is responsible for continuing the pain even without continuing input from the peripheral nerves. 1931:

Luu-The V, Bélanger A, Labrie F (April 2008). "Androgen biosynthetic pathways in the human prostate".

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were proposed as a cause of prostatic calcifications found in some CPPS patients. Patients were given

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Bergman J, Zeitlin S (Mar 2007). "Prostatitis and chronic prostatitis/chronic pelvic pain syndrome".

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Benson PJ, Smith CS (1992). "Cytomegalovirus prostatitis. Case report and review of the literature".

4328: 3916: 1844: 1726: 1655: 778: 4175: 3104: 2382: 2145: 2062: 1900: 5340: 1603:"Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome" 1165:

Holt JD, Garrett WA, McCurry TK, Teichman JM (2016). "Common Questions About Chronic Prostatitis".

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The cause is unknown. Diagnosis involves ruling out other potential causes of the symptoms such as

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Doble A, Harris JR, Taylor-Robinson D (1991). "Prostatodynia and herpes simplex virus infection".

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Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic or perineal

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the cause of CP/CPPS when both men and women in the general population were tested using the (1)

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In recent years, the prognosis for CP/CPPS has improved with the advent of multimodal treatment,

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in certain newly diagnosed cases. Some evidence supports some non medication based treatments.

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Murphy A, Macejko A, Taylor A, Nadler R (2009). "Chronic prostatitis: management strategies".

2158: 2113: 2075: 2022: 1973: 1948: 1913: 1860: 1809: 1755: 1747: 1684: 1676: 1632: 1580: 1528: 1471: 1429: 1394: 1350: 1315: 1280: 1262: 1199: 1174: 1139: 1104: 1050: 998: 798: 215: 64: 4007:"Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome" 3695:"Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome" 2368:

A Pontari M (Dec 2002). "Inflammation and anti-inflammatory therapy in chronic prostatitis".

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suggested as an explanation for their partial efficacy in treating CPPS. Antibiotics such as

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Larish AM, Dickson RR, Kudgus RA, McGovern RM, Reid JM, Hooten WM, et al. (June 2019).

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Habermacher GM, Chason JT, Schaeffer AJ (2006). "Prostatitis/chronic pelvic pain syndrome".

2267: 2193: 2150: 2105: 2067: 2014: 1940: 1905: 1852: 1801: 1739: 1668: 1622: 1614: 1570: 1562: 1518: 1510: 1463: 1421: 1386: 1342: 1307: 1270: 1254: 1131: 1094: 1086: 1040: 1032: 988: 980: 759: 393: 5438: 5057: 4995: 1298:

Schaeffer AJ (2007). "Epidemiology and evaluation of chronic pelvic pain syndrome in men".

487:) and the prostate gland (i.e. chronic prostatitis/chronic pelvic pain syndrome, CP/CPPS). 443:

Some conditions have similar symptoms to chronic prostatitis: bladder neck hypertrophy and

5755: 5663: 5655: 5645: 5412: 4981: 1967:"Precision Medicine in Urology: Molecular Mechanisms, Diagnostics and Therapeutic Targets" 917: 782: 730: 706: 631: 585: 5391: 3508:"Anatomy, Pathophysiology and Interventional Therapies for Chronic Pelvic Pain: A Review" 3023:"Multi-disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network" 2346: 4332: 4097:"Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile" 3920: 3447: 3422: 1848: 5567: 4847: 4830: 4768: 4743: 4633: 4616: 4471: 4446: 4351: 4316: 4269: 4242: 4072: 4055: 4031: 4006: 3939: 3904: 3809: 3784: 3719: 3694: 3166: 3139: 2677: 2652: 2554: 2529: 1627: 1602: 1575: 1550: 1523: 1498: 1275: 1242: 1099: 1074: 1045: 1020: 993: 968: 935: 829: 821: 810: 569: 483:), for research purposes, to refer to pain syndromes associated with the bladder (i.e. 270: 5345: 4550: 4388: 4184: 3484: 2915: 2791: 2629: 2594: 2506: 2391: 2256:"Painful bladder syndrome/interstitial cystitis: aetiology, evaluation and management" 2109: 2071: 1425: 1390: 1311: 5838: 5813: 5793: 5750: 5560: 5407: 5251: 5226: 4945: 4685: 4423: 4136: 3991: 3598: 3390: 3373: 2713: 2668: 2458: 2441: 2197: 2034: 1767: 1696: 1346: 1241:

Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, et al. (12 May 2018).

1151: 967:

Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, et al. (12 May 2018).

905: 888: 844:, which is expressed in the central nucleus of the amygdala, can block bladder pain. 763: 745: 734: 651: 647: 476: 348:

People may experience pain with bladder filling, which is also a typical sign of IC.

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Cohen JM, Fagin AP, Hariton E, Niska JR, Pierce MW, Kuriyama A, et al. (2012).

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Watanabe T, Inoue M, Sasaki K, Araki M, Uehara S, Monden K, et al. (Sep 2010).

2289: 2213: 2170: 1483: 824:; as of 2016, it appeared that males with CP/CPPS have increased grey matter in the 5718: 5590: 5585: 5555: 5550: 5540: 4601: 4523: 3710: 3438: 3156: 2888: 2475: 1909: 1872: 1821: 1805: 1362: 1258: 984: 929: 853: 771: 679: 635: 247:

and pain. The pain results in further anxiety and thus worsening of the condition.

3189:

Doiron RC, Shoskes DA, Nickel JC (June 2019). "Male CP/CPPS: where do we stand?".

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may give little or no difference in symptoms but also may not cause side effects.

29:

This article is about one kind of chronic pelvic pain in males. For females, see

5684: 5613: 5545: 5535: 5375: 3248: 2018: 911: 899: 713: 673: 600: 456: 309: 223: 186: 129: 30: 5356: 5170:"Teach Us to Sit Still: A Sceptic's Search for Health and Healing by Tim Parks" 4219: 4112: 3877: 3860: 3832:

Shoskes DA (June 2001). "Use of antibiotics in chronic prostatitis syndromes".

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have direct anti-inflammatory properties in the absence of infection, blocking

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Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC (2008).

1266: 5692: 5477: 5386: 4585: 4341: 4096: 3613: 3524: 3507: 2272: 2255: 1856: 923: 802: 762:

of 16 treatment-recalcitrant CPPS patients, controversial entities known as

683: 666: 639: 382: 342: 334: 5432: 5200: 4953: 4917: 4856: 4777: 4720: 4677: 4642: 4593: 4396: 4360: 4278: 4227: 4192: 4128: 4081: 4040: 3983: 3948: 3886: 3845: 3818: 3769: 3760: 3743: 3728: 3645: 3590: 3541: 3492: 3456: 3399: 3256: 3210: 3175: 3121: 3068: 2923: 2845: 2799: 2764: 2721: 2686: 2637: 2602: 2563: 2514: 2467: 2426: 2399: 2354: 2281: 2240: 2205: 2162: 2117: 2079: 2026: 1952: 1917: 1864: 1813: 1759: 1688: 1636: 1584: 1551:"Urine Trouble: Alterations in Brain Function Associated with Bladder Pain" 1532: 1475: 1433: 1398: 1354: 1319: 1284: 1178: 1143: 1108: 1054: 1002: 337:, have also shown some efficacy in CP/CPPS. Recent research has focused on 4558: 4515: 4480: 4431: 4317:"Purported nanobacteria in human blood as calcium carbonate nanoparticles" 4301: 4022: 3060: 2950: 2880: 2653:"Comorbid Clinical Conditions in Chronic Fatigue: A Co-Twin Control Study" 5723: 5713: 5605: 5525: 5500: 4742:

Taylor BC, Noorbaloochi S, McNaughton-Collins M, et al. (May 2008).

4462: 3047:

Hochreiter W, Bader P (January 2001). "Etiopathogenesis of prostatitis".

740: 643: 389: 5313: 3783:

Wagenlehner F, Naber K, Bschleipfer T, Brähler E, Weidner W (Mar 2009).

234:

The cause is unknown. However, there are several theories of causation.

5775: 4507: 4054:

Curtis Nickel J, Baranowski AP, Pontari M, Berger RE, Tripp DA (2007).

2872: 2836: 2528:

Shoskes DA, Berger R, Elmi A, Landis JR, Propert KJ, Zeitlin S (2008).

2254:

Rourke W, Khan SA, Ahmed K, Masood S, Dasgupta P, Khan MS (June 2014).

693: 338: 211: 203: 69: 17: 3629: 3423:"Non-surgical interventions for the management of chronic pelvic pain" 3372:

Champaneria R, Daniels JP, Raza A, Pattison HM, Khan KS (March 2012).

1090: 1036: 226:

pain, mediated by nerves and muscles, is a hallmark of the condition.

5473: 5426: 5325: 3618:

Neuromodulation: Journal of the International Neuromodulation Society

3276:"Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome" 423:

Men with CP/CPPS are more likely than the general population to have

167: 101: 4870: 4617:"Current treatment options in the management of chronic prostatitis" 3962:

Dhar NB, Shoskes DA (2007). "New therapies in chronic prostatitis".

3785:"Prostatitis and male pelvic pain syndrome: diagnosis and treatment" 539:

The UPOINT system allows for individualized and multimodal therapy.

4445:

Mastroianni A, Coronado O, Manfredi R, Chiodo F, Scarani P (1996).

584:

in 2014 listed manual physical therapy as a second line treatment.

555:

Current guidelines by the European Association of Urology include:

56: 5054:"John Cleese tour pays the 'Alimony' with West Coast comedy shows" 480: 329: 5252:"The Howard Stern Show for September 5, 2007, Pulling Out a Plum" 2965:"Prostatitis: Benign Prostate Disease: Merck Manual Professional" 2310:. Perelman School of Medicine at the University of Pennsylvania. 50:

chronic nonbacterial prostatitis, prostatodynia, painful prostate

3891:...treatment duration should be long enough (more than 3 months) 1075:"Management of chronic prostatitis/chronic pelvic pain syndrome" 702:

may reduce symptoms and may not lead to associated side effects.

562:

conversation with the patient about pain, its causes and impact.

473:

National Institute of Diabetes and Digestive and Kidney Diseases

198: 5442: 2303: 4998:. Australian Broadcasting Corporation Transcript. 2005-06-23. 3506:

Hunter CW, Stovall B, Chen G, Carlson J, Levy R (March 2018).

1335:

Journal of the European Academy of Dermatology and Venereology

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Hopkin M (17 April 2008). "Nanobacteria theory takes a hit".

4005:

Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE (2005).

42:

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

5201:"Prostatitis: 'How I meditated away chronic pelvic pain'" 4873:. Urologic Chronic Pelvic Pain Syndrome (UCPPS) archive. 2859:

Chiari R (1983). "Urethral obstruction and prostatitis".

2007:

The Journal of Steroid Biochemistry and Molecular Biology

4208:

Endocrine, Metabolic & Immune Disorders Drug Targets

1499:"Mechanisms in prostatitis/chronic pelvic pain syndrome" 447:

may both cause similar symptoms through urinary reflux (

222:(inflammation centred in bladder rather than prostate). 5706:

Pseudoepitheliomatous keratotic and micaceous balanitis

4829:

Daniels NA, Link CL, Barry MJ, McKinlay JB (May 2007).

468:

for the Meares–Stamey four-glass test to be abandoned.

485:

interstitial cystitis/painful bladder syndrome, IC/PBS

3859:

Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q (2006).

3748:

JAMA: The Journal of the American Medical Association

770:(to dissolve the calcifications) and three months of 5303: 400:

could also be used as a biomarker of the condition.

5806: 5774: 5683: 5676: 5654: 5604: 5576: 5491: 5484: 5366: 5307: 107: 83: 75: 63: 46: 41: 5136: 4744:"Excessive antibiotic use in men with prostatitis" 3556: 1725: 1654: 1195:Ferri's Clinical Advisor 2019 E-Book: 5 Books in 1 840:; studies in rodents have shown that blocking the 425:Myalgic encephalomyelitis/chronic fatigue syndrome 280:The role of androgens is studied in CP/CPPS, with 265:Theories behind the disease include stress-driven 3421:Cheong YC, Smotra G, Williams AC (5 March 2014). 5629:Chronic prostatitis/chronic pelvic pain syndrome 4794:Chronic Prostatitis/Chronic Pelvic Pain Syndrome 118:Chronic prostatitis/chronic pelvic pain syndrome 4321:Proceedings of the National Academy of Sciences 3230: 3228: 3133: 3131: 2575: 2573: 2487: 2485: 2091: 2089: 1719: 1717: 1648: 1646: 1596: 1594: 357: 2304:"A New Look at Urological Chronic Pelvic Pain" 140:. It affects about 2–6% of men. Together with 5454: 5227:"The Howard Stern Show for September 4, 2007" 5139:An Unfinished Life: John F. Kennedy 1917–1963 3378:Acta Obstetricia et Gynecologica Scandinavica 1014: 1012: 610:Transurethral needle ablation of the prostate 8: 5086:"The whole truth from Vincent Gallour Flies" 2937:Romero Pérez P, Mira Llinares A (1996). "". 2413:Ding XG, Li SW, Zheng XM, Hu LQ (2006). "". 789:failed to demonstrate the presence of viral 612:has been shown to be ineffective in trials. 4447:"Acute cytomegalovirus prostatitis in AIDS" 1247:The Cochrane Database of Systematic Reviews 1068: 1066: 1064: 672:An estrogen reabsorption inhibitor such as 353:bladder pain syndrome/interstitial cystitis 5680: 5488: 5461: 5447: 5439: 5304: 3336: 3334: 3270: 3268: 3266: 1449: 1447: 1445: 1443: 1198:. Elsevier Health Sciences. p. 1149. 962: 960: 958: 926:– British novelist, translator and author. 55: 38: 4846: 4767: 4632: 4470: 4350: 4340: 4268: 4258: 4174: 4071: 4030: 3938: 3928: 3876: 3808: 3759: 3718: 3558:"Neuromodulation in Treating Pelvic Pain" 3523: 3446: 3389: 3165: 3155: 3103: 2835: 2676: 2553: 2457: 2381: 2271: 2144: 2061: 1899: 1626: 1574: 1544: 1542: 1522: 1274: 1098: 1044: 992: 644:inflammatory chemical signals (cytokines) 5416:) is being considered for deletion. See 479:urologic chronic pelvic pain syndromes ( 5022:The Intimate Sex Lives of Famous People 4615:Duclos A, Lee C, Shoskes D (Aug 2007). 3699:Cochrane Database of Systematic Reviews 3427:Cochrane Database of Systematic Reviews 1079:Canadian Urological Association Journal 1025:Canadian Urological Association Journal 973:Cochrane Database of Systematic Reviews 954: 451:) and can be excluded through flexible 273:hormone (endocrine) abnormalities, and 4977: 4967: 3343:"A Fix for Stress-Related Pelvic Pain" 5634:Asymptomatic inflammatory prostatitis 3688: 3686: 3684: 3682: 3680: 3678: 3676: 3674: 3310:"EAU Guidelines: Chronic Pelvic Pain" 3303: 3301: 661:The effectiveness of alpha blockers ( 535:enderness of the pelvic floor muscles 147:urologic chronic pelvic pain syndrome 7: 5693:Balanoposthitis / Balanitis 4496:International Urology and Nephrology 3555:Hunter CW, Falowski S (2021-02-03). 3237:Cleveland Clinic Journal of Medicine 2651:Leslie A Aaron, et al. (2001). 2376:(6 Suppl): 29–33, discussion 33–34. 2347:10.1146/annurev.med.57.011205.135654 1933:Best Pract Res Clin Endocrinol Metab 1497:Pontari MA, Ruggieri MR (May 2008). 1236: 1234: 1232: 1230: 1228: 1226: 885:– Deputy Prime Minister of Australia 416:provide no benefit for the patient. 5766:Persistent genital arousal disorder 5088:. Chicago Sun Times. Archived from 4315:Martel J, Young JD (8 April 2008). 2314:from the original on 10 August 2020 345:aspects of the related conditions. 267:hypothalamic–pituitary–adrenal axis 5143:. Boston: Little, Brown. pp. 4011:Evid Based Complement Alternat Med 3612:Hunter CW, Yang A (January 2019). 3353:from the original on 27 March 2019 3098:(3): 538–542, discussion 542–543. 2990:"Treatment of Chronic Prostatitis" 2056:(2): 584–587, discussion 587–588. 1549:Sadler KE, Kolber BJ (July 2016). 1073:Doiron RC, Nickel JC (June 2018). 1019:Doiron RC, Nickel JC (June 2018). 25: 5420:to help reach a consensus. › 4243:"Nanobacteria: facts or fancies?" 4185:10.1097/01.ju.0000150062.60633.b2 3563:Current Pain and Headache Reports 2595:10.1097/01.ju.0000082252.49374.e9 2507:10.1016/j.ijantimicag.2007.07.044 1724:Dimitrakoff J, Nickel JC (2022). 1426:10.1097/01.ju.0000132798.48067.23 1391:10.1097/01.ju.0000182152.28519.e7 1312:10.1016/j.ijantimicag.2007.08.027 842:metabotropic glutamate receptor 5 705:When injected into the prostate, 355:(BPS/IC) are related conditions. 5180:from the original on 10 May 2019 4946:10.1111/j.1464-410X.2007.07196.x 3391:10.1111/j.1600-0412.2011.01314.x 2714:10.1111/j.1464-410X.2006.06133.x 2669:10.1111/j.1525-1497.2001.03419.x 2459:10.1111/j.1464-410X.2010.09716.x 2198:10.2165/00003495-200969010-00005 1347:10.1046/j.1468-3083.2002.00481.x 920:– President of the United States 605:extracorporeal shockwave therapy 126:chronic nonbacterial prostatitis 5855:Inflammatory prostate disorders 5284:from the original on 2011-05-02 5258:from the original on 2013-03-21 5233:from the original on 2013-03-21 5207:from the original on 7 May 2019 5056:. tickenews.com. Archived from 5002:from the original on 2016-10-28 4877:from the original on 2021-04-10 4811:from the original on 2023-06-30 4143:from the original on 2023-02-18 3660:from the original on 2023-02-15 3320:from the original on 2021-01-16 3029:from the original on 2007-10-27 3004:from the original on 2017-04-27 2971:from the original on 2010-04-28 1987:from the original on 2024-02-05 1774:from the original on 2023-06-30 1703:from the original on 2023-06-30 1212:from the original on 2023-06-30 838:central nucleus of the amygdala 582:American Urological Association 173:Recommended treatments include 4101:The Journal of Sexual Medicine 3711:10.1002/14651858.CD012552.pub2 3439:10.1002/14651858.CD008797.pub2 3341:McNeil DG (30 December 2013). 3157:10.12688/f1000research.10558.1 2910:(1): 106–110, discussion 110. 2822:(2): 524–533, discussion 533. 1910:10.1016/j.urology.2006.08.1109 1806:10.1016/j.jneuroim.2003.10.041 1653:Masiutin MG, Yadav MK (2022). 1259:10.1002/14651858.CD012551.pub3 985:10.1002/14651858.CD012551.pub3 392:and pro-inflammatory cytokine 1: 5850:Urologic pelvic pain syndrome 5824:Postorgasmic illness syndrome 5761:Balanitis xerotica obliterans 5624:Chronic bacterial prostatitis 4797:. Humana Press. p. 171. 4551:10.1016/S0090-4295(91)80355-B 4389:10.1016/S0090-4295(02)02166-0 3485:10.1016/S0090-4295(02)01704-1 3114:10.1016/j.urology.2008.09.074 2916:10.1016/S0302-2838(03)00203-3 2792:10.1016/S0090-4295(99)00613-5 2757:10.1016/j.urology.2009.09.061 2630:10.1016/S0090-4295(99)00536-1 2392:10.1016/S0090-4295(02)02381-6 2110:10.1016/S0022-5347(05)63961-4 2072:10.1016/s0022-5347(05)63958-4 1744:10.1016/j.urology.2022.07.049 1673:10.1016/j.urology.2022.07.051 1619:10.1016/j.urology.2007.09.025 1468:10.1016/j.urology.2018.07.022 878:Notable cases have included: 867:National Institutes of Health 136:(LUTS) without evidence of a 5641:Benign prostatic hyperplasia 4910:10.1016/j.eururo.2008.03.073 4760:10.1016/j.amjmed.2008.01.043 4424:10.1016/0090-4295(92)90520-7 4260:10.1371/journal.ppat.0030055 3930:10.1371/journal.pone.0041941 2828:10.1016/j.eururo.2006.07.016 826:primary somatosensory cortex 720:Traditional Chinese medicine 690:5-alpha reductase inhibitors 300:(11KP4) can be converted to 160:benign prostatic hypertrophy 134:lower urinary tract symptoms 94:benign prostatic hypertrophy 5860:Syndromes of unknown causes 5052:Allison Reitz (July 2009). 4241:Urbano P, Urbano F (2007). 3249:10.3949/ccjm.74.Suppl_3.S63 2019:10.1016/j.jsbmb.2019.105497 744:benzodiazepines act on the 251:Nerves, stress and hormones 5876: 5699:Balanitis plasmacellularis 5168:Jeffries S (3 July 2010). 4220:10.2174/187153007782794344 4113:10.1016/j.jsxm.2019.03.003 3878:10.2164/jandrol.106.000661 3575:10.1007/s11916-020-00927-y 3203:10.1007/s00345-019-02718-6 2546:10.1016/j.juro.2007.09.088 1945:10.1016/j.beem.2008.01.008 1567:10.1016/j.juro.2015.10.198 1515:10.1016/j.juro.2008.03.139 1136:10.1007/s11916-020-00857-9 712:For men with CPPS, taking 302:11-ketodihydrotestosterone 28: 5433:NHS Choices (prostatitis) 4670:10.1007/s11934-005-0027-0 3976:10.1007/s11934-007-0078-5 3801:10.3238/arztebl.2009.0175 2155:10.1517/14656560802519845 834:anterior cingulate cortex 785:(CMV), but a study using 312:associated with CP/CPPS. 54: 5418:templates for discussion 5276:Leavitt D (2008-05-11). 5111:"Glenn Gould as Patient" 4713:10.1586/14737175.7.3.301 3138:Sandhu J, Tu HV (2017). 2133:Expert Opin Pharmacother 1085:(6 Suppl 3): S161–S163. 1031:(6 Suppl 3): S152–S154. 797:cases the patients were 511:sychological dysfunction 475:(NIDDK) began using the 429:irritable bowel syndrome 238:Pelvic floor dysfunction 183:alpha blocker medication 4791:Daniel Shoskes (2008). 4586:10.1038/nrurol.2016.227 4574:Nature Reviews. Urology 4342:10.1073/pnas.0711744105 3525:10.36076/ppj.2018.2.147 2495:Int J Antimicrob Agents 2273:10.4081/aiua.2014.2.126 1857:10.1196/annals.1366.025 1300:Int J Antimicrob Agents 700:Anti-inflammatory drugs 294:11β-hydroxyprogesterone 275:neurogenic inflammation 202:pubic or bladder area. 124:), previously known as 5845:Chronic pain syndromes 5819:Retrograde ejaculation 4451:Genitourinary Medicine 3761:10.1001/jama.2010.1913 3282:. 2014. Archived from 1555:The Journal of Urology 1124:Curr Pain Headache Rep 894:Life of Samuel Johnson 758:In a preliminary 2005 592:Psychological therapy: 578:Wise-Anderson protocol 517:rgan-specific symptoms 494:Symptom classification 439:Differential diagnosis 368: 260:central nervous system 85:Differential diagnosis 4302:10.1038/news.2008.762 3061:10.1007/s001200050424 2260:Arch Ital Urol Androl 656:tumor necrosis factor 529:eurologic dysfunction 407:Chlamydia trachomatis 220:interstitial cystitis 156:bacterial prostatitis 90:Bacterial prostatitis 5734:Erectile dysfunction 4701:Expert Rev Neurother 4621:Ther Clin Risk Manag 4463:10.1136/sti.72.6.447 3286:on 20 September 2018 1509:(5 Suppl): S61–S67. 779:herpes simplex virus 5664:Seminal vesiculitis 5025:. Doubleday. 2008. 4333:2008PNAS..105.5549M 4023:10.1093/ecam/neh128 3921:2012PLoSO...741941C 2994:Nat Clin Pract Urol 2415:Zhonghua Nan Ke Xue 2229:Folia Med (Plovdiv) 1849:2006NYASA1088...78T 1837:Ann. N.Y. Acad. Sci 932:– radio personality 874:Society and culture 551:Non-drug treatments 398:nerve growth factor 381:inflammation, like 324:Overlap with IC/PBS 316:Bacterial infection 298:11-ketoprogesterone 138:bacterial infection 5746:Peyronie's disease 5741:Spontaneous orgasm 5729:Sexual dysfunction 5516:Testicular torsion 5367:External resources 5278:"Styron's Choices" 4980:has generic name ( 4508:10.1007/bf02767655 4060:Reviews in Urology 3840:(Suppl 1): 24–28. 3347:The New York Times 3308:Professionals SO. 3243:(Suppl 3): 63–71. 2873:10.1007/BF02083011 1894:(4 Suppl): 34–40. 445:urethral stricture 193:Signs and symptoms 175:multimodal therapy 164:overactive bladder 98:overactive bladder 5832: 5831: 5802: 5801: 5784:Fournier gangrene 5672: 5671: 5619:Acute prostatitis 5531:Asthenozoospermia 5511:Testicular cancer 5401: 5400: 5154:978-0-316-17238-7 5135:Dallek R (2003). 4804:978-1-934115-27-5 4327:(14): 5549–5554. 3789:Dtsch Ärztebl Int 3630:10.1111/ner.12801 2139:(17): 2979–2994. 1192:Ferri FF (2018). 1091:10.5489/cuaj.5325 1037:10.5489/cuaj.5322 799:immunocompromised 754:Emerging research 707:Botulinum toxin A 680:Phytotherapeutics 574:Stanford protocol 566:Physical therapy: 181:, and a trial of 115: 114: 36:Medical condition 16:(Redirected from 5867: 5681: 5521:Male infertility 5506:Hydrocele testis 5489: 5463: 5456: 5449: 5440: 5305: 5293: 5292: 5290: 5289: 5273: 5267: 5266: 5264: 5263: 5254:. Howard Stern. 5248: 5242: 5241: 5239: 5238: 5229:. Howard Stern. 5223: 5217: 5216: 5214: 5212: 5196: 5190: 5189: 5187: 5185: 5165: 5159: 5158: 5142: 5132: 5126: 5125: 5123: 5122: 5113:. Archived from 5107: 5101: 5100: 5098: 5097: 5081: 5075: 5071: 5066: 5065: 5049: 5043: 5042: 5040: 5039: 5017: 5011: 5010: 5008: 5007: 4992: 4986: 4985: 4979: 4975: 4973: 4965: 4928: 4922: 4921: 4892: 4886: 4885: 4883: 4882: 4867: 4861: 4860: 4850: 4835:J Natl Med Assoc 4826: 4820: 4819: 4817: 4816: 4788: 4782: 4781: 4771: 4739: 4733: 4732: 4696: 4690: 4689: 4653: 4647: 4646: 4636: 4612: 4606: 4605: 4569: 4563: 4562: 4534: 4528: 4527: 4491: 4485: 4484: 4474: 4442: 4436: 4435: 4407: 4401: 4400: 4371: 4365: 4364: 4354: 4344: 4312: 4306: 4305: 4289: 4283: 4282: 4272: 4262: 4238: 4232: 4231: 4203: 4197: 4196: 4178: 4158: 4152: 4151: 4149: 4148: 4092: 4086: 4085: 4075: 4051: 4045: 4044: 4034: 4002: 3996: 3995: 3959: 3953: 3952: 3942: 3932: 3900: 3894: 3893: 3880: 3856: 3850: 3849: 3829: 3823: 3822: 3812: 3780: 3774: 3773: 3763: 3739: 3733: 3732: 3722: 3705:(10): CD012552. 3690: 3669: 3668: 3666: 3665: 3609: 3603: 3602: 3560: 3552: 3546: 3545: 3527: 3503: 3497: 3496: 3467: 3461: 3460: 3450: 3418: 3412: 3411: 3393: 3369: 3363: 3362: 3360: 3358: 3338: 3329: 3328: 3326: 3325: 3305: 3296: 3295: 3293: 3291: 3272: 3261: 3260: 3232: 3223: 3222: 3197:(6): 1015–1022. 3186: 3180: 3179: 3169: 3159: 3135: 3126: 3125: 3107: 3087: 3081: 3080: 3044: 3038: 3037: 3035: 3034: 3019: 3013: 3012: 3010: 3009: 2986: 2980: 2979: 2977: 2976: 2961: 2955: 2954: 2934: 2928: 2927: 2899: 2893: 2892: 2861:Int Urol Nephrol 2856: 2850: 2849: 2839: 2810: 2804: 2803: 2775: 2769: 2768: 2740: 2734: 2733: 2708:(5): 1043–1046. 2697: 2691: 2690: 2680: 2657:J Gen Intern Med 2648: 2642: 2641: 2613: 2607: 2606: 2577: 2568: 2567: 2557: 2525: 2519: 2518: 2489: 2480: 2479: 2461: 2437: 2431: 2430: 2410: 2404: 2403: 2385: 2365: 2359: 2358: 2330: 2324: 2323: 2321: 2319: 2300: 2294: 2293: 2275: 2251: 2245: 2244: 2224: 2218: 2217: 2181: 2175: 2174: 2148: 2128: 2122: 2121: 2093: 2084: 2083: 2065: 2045: 2039: 2038: 2002: 1996: 1995: 1993: 1992: 1986: 1971: 1963: 1957: 1956: 1928: 1922: 1921: 1903: 1883: 1877: 1876: 1832: 1826: 1825: 1789: 1783: 1782: 1780: 1779: 1729: 1721: 1712: 1711: 1709: 1708: 1658: 1650: 1641: 1640: 1630: 1598: 1589: 1588: 1578: 1546: 1537: 1536: 1526: 1494: 1488: 1487: 1451: 1438: 1437: 1409: 1403: 1402: 1385:(6): 2319–2322. 1373: 1367: 1366: 1330: 1324: 1323: 1295: 1289: 1288: 1278: 1238: 1221: 1220: 1218: 1217: 1189: 1183: 1182: 1167:Am Fam Physician 1162: 1156: 1155: 1119: 1113: 1112: 1102: 1070: 1059: 1058: 1048: 1016: 1007: 1006: 996: 964: 908:– movie director 760:open label study 632:fluoroquinolones 523:nfectious causes 385:, are measured. 366: 365:The MAPP Network 306:backdoor pathway 291: 290: 289: 269:dysfunction and 224:Post-ejaculatory 59: 39: 21: 5875: 5874: 5870: 5869: 5868: 5866: 5865: 5864: 5835: 5834: 5833: 5828: 5798: 5770: 5756:Penile fracture 5668: 5656:Seminal vesicle 5650: 5646:Prostate cancer 5600: 5572: 5480: 5467: 5421: 5402: 5397: 5396: 5362: 5361: 5316: 5302: 5297: 5296: 5287: 5285: 5275: 5274: 5270: 5261: 5259: 5250: 5249: 5245: 5236: 5234: 5225: 5224: 5220: 5210: 5208: 5198: 5197: 5193: 5183: 5181: 5167: 5166: 5162: 5155: 5134: 5133: 5129: 5120: 5118: 5109: 5108: 5104: 5095: 5093: 5083: 5082: 5078: 5063: 5061: 5051: 5050: 5046: 5037: 5035: 5033: 5019: 5018: 5014: 5005: 5003: 4996:"Anderson goes" 4994: 4993: 4989: 4976: 4966: 4930: 4929: 4925: 4894: 4893: 4889: 4880: 4878: 4869: 4868: 4864: 4828: 4827: 4823: 4814: 4812: 4805: 4790: 4789: 4785: 4741: 4740: 4736: 4698: 4697: 4693: 4655: 4654: 4650: 4614: 4613: 4609: 4571: 4570: 4566: 4536: 4535: 4531: 4493: 4492: 4488: 4444: 4443: 4439: 4409: 4408: 4404: 4373: 4372: 4368: 4314: 4313: 4309: 4291: 4290: 4286: 4240: 4239: 4235: 4205: 4204: 4200: 4176:10.1.1.384.2090 4160: 4159: 4155: 4146: 4144: 4094: 4093: 4089: 4053: 4052: 4048: 4004: 4003: 3999: 3961: 3960: 3956: 3902: 3901: 3897: 3858: 3857: 3853: 3831: 3830: 3826: 3795:(11): 175–183. 3782: 3781: 3777: 3741: 3740: 3736: 3692: 3691: 3672: 3663: 3661: 3611: 3610: 3606: 3554: 3553: 3549: 3505: 3504: 3500: 3469: 3468: 3464: 3433:(3): CD008797. 3420: 3419: 3415: 3371: 3370: 3366: 3356: 3354: 3340: 3339: 3332: 3323: 3321: 3307: 3306: 3299: 3289: 3287: 3274: 3273: 3264: 3234: 3233: 3226: 3188: 3187: 3183: 3137: 3136: 3129: 3105:10.1.1.384.4216 3089: 3088: 3084: 3046: 3045: 3041: 3032: 3030: 3025:. NIDDK. 2007. 3021: 3020: 3016: 3007: 3005: 2988: 2987: 2983: 2974: 2972: 2963: 2962: 2958: 2936: 2935: 2931: 2901: 2900: 2896: 2858: 2857: 2853: 2812: 2811: 2807: 2777: 2776: 2772: 2742: 2741: 2737: 2699: 2698: 2694: 2650: 2649: 2645: 2615: 2614: 2610: 2579: 2578: 2571: 2527: 2526: 2522: 2491: 2490: 2483: 2439: 2438: 2434: 2421:(11): 982–984. 2412: 2411: 2407: 2383:10.1.1.383.9485 2367: 2366: 2362: 2332: 2331: 2327: 2317: 2315: 2302: 2301: 2297: 2253: 2252: 2248: 2226: 2225: 2221: 2183: 2182: 2178: 2146:10.1.1.470.7817 2130: 2129: 2125: 2095: 2094: 2087: 2063:10.1.1.605.5540 2047: 2046: 2042: 2004: 2003: 1999: 1990: 1988: 1984: 1969: 1965: 1964: 1960: 1930: 1929: 1925: 1901:10.1.1.383.9862 1885: 1884: 1880: 1834: 1833: 1829: 1794:J. Neuroimmunol 1791: 1790: 1786: 1777: 1775: 1723: 1722: 1715: 1706: 1704: 1652: 1651: 1644: 1600: 1599: 1592: 1548: 1547: 1540: 1496: 1495: 1491: 1453: 1452: 1441: 1411: 1410: 1406: 1375: 1374: 1370: 1332: 1331: 1327: 1297: 1296: 1292: 1253:(5): CD012551. 1240: 1239: 1224: 1215: 1213: 1206: 1191: 1190: 1186: 1164: 1163: 1159: 1121: 1120: 1116: 1072: 1071: 1062: 1018: 1017: 1010: 979:(5): CD012551. 966: 965: 956: 951: 941:Sophie's Choice 918:John F. Kennedy 902:– British actor 876: 862: 850: 783:cytomegalovirus 756: 731:benzodiazepines 622: 586:Kegel exercises 560:Pain education: 553: 545: 505:rinary symptoms 496: 465: 441: 373: 367: 364: 326: 318: 288: 285: 284: 283: 281: 253: 240: 232: 195: 128:, is long-term 37: 34: 23: 22: 15: 12: 11: 5: 5873: 5871: 5863: 5862: 5857: 5852: 5847: 5837: 5836: 5830: 5829: 5827: 5826: 5821: 5816: 5810: 5808: 5804: 5803: 5800: 5799: 5797: 5796: 5791: 5786: 5780: 5778: 5772: 5771: 5769: 5768: 5763: 5758: 5753: 5748: 5743: 5738: 5737: 5736: 5726: 5721: 5716: 5711: 5710: 5709: 5702: 5689: 5687: 5678: 5674: 5673: 5670: 5669: 5667: 5666: 5660: 5658: 5652: 5651: 5649: 5648: 5643: 5638: 5637: 5636: 5631: 5626: 5621: 5610: 5608: 5602: 5601: 5599: 5598: 5593: 5588: 5582: 5580: 5574: 5573: 5571: 5570: 5568:Ectopic testis 5565: 5564: 5563: 5558: 5553: 5548: 5543: 5538: 5533: 5528: 5518: 5513: 5508: 5503: 5497: 5495: 5486: 5482: 5481: 5468: 5466: 5465: 5458: 5451: 5443: 5437: 5436: 5429: 5405: 5399: 5398: 5395: 5394: 5392:article/437745 5383: 5371: 5370: 5368: 5364: 5363: 5360: 5359: 5348: 5333: 5317: 5312: 5311: 5309: 5308:Classification 5301: 5300:External links 5298: 5295: 5294: 5268: 5243: 5218: 5191: 5160: 5153: 5127: 5102: 5076: 5044: 5031: 5012: 4987: 4978:|first15= 4923: 4904:(2): 499–507. 4887: 4862: 4841:(5): 509–516. 4821: 4803: 4783: 4754:(5): 444–449. 4734: 4707:(3): 301–307. 4691: 4664:(4): 296–299. 4648: 4627:(4): 507–512. 4607: 4580:(3): 153–163. 4564: 4545:(3): 247–248. 4529: 4502:(5): 535–540. 4486: 4457:(6): 447–448. 4437: 4418:(2): 165–167. 4402: 4383:(2): 397–401. 4366: 4307: 4284: 4247:PLOS Pathogens 4233: 4214:(4): 232–236. 4198: 4169:(2): 474–477. 4153: 4107:(6): 763–766. 4087: 4046: 4017:(4): 495–501. 3997: 3970:(4): 313–318. 3954: 3895: 3871:(6): 847–852. 3851: 3824: 3775: 3734: 3670: 3604: 3547: 3518:(2): 147–167. 3512:Pain Physician 3498: 3479:(2): 300–304. 3462: 3413: 3384:(3): 281–286. 3364: 3330: 3297: 3280:www.auanet.org 3262: 3224: 3181: 3127: 3082: 3039: 3014: 2981: 2956: 2945:(9): 786–793. 2941:(in Spanish). 2939:Actas Urol Esp 2929: 2894: 2867:(3): 245–255. 2851: 2805: 2786:(6): 881–885. 2770: 2751:(3): 654–657. 2735: 2692: 2643: 2624:(3): 403–407. 2608: 2589:(3): 818–822. 2569: 2540:(2): 556–560. 2520: 2501:(2): S91–S95. 2481: 2452:(2): 248–251. 2432: 2417:(in Chinese). 2405: 2360: 2335:Annu. Rev. Med 2325: 2295: 2266:(2): 126–131. 2246: 2219: 2176: 2123: 2104:(2): 597–598. 2085: 2040: 1997: 1958: 1939:(2): 207–221. 1923: 1878: 1827: 1784: 1727:"Author reply" 1713: 1642: 1613:(2): 261–266. 1590: 1538: 1489: 1439: 1420:(2): 542–547. 1404: 1368: 1341:(3): 253–256. 1325: 1290: 1222: 1204: 1184: 1173:(4): 290–296. 1157: 1114: 1060: 1008: 953: 952: 950: 947: 946: 945: 936:William Styron 933: 927: 921: 915: 909: 903: 897: 886: 875: 872: 861: 858: 849: 846: 830:insular cortex 822:functional MRI 811:gut-brain axis 755: 752: 751: 750: 738: 723: 717: 710: 703: 697: 687: 677: 670: 659: 621: 618: 596: 595: 589: 570:trigger points 563: 552: 549: 544: 541: 537: 536: 530: 524: 518: 512: 506: 495: 492: 464: 461: 440: 437: 372: 369: 362: 325: 322: 317: 314: 286: 271:adrenocortical 252: 249: 245:trigger points 239: 236: 231: 228: 214:, unexplained 194: 191: 144:, it makes up 113: 112: 109: 105: 104: 87: 81: 80: 77: 73: 72: 67: 61: 60: 52: 51: 48: 44: 43: 35: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5872: 5861: 5858: 5856: 5853: 5851: 5848: 5846: 5843: 5842: 5840: 5825: 5822: 5820: 5817: 5815: 5814:Hematospermia 5812: 5811: 5809: 5805: 5795: 5794:Pneumoscrotum 5792: 5790: 5787: 5785: 5782: 5781: 5779: 5777: 5773: 5767: 5764: 5762: 5759: 5757: 5754: 5752: 5751:Penile cancer 5749: 5747: 5744: 5742: 5739: 5735: 5732: 5731: 5730: 5727: 5725: 5722: 5720: 5717: 5715: 5712: 5708: 5707: 5703: 5701: 5700: 5696: 5695: 5694: 5691: 5690: 5688: 5686: 5682: 5679: 5675: 5665: 5662: 5661: 5659: 5657: 5653: 5647: 5644: 5642: 5639: 5635: 5632: 5630: 5627: 5625: 5622: 5620: 5617: 5616: 5615: 5612: 5611: 5609: 5607: 5603: 5597: 5594: 5592: 5589: 5587: 5584: 5583: 5581: 5579: 5575: 5569: 5566: 5562: 5561:Teratospermia 5559: 5557: 5554: 5552: 5549: 5547: 5544: 5542: 5539: 5537: 5534: 5532: 5529: 5527: 5524: 5523: 5522: 5519: 5517: 5514: 5512: 5509: 5507: 5504: 5502: 5499: 5498: 5496: 5494: 5490: 5487: 5483: 5479: 5475: 5471: 5470:Male diseases 5464: 5459: 5457: 5452: 5450: 5445: 5444: 5441: 5435: 5434: 5430: 5428: 5424: 5419: 5415: 5414: 5409: 5404: 5403: 5393: 5389: 5388: 5384: 5382: 5378: 5377: 5373: 5372: 5369: 5365: 5358: 5354: 5353: 5349: 5347: 5343: 5342: 5338: 5334: 5332: 5328: 5327: 5323: 5319: 5318: 5315: 5310: 5306: 5299: 5283: 5279: 5272: 5269: 5257: 5253: 5247: 5244: 5232: 5228: 5222: 5219: 5206: 5202: 5195: 5192: 5179: 5175: 5171: 5164: 5161: 5156: 5150: 5146: 5141: 5140: 5131: 5128: 5117:on 2008-06-07 5116: 5112: 5106: 5103: 5092:on 2008-05-13 5091: 5087: 5084:Roger Ebert. 5080: 5077: 5074: 5070: 5060:on 2009-07-28 5059: 5055: 5048: 5045: 5034: 5032:9781932595291 5028: 5024: 5023: 5016: 5013: 5001: 4997: 4991: 4988: 4983: 4971: 4963: 4959: 4955: 4951: 4947: 4943: 4939: 4935: 4927: 4924: 4919: 4915: 4911: 4907: 4903: 4899: 4891: 4888: 4876: 4872: 4866: 4863: 4858: 4854: 4849: 4844: 4840: 4836: 4832: 4825: 4822: 4810: 4806: 4800: 4796: 4795: 4787: 4784: 4779: 4775: 4770: 4765: 4761: 4757: 4753: 4749: 4745: 4738: 4735: 4730: 4726: 4722: 4718: 4714: 4710: 4706: 4702: 4695: 4692: 4687: 4683: 4679: 4675: 4671: 4667: 4663: 4659: 4658:Curr Urol Rep 4652: 4649: 4644: 4640: 4635: 4630: 4626: 4622: 4618: 4611: 4608: 4603: 4599: 4595: 4591: 4587: 4583: 4579: 4575: 4568: 4565: 4560: 4556: 4552: 4548: 4544: 4540: 4533: 4530: 4525: 4521: 4517: 4513: 4509: 4505: 4501: 4497: 4490: 4487: 4482: 4478: 4473: 4468: 4464: 4460: 4456: 4452: 4448: 4441: 4438: 4433: 4429: 4425: 4421: 4417: 4413: 4406: 4403: 4398: 4394: 4390: 4386: 4382: 4378: 4370: 4367: 4362: 4358: 4353: 4348: 4343: 4338: 4334: 4330: 4326: 4322: 4318: 4311: 4308: 4303: 4299: 4295: 4288: 4285: 4280: 4276: 4271: 4266: 4261: 4256: 4252: 4248: 4244: 4237: 4234: 4229: 4225: 4221: 4217: 4213: 4209: 4202: 4199: 4194: 4190: 4186: 4182: 4177: 4172: 4168: 4164: 4157: 4154: 4142: 4138: 4134: 4130: 4126: 4122: 4118: 4114: 4110: 4106: 4102: 4098: 4091: 4088: 4083: 4079: 4074: 4069: 4065: 4061: 4057: 4050: 4047: 4042: 4038: 4033: 4028: 4024: 4020: 4016: 4012: 4008: 4001: 3998: 3993: 3989: 3985: 3981: 3977: 3973: 3969: 3965: 3964:Curr Urol Rep 3958: 3955: 3950: 3946: 3941: 3936: 3931: 3926: 3922: 3918: 3915:(8): e41941. 3914: 3910: 3906: 3899: 3896: 3892: 3888: 3884: 3879: 3874: 3870: 3866: 3862: 3855: 3852: 3847: 3843: 3839: 3835: 3828: 3825: 3820: 3816: 3811: 3806: 3802: 3798: 3794: 3790: 3786: 3779: 3776: 3771: 3767: 3762: 3757: 3753: 3749: 3745: 3738: 3735: 3730: 3726: 3721: 3716: 3712: 3708: 3704: 3700: 3696: 3689: 3687: 3685: 3683: 3681: 3679: 3677: 3675: 3671: 3659: 3655: 3651: 3647: 3643: 3639: 3635: 3631: 3627: 3623: 3619: 3615: 3608: 3605: 3600: 3596: 3592: 3588: 3584: 3580: 3576: 3572: 3568: 3564: 3559: 3551: 3548: 3543: 3539: 3535: 3531: 3526: 3521: 3517: 3513: 3509: 3502: 3499: 3494: 3490: 3486: 3482: 3478: 3474: 3466: 3463: 3458: 3454: 3449: 3444: 3440: 3436: 3432: 3428: 3424: 3417: 3414: 3409: 3405: 3401: 3397: 3392: 3387: 3383: 3379: 3375: 3368: 3365: 3352: 3348: 3344: 3337: 3335: 3331: 3319: 3315: 3311: 3304: 3302: 3298: 3285: 3281: 3277: 3271: 3269: 3267: 3263: 3258: 3254: 3250: 3246: 3242: 3238: 3231: 3229: 3225: 3220: 3216: 3212: 3208: 3204: 3200: 3196: 3192: 3185: 3182: 3177: 3173: 3168: 3163: 3158: 3153: 3149: 3145: 3141: 3134: 3132: 3128: 3123: 3119: 3115: 3111: 3106: 3101: 3097: 3093: 3086: 3083: 3078: 3074: 3070: 3066: 3062: 3058: 3054: 3051:(in German). 3050: 3043: 3040: 3028: 3024: 3018: 3015: 3003: 2999: 2995: 2991: 2985: 2982: 2970: 2966: 2960: 2957: 2952: 2948: 2944: 2940: 2933: 2930: 2925: 2921: 2917: 2913: 2909: 2905: 2898: 2895: 2890: 2886: 2882: 2878: 2874: 2870: 2866: 2862: 2855: 2852: 2847: 2843: 2838: 2833: 2829: 2825: 2821: 2817: 2809: 2806: 2801: 2797: 2793: 2789: 2785: 2781: 2774: 2771: 2766: 2762: 2758: 2754: 2750: 2746: 2739: 2736: 2731: 2727: 2723: 2719: 2715: 2711: 2707: 2703: 2696: 2693: 2688: 2684: 2679: 2674: 2670: 2666: 2662: 2658: 2654: 2647: 2644: 2639: 2635: 2631: 2627: 2623: 2619: 2612: 2609: 2604: 2600: 2596: 2592: 2588: 2584: 2576: 2574: 2570: 2565: 2561: 2556: 2551: 2547: 2543: 2539: 2535: 2531: 2524: 2521: 2516: 2512: 2508: 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1761: 1757: 1753: 1749: 1745: 1741: 1737: 1733: 1728: 1720: 1718: 1714: 1702: 1698: 1694: 1690: 1686: 1682: 1678: 1674: 1670: 1666: 1662: 1657: 1649: 1647: 1643: 1638: 1634: 1629: 1624: 1620: 1616: 1612: 1608: 1604: 1597: 1595: 1591: 1586: 1582: 1577: 1572: 1568: 1564: 1560: 1556: 1552: 1545: 1543: 1539: 1534: 1530: 1525: 1520: 1516: 1512: 1508: 1504: 1500: 1493: 1490: 1485: 1481: 1477: 1473: 1469: 1465: 1461: 1457: 1450: 1448: 1446: 1444: 1440: 1435: 1431: 1427: 1423: 1419: 1415: 1408: 1405: 1400: 1396: 1392: 1388: 1384: 1380: 1372: 1369: 1364: 1360: 1356: 1352: 1348: 1344: 1340: 1336: 1329: 1326: 1321: 1317: 1313: 1309: 1306:: S108–S111. 1305: 1301: 1294: 1291: 1286: 1282: 1277: 1272: 1268: 1264: 1260: 1256: 1252: 1248: 1244: 1237: 1235: 1233: 1231: 1229: 1227: 1223: 1211: 1207: 1205:9780323550765 1201: 1197: 1196: 1188: 1185: 1180: 1176: 1172: 1168: 1161: 1158: 1153: 1149: 1145: 1141: 1137: 1133: 1129: 1125: 1118: 1115: 1110: 1106: 1101: 1096: 1092: 1088: 1084: 1080: 1076: 1069: 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