Dear Editor,
Even without biopsy-proven evidence of the denervation-reinnervation sequence, pelvic pain associated with chronic prostatitis (1) looks clinically-analogous to pelvic pain associated with “nulliparous endometriosis” (2). Persistent & prolonged, coordinate, straining during defaecation injures “mixed” autonomic nerve fibres from sympathetic segments T10-L2, that are unleashed into uterine and prostatic stroma to cause chronic pain, recurrent infections, hyperplasia, etc The specific histological finding is perivascular nerve fibre proliferation where circumferential layers of regenerating, injured nerve fibres encase narrowed arterioles (3, Fig.) Optimal management is prevention as once the regenerating nerves breach nerve bundle sheaths it becomes very difficult ? Advice on improving diets and bowel habits are essential ?
MJ Quinn MD LLM
Visiting Fellow,
International Peace Hospital, 910, Hengshan Road, Shanghai, PR 230000
References
(1) Healy R, Thorne C, Manjunath A. Chronic prostatitis (chronic pelvic pain syndrome). BMJ 2023;383:e073908.
(2) Atwal G, du Plessis D, Armstrong G, Slade R, Quinn M. Uterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis. Am J Obstet Gynecol. 2005 Nov;193(5):1650-5.
(3) Quinn MJ. Perivascular nerve fibre proliferation: the consequence of prolonged straining. J Obstet Gynaecol. 2007 Feb;27(2):185-8.
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Re: Chronic prostatitis (chronic pelvic pain syndrome)