PROSTATITIS CRÓNICA / SÍNDROME DE DOLOR PÉLVICO CRÓNICO: FENOTIPOS CLÍNICOS Y RESPUESTA TERAPÉUTICA
Palabras clave:
prostatitis crónica; síndrome de dolor pélvico crónico; UPOINT; fenotipos; NIH-CPSI; dolor pélvico masculino; tratamiento multimodalResumen
DOI: https://doi.org/10.46296/yc.v10i18.0876
Resumen
Introducción: La prostatitis crónica / síndrome de dolor pélvico crónico (CP/CPPS, por sus siglas en inglés) corresponde a un cuadro heterogéneo caracterizado por dolor o malestar pélvico persistente o recurrente, habitualmente por más de tres meses, en ausencia de infección bacteriana demostrada u otra patología local evidente que explique completamente los síntomas. Su impacto clínico es relevante porque compromete dolor, función urinaria, actividad sexual, salud mental y calidad de vida. Objetivo: Analizar los fenotipos clínicos de la CP/CPPS y su relación con la respuesta terapéutica, destacando la utilidad del modelo UPOINT/UPOINTS para orientar un manejo individualizado, multimodal y multidisciplinario. Métodos: Se realizó una revisión narrativa basada en guías clínicas internacionales, revisiones sistemáticas, estudios de fenotipificación y literatura relevante sobre diagnóstico, evaluación de respuesta y tratamiento de la CP/CPPS. Desarrollo: La evidencia disponible indica que ningún tratamiento aislado produce una respuesta universal. La clasificación por fenotipos permite identificar dominios predominantes: urinario, psicosocial, órgano-específico, infeccioso, neurológico/sistémico, sensibilidad muscular del piso pélvico y disfunción sexual. Cada dominio se asocia con estrategias terapéuticas específicas, como alfa-bloqueadores, antibióticos dirigidos por cultivo, antiinflamatorios, fitoterapia, neuromoduladores del dolor, fisioterapia del piso pélvico, terapia psicológica y tratamiento de la disfunción sexual. Conclusiones: La CP/CPPS debe abordarse como un síndrome biopsicosocial de expresión variable. La respuesta terapéutica mejora cuando el tratamiento se adapta al fenotipo clínico, se evita el uso repetido e injustificado de antibióticos y se integran intervenciones urológicas, fisioterapéuticas, psicológicas y de medicina del dolor. El NIH-CPSI constituye una herramienta útil para cuantificar gravedad y seguimiento, considerándose clínicamente relevante una disminución aproximada de 6 puntos en el puntaje total.
Palabras claves: prostatitis crónica; síndrome de dolor pélvico crónico; UPOINT; fenotipos; NIH-CPSI; dolor pélvico masculino; tratamiento multimodal.
Abstract
Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogeneous condition characterized by persistent or recurrent pelvic pain, usually for more than three months, in the absence of proven bacterial infection or another evident local disease explaining symptoms. It affects pain, urinary function, sexual health, psychosocial well-being and quality of life. Objective: To analyze the clinical phenotypes of CP/CPPS and their relationship with therapeutic response, emphasizing the UPOINT/UPOINTS model as a practical framework for individualized and multimodal care. Methods: A narrative review was conducted using international clinical guidelines, systematic reviews, phenotyping studies and relevant literature on diagnosis, outcome assessment and treatment of CP/CPPS. Discussion: Current evidence supports a phenotype-directed approach because no single monotherapy benefits all patients. The UPOINT/UPOINTS domains include urinary, psychosocial, organ-specific, infection, neurologic/systemic, tenderness of pelvic floor muscles and sexual dysfunction. Each domain suggests specific therapeutic strategies, such as alpha-blockers, culture-guided antibiotics, anti-inflammatory agents, phytotherapy, pain neuromodulators, pelvic floor physical therapy, psychological therapy and sexual dysfunction management. Conclusions: CP/CPPS should be understood as a biopsychosocial syndrome with variable clinical expression. Therapeutic response is optimized when treatment is tailored to the dominant phenotype, unnecessary repeated antibiotics are avoided and multidisciplinary care is implemented. NIH-CPSI is useful for monitoring symptom burden and response over time.
Keywords: chronic prostatitis; chronic pelvic pain syndrome; UPOINT; phenotypes; NIH-CPSI; male pelvic pain; multimodal therapy.
Información del manuscrito:
Fecha de recepción: 09 de febrero de 2026.
Fecha de aceptación: 10 de abril de 2026.
Fecha de publicación: 10 de mayo de 2026.
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Lai HH, Pontari MA, Argoff CE, et al. Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach. J Urol. 2025;214(2):116-126. doi:10.1097/JU.0000000000004564.
Lai HH, Pontari MA, Argoff CE, et al. Male Chronic Pelvic Pain: AUA Guideline: Part II Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. J Urol. 2025;214(2):127-137. doi:10.1097/JU.0000000000004565.
European Association of Urology. EAU Guidelines on Chronic Pelvic Pain. Arnhem: EAU Guidelines Office; 2025.
Pendegast HJ, Leslie SW, Tadi P. Chronic Prostatitis and Chronic Pelvic Pain Syndrome in Men. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. J Urol. 1999;162(2):369-375.
Propert KJ, Litwin MS, Wang Y, et al. Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index. Qual Life Res. 2006;15(2):299-305.
Shoskes DA, Nickel JC, Dolinga R, Prots D. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology. 2009;73(3):538-542. doi:10.1016/j.urology.2008.09.074.
Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249-1253. doi:10.1016/j.urology.2010.01.021.
Shoskes DA, Nickel JC. Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system. World J Urol. 2013;31(4):755-760.
Magri V, Wagenlehner F, Perletti G, et al. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 2010;184(6):2339-2345. doi:10.1016/j.juro.2010.08.025.
Samplaski MK, Li J, Shoskes DA. Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. J Urol. 2012;188(5):1788-1793. doi:10.1016/j.juro.2012.07.036.
Franco JVA, Turk T, Jung JH, et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2019;(10):CD012552. doi:10.1002/14651858.CD012552.pub2.
Maeda K, Shigemura K, Fujisawa M. A review of current treatments for chronic prostatitis/chronic pelvic pain syndrome under the UPOINTS system. Int J Urol. 2023;30(5):431-436.
Bryk DJ, Shoskes DA. Using the UPOINT system to manage men with chronic pelvic pain syndrome. Arab J Urol. 2021;19(3):387-393.
Zhang K, Zhang Y, Hong S, Cao Y, Liu C. Comparative analysis of efficacy of different combination therapies of alpha-receptor blockers and traditional Chinese medicine external therapy in chronic prostatitis/chronic pelvic pain syndrome: Bayesian network meta-analysis. PLoS One. 2023;18(4):e0280821.
Qin Z, Guo J, Chen H, Wu J. Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a GRADE-assessed systematic review and meta-analysis. Eur Urol Open Sci. 2022;46:55-67.
Pan J, Jin S, Xie Q, et al. Acupuncture for chronic prostatitis or chronic pelvic pain syndrome: an updated systematic review and meta-analysis. Pain Res Manag. 2023;2023:7754876.
Nickel JC, Krieger JN, McNaughton-Collins M, et al. Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med. 2008;359(25):2663-2673.
Pontari MA, Krieger JN, Litwin MS, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010;170(17):1586-1593.
FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013;189(1 Suppl):S75-S85.
Wagenlehner FM, Schneider H, Ludwig M, et al. A pollen extract in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomized, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544-551.
Herati AS, Shorter B, Srinivasan AK, Tai J, Seideman C, Lesser M, Moldwin RM. Effects of foods and beverages on the symptoms of chronic prostatitis/chronic pelvic pain syndrome. Urology. 2013;82(6):1376-1380.
Zhang R, Chomistek AK, Dimitrakoff JD, Giovannucci EL, Willett WC, Rosner BA, Wu K. Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc. 2015;47(4):757-764.
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Derechos de autor 2026 REVISTA CIENTÍFICA MULTIDISCIPLINARIA ARBITRADA YACHASUN - ISSN: 2697-3456
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