NEJM

[dshoskes]

There is a New England Journal article coming out today that has a clinical vignette of a patient with CPPS and a small review article by Tony Schaeffer. Given the abysmal knowledge level of most internists about the condition, just having the classification system published in this journal should be a positive.

[webslave]

Yes, a truly awful article that takes us back several years, and doesn't even mention neuromuscular or psychotherapeutic approaches or treatments. Time for Dr Schaeffer (born in 1942) to retire, methinks.



For example, here's the laughable "conclusion":

Conclusions and Recommendations

....

In the absence of evidence of urinary tract infections that are associated with symptoms, an infectious cause is unlikely. In such cases, the therapy should be guided by the patient's preferences and its effects on symptoms monitored according to scores on the NIH Chronic Prostatitis Symptom Index. On the basis of data from randomized trials (although these are inconsistent), I would recommend a 12-week trial of alpha-blocker therapy, which can be continued if a good response is observed.

Urologic referral is recommended for patients with significant lower urinary tract symptoms in addition to chronic pelvic pain or in whom the response to empiric therapy is inadequate. Symptoms of discomfort after ejaculation, as in the patient described, might be associated with an uncommon but remediable problem such as obstruction of the ejaculatory duct.

In other words, use alpha blockers (usually only partially successful at best), or else do whatever the will make the patient happy! How about updating your knowledge in this area, Dr Schaeffer?