Imaging of chronic male pelvic pain: what the abdominal imager should know
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SPECIAL SECTION: MALE PELVIS
Imaging of chronic male pelvic pain: what the abdominal imager should know Jessica A. Rotman1 · Andrea Siobhan Kierans1 · Grace Lo1 · Alexander Gavlin1 · Preethi Guniganti1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic role of imaging, much less attention has been given to imaging of nongynecologic causes of chronic pelvic pain. Chronic pelvic pain in men can be a challenge to diagnose as pain may arise from visceral, musculoskeletal, or neurovascular pathology. Imaging of the pelvic viscera has been covered in detail elsewhere in this edition and therefore will not be reviewed here. We will focus upon topics less familiar to the abdominal radiologist, including imaging of pelvic floor, musculoskeletal, and neurovascular pathology. Keywords Pelvis · MRI · Musculoskeletal · Hernia
Introduction Chronic pelvic pain in men is an important source of morbidity and health care expenditures, due to its prevalence and the difficulty of diagnosis and treatment. Historically, emphasis has been placed on the prostate gland as the primary source of chronic male pelvic pain, commonly referred to as prostatodynia. More recently, focus has shifted away from the prostate gland as the dominant source of male pelvic pain, and other terms, such as chronic pelvic pain syndrome (CPPS), have become more prevalent. CPPS refers to pain in or around the groin, genitalia, or perineum, with or without voiding symptoms, in the absence of urinary tract infection. CPPS has a worldwide prevalence between 2 and 16% and is the most common urologic disease in men below 50 years old [1]. Due to the heterogeneity of presenting symptoms and potential etiologies, men with chronic pelvic pain may be treated by a variety of specialists, including neurologists, orthopedists, gastroenterologists, colorectal surgeons, pain medicine specialists, and urologists, with a variety of treatment algorithms. The role of imaging in the evaluation of chronic male pelvic pain is not well established, and imaging * Preethi Guniganti [email protected] 1
Department of Radiology, Weill Cornell Medical Center, 525 E 68th St., New York, NY 10065, USA
does not have an established role in the conventional workup of CPPS [2]. The American College of Radiology Appropriateness Criteria addresses imaging for female chronic pelvic pain, but does not specifically address imaging for men with chronic pelvic pain, and there is little research on imaging effectiveness. No major studies have established reliable imaging markers for CPPS. In one retrospective review, authors found that 34% of non-musculoskeletal pelvic MR examinations performed for chronic pelvic pain in men demonstrated a congenital or acquired anatomic abnormality [3]. The abnormalities seen most often were prostatitis, bony fractures, osteomyelitis, labral tears, proctitis, peri
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