@@ Line 31: / Line 31: @@
 * It has been estimated that < 10% of all environmental bacteria have been identified
 * '''<span style="color:#ff0000">Gram-negative</span>'''
-** '''<span style="color:#ff0000">Most common pathogens are from the Enterobacteriaceae family</span>''', which originate in the gastrointestinal flora.
+** '''<span style="color:#ff0000">Most common pathogens are from the Enterobacteriaceae family (e.g., E. coli, Serratia, Klebsiella, Proteus, Pseudomonas)</span>''', which originate in the gastrointestinal flora.
 *** '''<span style="color:#ff0000">Most common organism is E. coli (65-80%)</span>'''
 * '''<span style="color:#ff0000">Gram-positive</span>'''
@@ Line 124: / Line 124: @@
 ** '''<span style="color:#ff0000">History</span>'''
 *** '''<span style="color:#ff0000">Phenotype Assessment in Chronic Prostatitis and CPPS</span>'''
-**** '''<span style="color:##0000ff">UPOINT</span> <span style="color:#ff0000">is a 6-point clinical classification system that categorizes the phenotype of patients with CPPS into one or more of 6 clinically identifiable domains:</span>'''
+**** '''<span style="color:#0000ff">UPOINT</span> <span style="color:#ff0000">is a 6-point clinical classification system that categorizes the phenotype of patients with CPPS into one or more of 6 clinically identifiable domains:</span>'''
-****# '''<span style="color:##0000ff">U</span><span style="color:#ff0000">rinary</span>'''
+****# '''<span style="color:#0000ff">U</span><span style="color:#ff0000">rinary</span>'''
-****# '''<span style="color:##0000ff">P</span><span style="color:#ff0000">sychosocial</span>'''
+****# '''<span style="color:#0000ff">P</span><span style="color:#ff0000">sychosocial</span>'''
-****# '''<span style="color:##0000ff">O</span><span style="color:#ff0000">rgan-specific</span>'''
+****# '''<span style="color:#0000ff">O</span><span style="color:#ff0000">rgan-specific</span>'''
-****# '''<span style="color:##0000ff">I</span><span style="color:#ff0000">nfection</span>'''
+****# '''<span style="color:#0000ff">I</span><span style="color:#ff0000">nfection</span>'''
-****# '''<span style="color:##0000ff">N</span><span style="color:#ff0000">eurologic/systemic</span>'''
+****# '''<span style="color:#0000ff">N</span><span style="color:#ff0000">eurologic/systemic</span>'''
-****# '''<span style="color:##0000ff">T</span><span style="color:#ff0000">enderness (muscle)</span>'''
+****# '''<span style="color:#0000ff">T</span><span style="color:#ff0000">enderness (muscle)</span>'''
 **** '''Guidelines for the management of CP/CPPS have recommended that patients be clinically phenotyped during evaluation and treated according to individual phenotypes identified'''
 ** '''<span style="color:#ff0000">Physical exam</span>'''
@@ Line 143: / Line 143: @@
 ***# '''<span style="color:#ff0000">Urinary function</span>'''
 ***# '''<span style="color:#ff0000">Quality of life</span>'''
-* ''<span style="color:#ff0000">'Lower Urinary Tract Cytologic Examination and Culture Techniques</span>'''
+* '''<span style="color:#ff0000">Lower Urinary Tract Cytologic Examination and Culture Techniques</span>'''
 ** '''<span style="color:#ff0000">Category I (acute bacterial prostatitis): a urine culture is the only laboratory evaluation of the lower urinary tract required</span>'''
 ** '''<span style="color:#ff0000">Category II/II: 4-glass urine collection</span>'''
@@ Line 166: / Line 166: @@
 === Management ===
-* '''Acute prostatitis'''
+==== Acute prostatitis ====
-** '''Therapy is initially with parenteral antibiotics (depending on the severity of the infection) followed by oral antibiotics with wide-spectrum antimicrobial activity'''
+* '''<span style="color:#ff0000">Antibiotics Regimen'''
-*** '''The Enterobacteriaceae (e.g., E. coli, Serratia, Klebsiella, Proteus, Pseudomonas) represent the most common uropathogens, followed by gram-positive enterococci.'''
+**'''<span style="color:#ff0000">AUA[https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/adult-uti §]'''
-*** '''The most common drugs suggested for initial therapy are a combination of penicillin (i.e., ampicillin) and an aminoglycoside (i.e., gentamicin), second- or third-generation cephalosporins (i.e. ceftriaxone), or one of the fluoroquinolones.'''
+***'''<span style="color:#ff0000">1<sup>st</sup> Line: Trimethoprim/Sulfamethoxazole or Fluoroquinolone[https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/adult-uti §]'''
-**** This traditional approach has changed recently because of the increasing risk of post–prostate biopsy prostate infection with ESBL microorganisms
+****TMP/SMX 1 tab DS PO BID x 14 days
-**** In acute bacterial prostatitis that result from previous manipulation of the lower urinary tract (including prostate biopsy), the organisms show different patterns of virulence and resistance (e.g., to quinolones and cephalosporins) compared with the organisms associated with spontaneous acute prostatitis
+*** '''<span style="color:#ff0000">2<sup>nd</sup> Line: 2<sup>nd</sup> generation cephalosporin'''
-*** '''In patients with acute prostatitis with ESBL or suspected ESBL organisms (usually associated with transrectal prostate biopsies), treatment with a carbapenem (ertapenem, imipenem, or meropenem),''' amikacin, or colistin '''for at least 10 to 14 days is recommended'''
+*** '''<span style="color:#ff0000">3<sup>rd</sup> Line: 3<sup>rd</sup> generation cephalosporin'''
-** '''Once the acute infection has settled down, therapy should be continued with one of the oral antimicrobial agents appropriate for the treatment of chronic bacterial prostatitis''' (e.g., trimethoprim or fluoroquinolones or ESBL-effective antimicrobial therapy based on sensitivity analysis). '''The duration of optimal therapy is unknown; between 2 and 4 weeks has been suggested'''
+**Australian Family Physician'''<span style="color:#ff0000">[https://www.racgp.org.au/afp/2013/april/prostatitis §]'''
-* '''CPPS'''
+*** Trimethoprim 300 mg orally daily for 14 days, or
-** Medical therapies that have been properly evaluated in RCTs in CPPS: antibiotics, α-adrenergic blockers, anti-inflammatory agents, hormonal therapies, phytotherapies, and pregabalin
+*** Cephalexin 500 mg orally twice daily for 14 days, or
-** Minimally invasive therapies that have been properly evaluated in RCTs in CPPS: extracorporeal shockwave therapy (ESWT), transurethral microwave therapy (TUMT), and neuromodulation (electrostimulation, botulinum toxin).
+*** Amoxicillin and clavulanic acid 500 mg + 125 mg orally twice daily for 14 days
-** '''Therapies that have shown benefits in placebo sham-controlled studies in CPPS:'''
+*'''<span style="color:#ff0000">Duration</span>'''
-*** '''Marked benefit—none'''
+**'''<span style="color:#ff0000">Treat for 2 weeks duration</span>'''
-*** '''Moderate benefit in some selected trials (2):'''
+*'''<span style="color:#ff0000">Therapy is initially with parenteral antibiotics (depending on the severity of the infection) followed by oral antibiotics with wide-spectrum antimicrobial activity</span>'''
-***# '''α-adrenergic blockers'''
+* '''<span style="color:#ff0000">In patients with acute prostatitis with ESBL or suspected ESBL organisms (usually associated with transrectal prostate biopsies), treatment with a carbapenem (ertapenem, imipenem, or meropenem),</span>''' amikacin, or colistin '''for at least 10 to 14 days is recommended'''
-***# '''Pregabalin'''
-*** '''Modest benefit'''
+==== Chronic Pelvic Pain Syndrome (CPPS) ====
-***# '''Anti-inflammatory agents'''
+* Medical therapies that have been properly evaluated in RCTs in CPPS: antibiotics, α-adrenergic blockers, anti-inflammatory agents, hormonal therapies, phytotherapies, and pregabalin
-***# '''Phytotherapies'''
+* Minimally invasive therapies that have been properly evaluated in RCTs in CPPS: extracorporeal shockwave therapy (ESWT), transurethral microwave therapy (TUMT), and neuromodulation (electrostimulation, botulinum toxin).
-***# '''ESWT'''
+* '''<span style="color:#ff0000">Therapies that have shown benefits in placebo sham-controlled studies in CPPS:</span>'''
-***# '''TUMT'''
+** '''<span style="color:#ff0000">Marked benefit—none</span>'''
-***# '''Selected neurostimulation'''
+** '''<span style="color:#ff0000">Moderate benefit in some selected trials (2):</span>'''
-** '''Recommended'''
+**# '''<span style="color:#ff0000">α-adrenergic blockers</span>'''
-**# '''α-Blocker therapy as part of a multimodal treatment strategy for newly diagnosed, α blocker–naive patients who have voiding symptoms.'''
+**# '''<span style="color:#ff0000">Pregabalin</span>'''
-**# '''Antibiotic trial for selected newly diagnosed, antibiotic-naive patients'''
+** '''<span style="color:#ff0000">Modest benefit</span>'''
-**# '''Selected phytotherapies: Cernilton and Quercetin'''
+**# '''<span style="color:#ff0000">Anti-inflammatory agents</span>'''
-**# '''Multimodal therapy directed at individual UPOINT phenotypes may result in better management outcomes'''
+**# '''<span style="color:#ff0000">Phytotherapies</span>'''
-**# '''Directed physiotherapy'''
+**# '''<span style="color:#ff0000">ESWT</span>'''
-** '''Not recommended'''
+**# '''<span style="color:#ff0000">TUMT</span>'''
-**# '''α-Blocker monotherapy, particularly in patients previously treated with α-blockers.'''
+**# '''<span style="color:#ff0000">Selected neurostimulation</span>'''
-**# '''Anti-inflammatory monotherapy'''
+* '''<span style="color:#ff0000">Recommended</span>'''
-**# '''Antibiotics as primary therapy, particularly for patients in whom treatment with antibiotics has previously failed'''
+*# '''<span style="color:#ff0000">α-Blocker therapy as part of a multimodal treatment strategy for newly diagnosed, α blocker–naive patients who have voiding symptoms.</span>'''
-**# '''5α-Reductase inhibitor monotherapy;''' can be considered in older patients with coexisting benign prostatic hyperplasia
+*# '''<span style="color:#ff0000">Antibiotic trial for selected newly diagnosed, antibiotic-naive patients</span>'''
-**# '''Most minimally invasive therapies''' such as transurethral needle ablation (TUNA), laser therapies
+*# '''<span style="color:#ff0000">Selected phytotherapies: Cernilton and Quercetin</span>'''
-**# '''Invasive surgical therapies''' such as transurethral resection of the prostate (TURP) and radical prostatectomy
+*# '''<span style="color:#ff0000">Multimodal therapy directed at individual UPOINT phenotypes may result in better management outcomes</span>'''
-** Requiring further evaluation
+*# '''<span style="color:#ff0000">Directed physiotherapy</span>'''
-**# Low-intensity shock wave treatment.
+* '''<span style="color:#ff0000">Not recommended</span>'''
-**# Acupuncture.
+*# '''<span style="color:#ff0000">α-Blocker monotherapy,</span> particularly in patients previously treated with α-blockers.'''
-**# Biofeedback.
+*# '''<span style="color:#ff0000">Anti-inflammatory monotherapy</span>'''
-**# Invasive neuromodulation (e.g., pudendal nerve modulation).
+*# '''Antibiotics as primary therapy, particularly for patients in whom treatment with antibiotics has previously failed'''
-**# Electromagnetic stimulation.
+*# '''5α-Reductase inhibitor monotherapy;''' can be considered in older patients with coexisting benign prostatic hyperplasia
-**# Botulinum toxin A injection.
+*# '''Most minimally invasive therapies''' such as transurethral needle ablation (TUNA), laser therapies
-**# Medical therapies including mepartricin, muscle relaxants, neuromodulators, immunomodulators.
+*# '''Invasive surgical therapies''' such as transurethral resection of the prostate (TURP) and radical prostatectomy
-* '''Antibiotics'''
+* Requiring further evaluation
+*# Low-intensity shock wave treatment.
+*# Acupuncture.
+*# Biofeedback.
+*# Invasive neuromodulation (e.g., pudendal nerve modulation).
+*# Electromagnetic stimulation.
+*# Botulinum toxin A injection.
+*# Medical therapies including mepartricin, muscle relaxants, neuromodulators, immunomodulators.
+* '''<span style="color:#ff0000">Antibiotics</span>'''
 ** Although bacteria are cultured in only 5-10% of cases of prostatitis, bacteria may be the cause of CP symptoms in a significant percentage of patients with this syndrome
-** '''Antibiotic therapy may benefit CP/CPPS patients by 3 different mechanisms:'''
+** '''<span style="color:#ff0000">Antibiotic therapy may benefit CP/CPPS patients by 3 different mechanisms:</span>'''
-**# '''Strong placebo effect'''
+**# '''<span style="color:#ff0000">Strong placebo effect</span>'''
-**# '''Eradication or suppression of non-cultured microorganisms'''
+**# '''<span style="color:#ff0000">Eradication or suppression of non-cultured microorganisms</span>'''
-**# '''Anti-inflammatory effect of some antibiotics'''
+**# '''<span style="color:#ff0000">Anti-inflammatory effect of some antibiotics</span>'''
-*** '''For CP caused by E. coli, 1 month of fluoroquinolones is recommended; antibiotics should be continued only for 4-6 weeks if pre-treatment cultures are positive and/or the patient has reported positive effects from treatment'''
+*** '''<span style="color:#ff0000">For CP caused by E. coli, 1 month of fluoroquinolones is recommended; antibiotics should be continued only for 4-6 weeks if pre-treatment cultures are positive and/or the patient has reported positive effects from treatment</span>'''
 **** The fluoroquinolones have demonstrated improved therapeutic results, especially in prostatitis caused by E. coli and other members of the Enterobacteriaceae but not necessarily in prostatitis caused by P. aeruginosa or enterococci.
 **** '''TMP/SMX is less effective both in bacterial eradication and cost-effectiveness when compared with the newer fluoroquinolones'''
@@ Line 223: / Line 232: @@
 **** '''As many as 20% of patients in whom an initial treatment period fails could be rescued with a second cycle of treatment with another antibiotic'''
 *** '''Antibiotics should not be prescribed for previously treated men with CP/CPPS of long duration.'''
-** '''Antibiotic treatment may be considered for antibiotic-naive patients with a recent diagnosis of prostatitis, regardless of culture status.'''
+** '''<span style="color:#ff0000">Antibiotic treatment may be considered for antibiotic-naive patients with a recent diagnosis of prostatitis, regardless of culture status.</span>'''
 * '''Alpha-blockers'''
 ** '''Patients with CP/CPPS have significant lower urinary tract symptoms, which appear to be related to poor relaxation of the bladder neck during voiding;''' α-adrenergic blockade may improve outflow obstruction, improving urinary flow and perhaps diminishing intraprostatic ductal reflux.
@@ Line 259: / Line 268: @@
 * Minimally invasive techniques
 ** Some minimally invasive surgical procedures (electrical neuromodulation, extracorporeal shock wave therapy, electroacupuncture, and perhaps transurethral microwave thermotherapy (TUMT) and botulinum toxin injection may be beneficial for treatment for CP/CPPS in selected patients; however, large, well-designed sham-controlled trials are required before these therapies can be considered recommended.
-* '''Traditional surgery'''
+* '''<span style="color:#ff0000">Traditional surgery</span>'''
 ** '''Surgery does not have an important role in the treatment of most CP syndromes unless a specific indication is discovered during the evaluation of the patient'''
-*** '''A developing prostate abscess that fails to respond quickly to antibiotics is optimally drained (transurethral or percutaneous; percutaneous drainage is the more effective and less morbid)'''
+*** '''<span style="color:#ff0000">A developing prostate abscess that fails to respond quickly to antibiotics is optimally drained (transurethral or percutaneous; percutaneous drainage is the more effective and less morbid)</span>'''
-*** '''Seminal vesicle abscesses can be managed with antibiotic therapy, transrectal aspiration, and, if necessary, an operation to remove the seminal vesicles'''.
+*** '''<span style="color:#ff0000">Seminal vesicle abscesses can be managed with antibiotic therapy, transrectal aspiration, and, if necessary, an operation to remove the seminal vesicles</span>'''.
-* '''Phenotype directed multimodal treatment'''
+* '''<span style="color:#ff0000">Phenotype directed multimodal treatment</span>'''
 ** '''No one all-encompassing causative mechanism responsible for all cases of CP/CPPS.'''
 ** UPOINT is a clinical tool for urologists to use to direct individually based therapy; each of these domains has been associated with specific therapy based on best evidence and expert experience
 * See CW11 Figure 13-9 for suggested diagnostic and therapeutic algorithm for the treatment of CPPS based on UPOINT
 * See CW11 Table 13-4 for suggested doses of medical therapy for CPPS
-== Orchitis ==
-=== Definitions ===
-* Orchitis: inflammation of the testis
-** The term has been [inappropriately] used to describe testicular pain localized to the testis without objective evidence of inflammation
-* Acute orchitis: sudden occurrence of pain and swelling of the testis associated with acute inflammation of that testis
-* '''Chronic orchitis:''' inflammation and pain in the testis, usually without swelling, '''persisting for > 6 weeks'''
-=== Classification ===
-* '''Acute bacterial orchitis'''
-** Secondary to urinary tract infection
-** Secondary to sexually transmitted disease
-* '''Non-bacterial infectious orchitis'''
-** Viral
-*** '''most common cause of viral orchitis is mumps'''
-** Fungal
-** Parasitic
-** Rickettsial
-* '''Non-infectious orchitis'''
-** Idiopathic
-** Traumatic
-** Autoimmune
-* '''Chronic orchitis'''
-* '''Chronic orchialgia'''
-** It may be impossible to clinically distinguish chronic orchitis from chronic orchialgia
-=== Pathogenesis ===
-* '''Orchitis (especially bacterial) usually occurs with epididymitis (secondary to local spread of an ipsilateral epididymitis) and are referred to as epididymo-orchitis.'''
-** '''In boys and elderly men, UTIs ('''including E. coli and Pseudomonas''') are usually the underlying source.'''
-** '''In young sexually active men, sexually transmitted diseases are often responsible'''
-** '''Isolated orchitis without epididymitis is a relatively rare condition and is usually viral in origin, which spreads to the testis by a hematogenous route)'''
-** Mycobacterial infections, tuberculosis, and BCG therapy can also cause orchitis
-* '''The process is usually unilateral; however, sometimes bilateral, especially if viral'''
-=== Diagnosis and Evaluation ===
-* '''Acute infectious orchitis'''
-** '''History: recent onset of testicular pain, often associated with abdominal discomfort, nausea, and vomiting.''' These symptoms may be preceded by symptoms of parotitis in boys or young men, by UTIs in boys or elderly men, or alternatively by symptoms of a sexually transmitted disease in sexually active men.
-** '''Physical exam''' may reveal a toxic and febrile patient
-* Acute non-infectious orchitis
-** Similar presentation to acute infectious orchitis except that these patients lack the toxic appearance and fever
-** In the young patient, the most important differential diagnosis is torsion of the testis
-* Chronic orchitis and orchialgia
-** May have a history of previous episodes of testicular pain, usually secondary to acute bacterial orchitis, trauma, or other causes.
-** The scrotum is not usually erythematous, but the testis may be somewhat indurated and is almost always tender to palpation.
-* Labs
-** Urinalysis, urine microscopy, and urine culture
-** When a sexually transmitted disease is suspected, a urethral swab should be taken for culture
-* Imaging
-** If the diagnosis is not evident from the history, physical examination, and these simple tests, scrotal ultrasonography should be performed (to rule out malignancy in patients with chronic orchitis or orchialgia).
-** Insert figure
-=== Management ===
-* '''General principles of therapy include bed rest, scrotal support, hydration, antipyretics, anti-inflammatory agents, and analgesics.'''
-** '''Treatment of chronic orchitis or orchialgia is supportive.''' Anti-inflammatory agents, analgesics, support, heat therapies, and nerve blocks all have a role in ameliorating symptoms.
-* '''Antibiotic therapy (specific for UTIs, prostatitis, or sexually transmitted diseases) should be employed for infectious orchitis'''
-** If early testing findings are negative or results are unavailable, empirical treatment should be initiated, directed at the most likely pathogens based on the available clinical information; '''a fluoroquinolone would be the best agent in this scenario.'''
-** '''Orchitis resulting from Mycobacterium tuberculosis infection requires treatment with antituberculous drugs (rifampin, isoniazid, and pyrazinamide or ethambutol)''' and rarely surgery.
-** '''There are no specific anti-viral agents available to treat orchitis caused by mumps''', and the previously mentioned supportive measures are important.
-** Abscess formation is rare; if it does occur, then percutaneous or open drainage is necessary
-* '''Spermatic cord blocks with injection of a local anesthetic''' may sometimes be needed to relieve severe pain.
-* Surgical intervention is rarely indicated, unless testicular torsion (or rarely xanthogranulomatous orchitis) is suspected; orchidectomy is indicated only in cases in which pain control is refractory to all other measures (and even this might not be successful in alleviating the chronic pain)
-== Epididymitis ==
-=== Definitions ===
-* Epididymitis: inflammation of the epididymis
-* '''Acute epididymitis: sudden occurrence of pain and swelling of the epididymis associated with acute inflammation of the epididymis that lasts < 6 weeks'''
-* '''Chronic epididymitis: inflammation and pain in the epididymis, usually without swelling (but with induration in long-standing cases), persisting > 6 weeks'''
-** '''Chronic infectious epididymitis is most commonly seen with tuberculosis,''' as a consequence of hematogenous spread rather than seeding of the urinary tract from the kidneys
-=== Classification ===
-* '''Acute bacterial epididymitis'''
-** Secondary to UTI or sexually transmitted disease
-* '''Non-bacterial infectious epididymitis'''
-** Viral
-** Fungal
-** Parasitic
-* '''Non-infectious epididymitis'''
-** Idiopathic
-** Traumatic
-** Autoimmune
-** '''Amiodarone-induced'''
-** Associated with a known syndrome (e.g., Behçet disease)
-* '''Chronic epididymitis'''
-* '''Chronic epididymalgia'''
-=== Pathogenesis and Etiology ===
-* '''Acute epididymitis usually results from the spread of infection from the bladder, urethra, or prostate via the ejaculatory ducts and vas deferens into the epididymis.'''
-** '''In elderly men, BPH and associated stasis, UTI, and catheterization are the most common causes of epididymitis.''' '''The most common causative microorganisms in the pediatric and elderly age groups are the uropathogens''' '''with E. coli as the most common organism'''.
-** '''In sexually active men younger age < 35 who have sex with women, epididymitis is commonly the result of a sexually transmitted infection (N. gonorrhoeae and C. trachomatis)'''
-** '''Among MSM, acute epididymitis can be caused by enteric organisms such as E. coli and Pseudomonas as a result of anal intercourse'''
-* '''Chronic epididymitis may result from inadequately treated acute epididymitis, recurrent epididymitis, or some other cause including associations with other disease processes such as Behçet disease or treatment with amiodarone'''
-=== Diagnosis and Evaluation ===
-* Must rule out testicular torsion, especially in younger patients
-* '''Physical examination localizes the tenderness to the epididymis.''' However, in many cases the testis is also involved in the inflammatory process and subsequent pain; this is referred to as epididymo-orchitis. The spermatic cord is usually tender and swollen.
-* '''Laboratory tests should include Gram staining of a urethral smear and a midstream urine specimen.'''
-* Scrotal ultrasonography can be helpful but is not always diagnostic
-* Insert figure
-=== Management ===
-* '''Empirical therapy is indicated before laboratory test results are available'''
-* '''Acute bacterial epididymitis'''
-** '''Men age < 35: ceftriaxone 250 mg IM x1 + doxycycline 100 mg PO BID x 10-14 days''' (azithromycin 1g PO x 1 could be used instead of doxycycline)
-** '''Men age > 35:''' '''ofloxacin 200 mg PO BID x 14 days''' or levofloxacin
-** '''If concerned for both STI and enteric organisms, then ceftriaxone 250 mg IM x1 + ofloxacin 200 mg PO BID x 14 days'''
-* '''For chronic epididymitis, a 4- to 6-week trial of antibiotics that would potentially be effective against possible bacterial pathogens and particularly C. trachomatis may be appropriate.'''
-* '''Anti-inflammatory agents, analgesics, scrotal support, and nerve blocks have all been recommended as empirical treatment'''
-* '''Surgical removal of the epididymis (epididymectomy) should be considered only when all conservative measures have been exhausted''' and the patient accepts that the operation will have at best a 50% chance of curing his pain
 == Questions ==

Chronic Pelvic Pain Syndrome & Prostatitis: Difference between revisions