Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been a challenging condition regarding its diagnosis and approach towards its treatment. This retrospective study reviews the outcome of 200 cases with chronic prostatitis who underwent cystoscopy  and prostatic massage, in terms of its diagnostic utility and potential therapeutic implications.

A total of 200 patients with CP/CPPS underwent cystoscopy for evaluation and cystoscopy guided prostatic massage. Cystoscopic findings were noted in all patients and at the same time prostatic massage was performed to test the expressed prostatic secretions (EPS) for inflammatory cells and bacterial cultures. Patients were evaluated in terms of clinical outcome, improved symptomatology and correlation between cystoscopic and microbiological findings.

Results: Cystoscopy revealed bladder mucosal abnormalities such as erythema (55%), trabeculation (28%), and prostatic urethral changes (45%). Prostatic massage led to symptom improvement in 35% of cases, while 20% reported transient symptom exacerbation. EPS analysis showed inflammatory cells in 55% of cases, and bacterial growth was identified in 10% patients, guiding targeted antibiotic therapy. Patients with abnormal cystoscopic findings were more likely to have persistent symptoms compared to those with normal cystoscopic results (p < 0.05).

Results: Cystoscopy revealed bladder mucosal abnormalities such as erythema (55%), trabeculation (28%), and prostatic urethral changes (45%). Prostatic massage led to symptom improvement in 35% of cases, while 20% reported transient symptom exacerbation. EPS analysis showed inflammatory cells in 55% of cases, and bacterial growth was identified in 10% patients, guiding targeted antibiotic therapy. Patients with abnormal cystoscopic findings were more likely to have persistent symptoms compared to those with normal cystoscopic results (p < 0.05).

Cystoscopy plays a vital role in identification of bladder mucosal changes, prostatic urethral abnormalities associated with CP/CPPS, but its role in guiding the treatment for chronic prostatitis is still unclear. Cystoscopy guided prostatic massage helps in diagnosis through EPS analysis and provides symptomatic relief in some of the patients. Further prospective studies are needed to establish the clinical utility of these procedures in diagnosing and managing CP/CPPS.