Ep. 291 Pelvic Pain Syndromes: Clinical Assessment & Strategies with Dr. Susan MacDonald

What do the 2025 AUA guidelines change about how we evaluate and manage chronic male pelvic pain? In this episode of BackTable Urology, Dr. Susan MacDonald (Penn State) joins host Dr. George Koch (Ohio State University) to break down the new American Urological Association (AUA) guidelines on chronic male pelvic pain, including chronic prostatitis / chronic pelvic pain syndrome and chronic scrotal content pain.

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SYNPOSIS

They review a structured approach from initial evaluation and physical examination to pain management. The discussion outlines an evidence-informed, multimodal management framework incorporating medications, pelvic floor physical therapy, behavioral health interventions, neuromodulators, and selective procedural strategies, with an emphasis on realistic expectation setting in this complex patient population.

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TIMESTAMPS

00:00 - Introduction
01:41 - Path to Chronic Pelvic Pain Work
08:19 - Getting Involved with the AUA
13:02 - Developing Guidelines
19:56 - Initial Patient Evaluation
27:11 - Setting Expectations
32:05 - Making the Diagnosis
35:17 - Success Rates and Counseling Patients
39:51 - Central Sensitization
44:31 - Physical Exam Recommendations
49:26 - Non-Pharmacologic Options
54:38 - Follow Up Cadence
01:02:24 - Chronic Scrotal Pain vs CPPS
01:08:26 - Conclusion

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RESOURCES

Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain