Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature

Emily S. Barker, Kimberley Chiu, Victoria L. Brown, Haidy Morsy, Lauren H. Yaeger, Arya Catna, Ratna Pakpahan, Robert Moldwin, Barbara Shorter, Jerry L. Lowder, H. Henry Lai, Siobhan Sutcliffe

Research output: Contribution to journalReview articlepeer-review


Purpose:We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research.Materials and Methods:We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals.Results:Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms.Conclusions:Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.

Original languageEnglish
Pages (from-to)341-353
Number of pages13
JournalJournal of Urology
Issue number3
StatePublished - Mar 1 2024


  • bladder pain syndrome
  • chronic pelvic pain syndrome
  • chronic prostatitis
  • interstitial cystitis
  • symptom exacerbation


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