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Bosch PC, Parsons CL. Chronic scrotal pain: A variable symptom of interstitial cystitis/bladder pain syndrome. Urol Ann 2019; 11:261-264. [PMID: 31413503 PMCID: PMC6676835 DOI: 10.4103/ua.ua_161_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Treatment of chronic idiopathic scrotal pain is a dilemma and challenge. Many men with this condition undergo multiple therapies and surgeries with no improvement in their symptoms. Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) have a variable clinical presentation and initially complain of only one symptom of urinary urgency, frequency, or pain. We report on patients with chronic idiopathic scrotal pain treated with standard therapy for IC/BPS. Patients and Methods: Patients with chronic idiopathic scrotal content pain were evaluated, determined to have chronic idiopathic scrotal content pain, and were treated with either pentosan polysulfate sodium (PPS) or bladder instillations of alkalinized lidocaine and heparin. Results: Sixteen males were determined to have chronic idiopathic scrotal pain. Eight males received PPS and eight males received a bladder instillation of alkalinized lidocaine and heparin. All patients had improvement of their scrotal pain to a self-reported acceptable level. Conclusions: Chronic idiopathic scrotal pain may be one of the variable presenting symptoms of IC/BPS. This scrotal pain may actually be referred pain from the bladder. Standard therapies for IC/BPS may be a treatment option for chronic idiopathic scrotal pain.
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Affiliation(s)
| | - C Lowell Parsons
- Department of Surgery/Urology, UC San Diego Medical Center, San Diego, CA, USA
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Lai HH, Krieger JN, Pontari MA, Buchwald D, Hou X, Landis JR. Painful Bladder Filling and Painful Urgency are Distinct Characteristics in Men and Women with Urological Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. J Urol 2015; 194:1634-41. [PMID: 26192257 PMCID: PMC4669971 DOI: 10.1016/j.juro.2015.05.105] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE We describe bladder associated symptoms in patients with urological chronic pelvic pain syndromes. We correlated these symptoms with urological, nonurological, psychosocial and quality of life measures. MATERIALS AND METHODS Study participants included 233 women and 191 men with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome in a multicenter study. They completed a battery of measures, including items asking whether pain worsened with bladder filling (painful filling) or whether the urge to urinate was due to pain, pressure or discomfort (painful urgency). Participants were categorized into 3 groups, including group 1-painful filling and painful urgency (both), 2-painful filling or painful urgency (either) and 3-no painful filling or painful urgency (neither). RESULTS Of the men 75% and of the women 88% were categorized as both or either. These bladder characteristics were associated with more severe urological symptoms (increased pain, frequency and urgency), a higher somatic symptom burden, depression and worse quality of life (3-group trend test each p<0.01). A gradient effect was observed across the groups (both>either>neither). Compared to those in the neither group men categorized as both or either reported more frequent urological chronic pelvic pain syndrome symptom flares, catastrophizing and irritable bowel syndrome, and women categorized as both or either were more likely to have a negative affect and chronic fatigue syndrome. CONCLUSIONS Men and women with bladder symptoms characterized as painful filling or painful urgency had more severe urological symptoms, more generalized symptoms and worse quality of life than participants who reported neither characteristic, suggesting that these symptom characteristics might represent important subsets of patients with urological chronic pelvic pain syndromes.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery and Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
| | - John N Krieger
- Department of Urology, School of Medicine, University of Washington, Seattle, Washington
| | - Michel A Pontari
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Dedra Buchwald
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Xiaoling Hou
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Pierce AN, Christianson JA. Stress and Chronic Pelvic Pain. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 131:509-35. [DOI: 10.1016/bs.pmbts.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chung H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: What Are the Starting and Worsening Factors? ACTA ACUST UNITED AC 2013. [DOI: 10.14777/kjutii.2013.8.1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hong Chung
- Department of Urology, School of Medicine, Konkuk University, Chungju, Korea
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Nepomnyashchikh GI, Aidagulova SV, Nepomnyashchikh DL, Boboev MM, Isaenko VI, Abdullaev NA, Ivaninskii OI, Kunin IS. 67 stereotypes of structural modification of the urothelium in various diseases of the urinary bladder and prostate. Bull Exp Biol Med 2009; 146:415-9. [PMID: 19489309 DOI: 10.1007/s10517-009-0308-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Structural modification of the urothelium was studied in various diseases of the urinary bladder and prostate, including urinary bladder cancer, vibration cystopathy, chronic prostatitis, benign prostate hyperplasia, and chronic cystitis. The general phenomena of changes in urinary bladder epithelium were atrophy, squamous metaplasia, and instability of the urothelium (focal atrophy, dysplasia, hyperplasia, and metaplasia). This phenomenon can be interpreted as a morphological marker for cancer risk.
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Affiliation(s)
- G I Nepomnyashchikh
- Institute of Regional Pathology and Pathomorphology, Siberian Division of the Russian Academy of Medical Sciences, Novosibirsk, Russia.
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Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn 2009; 28:274-86. [DOI: 10.1002/nau.20687] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McDermott P. Painful bladder syndrome/interstitial cystitis (history, epidemiology, symptoms, diagnosis and treatments). INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2009. [DOI: 10.1111/j.1749-771x.2009.01059.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clemens JQ, Brown SO, Calhoun EA. Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study. J Urol 2008; 180:1378-82. [PMID: 18707716 DOI: 10.1016/j.juro.2008.06.032] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE We compared the rate of mental health disorders in male and female patients with pelvic pain and control subjects. MATERIALS AND METHODS Male patients with chronic prostatitis/chronic pelvic pain syndrome (174) and female patients with interstitial cystitis/painful bladder syndrome (111) were identified from a urology tertiary care clinic population. A control group consisting of 72 men and 175 women was also recruited. Subjects completed self-administered questionnaires that included items about demographics, medical history, medication use and urological symptoms. The Patient Health Questionnaire was used to identify depression and panic disorder. Multiple logistic regression was used to determine odds ratios for the presence of a mental health diagnosis. RESULTS Mental health disorders were identified in 13% of the chronic prostatitis/chronic pelvic pain syndrome cases and 4% of male controls (OR 2.0, p = 0.04), as well as in 23% of interstitial cystitis/painful bladder syndrome cases and 3% of female controls (OR 8.2, p <0.0001). Disease status (case vs control) (OR 10.4, p = 0.001) and income greater than $50,000 (OR 0.34, p = 0.008) were the only 2 variables independently predictive of the presence of a mental health diagnosis. Age, gender, race/ethnicity and education were not predictive. Medications for anxiety, depression or stress were being taken by 18% of patients with chronic prostatitis/chronic pelvic pain syndrome, 37% of those with interstitial cystitis/painful bladder syndrome, 7% of male controls and 13% of female controls. CONCLUSIONS Depression and panic disorder are significantly more common in men and women with pelvic pain conditions than in controls. Medication use data suggest that anxiety and depression may be more difficult to treat in patients with urological pain syndromes than in controls.
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Affiliation(s)
- J Quentin Clemens
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5330, USA.
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Abstract
PURPOSE Chronic prostatitis (CP) is a common condition. It causes significant suffering to the patients and constitutes a sizeable workload for the urologists. The purpose of this review is to describe the currently accepted concepts regarding the aspects of CP. MATERIALS AND METHODS Relevant papers on the epidemiology, etiology, diagnosis, evaluation and management of CP were identified through a search of MEDLINE using text terms "prostatitis", "chronic prostatitis" and "chronic pelvic pain syndrome". The list of articles thus obtained was supplemented by manual search of bibliographies of the identified articles and also by exploring the MEDLINE option "Related Articles". RESULTS The salient points of the relevant articles on each aspect of CP have been summarized in the form of a non-systematic narrative review. CONCLUSION Chronic prostatitis is caused by a variety of infective and non-infective factors and is characterized by a rather long remitting and relapsing clinical course. The diagnosis is based on symptoms comprising pain and nonspecific urinary and/or ejaculatory disturbances and microbiological tests to localize bacteria and/or leucocytes in segmented urinary tract specimens. The contemporary classification was proposed by the National Institutes of Health/National Institute of Diabetes Digestive Kidney Diseases (NIH/NIDDK). National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) is the patient evaluation tool used extensively in clinical practice and research. Management should be individualized, multimodal and of an appropriate duration.
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Srinivasan AK, Kaye JD, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies. Curr Pain Headache Rep 2007; 11:359-64. [PMID: 17894926 DOI: 10.1007/s11916-007-0218-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.
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Affiliation(s)
- Arun K Srinivasan
- The Arthur Smith Institute of Urology, North Shore and Long Island Jewish Health System, 425 Lakeville Road, New Hyde Park, New York, NY 11040, USA.
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Teichman JMH, Parsons CL. Contemporary Clinical Presentation of Interstitial Cystitis. Urology 2007; 69:41-7. [PMID: 17462478 DOI: 10.1016/j.urology.2006.08.1111] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 06/27/2006] [Accepted: 08/24/2006] [Indexed: 01/23/2023]
Abstract
For the purpose of presenting a comprehensive review of current information, the medical literature was reviewed to extract data related to the clinical presentation of interstitial cystitis (IC). The most common symptoms at diagnosis are urinary urgency, daytime frequency, dysuria, pain, and nocturia. The most common sites where pain is localized are the suprapubic, pubic, vaginal, and genital areas. Pain is commonly triggered or exacerbated by vaginal intercourse in women or ejaculation in men. The most common findings on physical examination are dysphoric mood, suprapubic tenderness, and anterior vaginal wall tenderness. A voiding diary typically shows an increased number of voids per day and reduced volumes per void. Overall, published reports in the literature indicate that the clinical presentation of IC is variable. IC is readily suggested by history, physical examination, and voiding diary findings.
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Affiliation(s)
- Joel M H Teichman
- Division of Urology, University of British Columbia, Vancouver, British Columbia, Canada
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Forrest JB, Nickel JC, Moldwin RM. Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Male Interstitial Cystitis: Enigmas and Opportunities. Urology 2007; 69:60-3. [PMID: 17462482 DOI: 10.1016/j.urology.2006.08.1106] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 05/22/2006] [Accepted: 08/14/2006] [Indexed: 11/21/2022]
Abstract
Recently, it has been recognized that interstitial cystitis (IC) in males is a more common clinical entity than was previously thought. Further, increasing evidence suggests clinical and pathogenetic similarities between male IC and chronic nonbacterial prostatitis (CP)/chronic pelvic pain syndrome. In this article, we highlight the similarities and differences between male IC and CP and review the presentation, diagnosis, and treatment of IC in men, with particular attention to those who have received an initial diagnosis of CP.
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Affiliation(s)
- John B Forrest
- University of Oklahoma Health Science Center-Tulsa, Tulsa, Oklahoma, USA.
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Brookoff D, Bennett DS. Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes. PAIN MEDICINE 2006. [DOI: 10.1111/j.1526-4637.2006.00132.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vera PL, Meyer-Siegler KL. Inflammation of the rat prostate evokes release of macrophage migration inhibitory factor in the bladder: evidence for a viscerovisceral reflex. J Urol 2006; 172:2440-5. [PMID: 15538287 DOI: 10.1097/01.ju.0000138055.01611.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Macrophage migration inhibitory factor (MIF), a proinflammatory cytokine, is found in preformed stores in bladder epithelium. We examined the effects of prostatic inflammation on micturition frequency, bladder histology and bladder MIF content as a model in which to study viscerovisceral reflexes mediating pelvic visceral inflammation. MATERIALS AND METHODS Cystometry was performed in urethane anesthetized male rats. Formalin or saline was injected into the ventral lobe of the prostate to induce inflammation. Cystometry continued 1 hour after injection. The bladder, ventral lobes of the prostates and lumbosacral spinal cord were then removed, and protein levels and gene expression of MIF, cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) were examined. Edema was verified histologically in the bladder and prostate. RESULTS Intraprostatic formalin produced almost immediate bladder hyperreflexia, which was maintained during the observation period. Bladder edema was noted during histological examination. Bladder MIF protein amounts decreased, while COX-2 and NGF increased after prostatic injection. Bladder MIF, COX-2 and NGF mRNA increased. In the lumbosacral spinal cord protein and mRNA amounts increased for all factors examined in animals that received intraprostatic formalin. No changes were observed in the cervical cord. Rats injected with formalin mixed with dye showed restriction of the dye to the prostate. CONCLUSIONS A viscerovisceral reflex in the rat, probably mediated by the lumbosacral spinal cord, produced bladder hyperreflexia and bladder edema, and evoked MIF release from the bladder and the induction of other inflammatory mediators. This supports our hypothesis that MIF is involved in neurogenic inflammation in the pelvic viscera and it may represent an interesting therapeutic target.
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Affiliation(s)
- Pedro L Vera
- Research and Development Service, Bay Pines Veterans Affairs Medical Center, Bay Pines, Florida 33744, USA.
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Wu EQ, Birnbaum H, Kang YJ, Parece A, Mallett D, Taitel H, Evans RJ. A retrospective claims database analysis to assess patterns of interstitial cystitis diagnosis. Curr Med Res Opin 2006; 22:495-500. [PMID: 16574033 DOI: 10.1185/030079906x80431] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Interstitial cystitis (IC) is often misdiagnosed as one of several other conditions manifesting similar symptoms. This analysis assesses the potential extent of IC misdiagnosis while considering concomitant conditions in a managed care population and identifies predictors of IC diagnosis. RESEARCH DESIGN AND METHODS Administrative insurance claims data covering 1.7 million lives (1999-2003) were analyzed. Insurance enrollees with >or= 1 IC diagnosis (ICD-9-CM of 595.1x) were identified as IC patients. A random sample of non-IC controls was selected using a 10:1 matching ratio. Six-month incidence rates of 'commonly misdiagnosed conditions', (overactive bladder, urinary tract infection, chronic pelvic pain, endometriosis, prostatitis) were compared before and after patients' initial IC diagnosis and the reduction in incidence rate of commonly misdiagnosed conditions was used as a suggestive measure of the extent of IC misdiagnosis. The Kaplan-Meier method was used to assess the extent that commonly misdiagnosed conditions were predictors of subsequent IC. A Cox Proportional Hazards regression model (that adjusts for patient demographics, concomitant and misdiagnosed conditions) was used to estimate the hazard ratio (HR) of these conditions. Similar analyses were performed for the 'commonly concomitant conditions' (fibromyalgia, irritable bowel syndrome, vulvodynia). RESULTS There were 992 IC patients and 9920 controls identified. The reduced incidence of commonly misdiagnosed conditions after initial IC diagnosis suggests that the misdiagnosis rate could be as high as 38% within the 6-month period before initial IC diagnosis. CONCLUSIONS Diagnoses of commonly misdiagnosed conditions are significant predictors of future IC diagnosis. When overlooked, potential misdiagnosis of IC can lead to underestimation of the true prevalence of IC. Similarly, diagnoses of commonly concomitant conditions are significant predictors of future IC diagnosis. These initial findings based on claims data suggest hypotheses for further investigation with clinical data. These results suggest more consideration of IC as a diagnosis is warranted, especially when certain diagnoses are repeatedly made and the resulting treatments do not alleviate the patient's symptoms.
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Affiliation(s)
- Eric Q Wu
- Analysis Group, Inc., Boston, MA 02199, USA.
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Ullrich PM, Turner JA, Ciol M, Berger R. Stress is associated with subsequent pain and disability among men with nonbacterial prostatitis/pelvic pain. Ann Behav Med 2006; 30:112-8. [PMID: 16173907 DOI: 10.1207/s15324796abm3002_3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Nonbacterial prostatitis is a syndrome characterized by persistent pelvic area pain in men with or without voiding symptoms. Its causes are poorly understood, and evidence-based treatments are lacking. Although psychological stress has been proposed as an etiological factor, the literature lacks prospective studies using standardized measures to examine associations between stress and male pelvic pain problems over time. PURPOSE This study examined whether perceived stress was associated longitudinally with pain intensity and pain-related disability in a sample of men with nonbacterial prostatitis/pelvic pain. METHODS Men (N = 224) completed measures of perceived stress, pain intensity, and pain-related disability 1 month after a health care visit with a new nonbacterial prostatitis/pelvic pain diagnosis and 3, 6, and 12 months later. RESULTS Greater perceived stress during the 6 months after the health care visit was associated with greater pain intensity (p = .03) and disability (p = .003) at 12 months, even after controlling for age, symptom duration, and pain and disability during the first 6 months. CONCLUSIONS These findings support further research into the associations between stress and male pelvic pain syndromes, as well as the assessment of stress in the evaluation of patients with pelvic pain.
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Affiliation(s)
- Philip M Ullrich
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104-2499, USA.
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Gupta SK, Pidcock L, Parr NJ. The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Int 2005; 96:1063-6. [PMID: 16225529 DOI: 10.1111/j.1464-410x.2005.05776.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the potassium sensitivity test (PST) can be used to predict the response to treatment with intravesical sodium hyaluronate in patients with interstitial cystitis. PATIENTS AND METHODS Thirty-eight patients diagnosed with interstitial cystitis were recruited; each had a PST, carried out in a double-blind fashion, followed by six weekly doses of intravesical sodium hyaluronate. The patients were assessed before and after treatment using a self-administered interstitial cystitis symptom index (CSI) and problem index (PI). The clinical response was defined as none (<25% improvement in clinical symptoms), mild (>25%), moderate (50-75%) and excellent (>75%). RESULTS The PST was positive in 23 and negative or indeterminate in 13 patients; two patients withdrew from the study. Overall 20 of 36 (55%) patients reported an improvement after six doses of intravesical sodium hyaluronate, but 17 (74%) with a positive PST improved, compared to only five (22%) with a negative test (P = 0.03). There was an improvement in the CSI after treatment in both groups, but a significant improvement in the PI only in patients with a positive PST (P = 0.01). The magnitude of change for the CSI and PI was significantly greater in the positive than in the negative group (CSI, P = 0.043; PI, P < 0.001). There were no major complications. Three patients complained of pain after the test, and two with a positive and one with a negative PST developed a urinary tract infection. CONCLUSIONS Although the role of the PST in the diagnosis of interstitial cystitis requires further clarification, the test helps to predict the response to treatment with glycosaminoglycan-substitution therapy.
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