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Prostatitis Foundation

Third International Chronic Prostatitis Network

Comparison of urodynamic findings in patients with Chronic Pelvic Pain Syndrome IIIa and IIIb

W.W. Hochreiter, P. Hruz, H. Danuser, U.E. Studer
Department of Urology, University of Berne, Switzerland
Introduction & Objectives
Medical therapy of Chronic Pelvic Pain Syndrome (CPPS) with alpha -blockers has been recommended for both categories IIIa and IIIb. The rational for this treatment strategy is based on clinical observations and urodynamic findings. The aim of this study was to look for urodynamic differences between IIIa and IIIb in order to distinguish further between these 2 forms of CPPS.
Material & Methods
Ninety-eight patients were included in this study. Based on symptoms and number of white blood cells (WBC) in the expressed prostatic secretions (<10 or ≥10 WBC/hpf) they were diagnosed to have CPPS IIIa (n=48) or IIIb (n=50). Infection has been excluded by standard microbiological methods. Urethrocystoscopy was normal in all patients. At the time of urodynamic evaluation any medical treatment with antibiotics or alpha -blockers has been discontinued for at least 6 weeks
The urodynamic parameters included detrusor opening pressure (DOP), maximal urinary flow (Qmax), maximal detrusor pressure (Pdetmax), detrusor pressure at maximal flow (PdetQmax), minimal urethral opening pressure (Pmuo) and micturition volume (Micvol). Both groups (IIIa vs. IIIb) showed similar values of DOP (39 vs. 38 cm H2O), Qmax (12 vs. 13 ml/sec), Pdetmax (51 vs. 55 cm H 2 O), PdetQmax (39 vs. 44 cm H2O) and Pmuo (26 vs. 26 cm H2O). There was no statistically significant difference between the 2 groups. Only the micturition volume was different between IIIa and IIIb (275 vs. 362 ml, p<0.05). The assessment of symptoms with the International Prostate Symptom Score (IPSS) was identical for both groups (13 vs. 13).
Patients with CPPS either IIIa or IIIb show a very similar spectrum of urodynamic findings. It is possible that the lower micturition volume in category IIIa is caused by a certain frequency due to the presence of prostatic inflammation. Although urodynamic investigation is an important instrument in the eval-uation of CPPS it does not seem to be of value to distinguish category IIIa from IIIb.

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