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Third International Chronic Prostatitis Network

Could a pelvic pain score be useful in an assessment of men with chronic pelvic pain?

R. Batstone and A. Doble
Addenbrooke's Hospital, Cambridge, England
Materials & Methods
This is a prospective, descriptive, controlled study of a pelvic pain score in 3 groups of patients:
  1. symptomatic types IIIa and IIIb prostatitis;
  2. patients presenting to our Chronic Pelvic Pain Syndrome (CPPS) clinic with unilateral testicular pain n=4 or asymptomatic (CPSI <13) patients previously diagnosed with types IIIa or IIIb prostatitis n=2;
  3. controls (general urology clinic patients undergoing DRE for other reasons).
From July 2000 to September 2000, 11 patient in group A and 6 patients in group B were assessed in our CPPS clinic. Group C included 10 men who completed a CPSI before their digital rectal examination (DRE). Instructions were given to the patients to complete a 10 cm visual analogue pain scale (VAS) during digital palpation with equal pressure for about 5 seconds in each of 4 areas a) posterior rectum, b) right lateral rectum, c) left lateral rectum, and d) prostate. These areas are all in the same plane as the prostate. The patient was positioned in the left lateral position and asked to mark a line through the VAS for each of the 4 areas referred to as position 1-4 by the examining surgeon. The scores were measured in cm using a ruler. The VAS prostate (VASP) and the highest other VAS (VASH) were used, and the difference between the 2 calculated. A power calculation has been performed Dr. B. Toms (Institute of Public Medicine, Cambridge University) and the study has an 80% power to detect a 2cm difference in the (VAS prostate-VAS highest) (VASP-H) with 9 patients in each group. Final statistical analysis was performed by Dr. B. Toms using a Bonferroni correction for multiple variables.
Results (See table below)
There is a statistically significant difference in the VASP-H between group A and group B p<0.0001, and between group A and group C p<0.0001. Interestingly only 2 patients in group A had a VASP-H of less than 2cm and both these had VASH of greater than 8cm which might indicate a generalized pelvic neuralgia. Only 1 patient in group C had a VASP-H greater than 2cm.
Conclusions
The prostate-pelvic tenderness test may prove to be useful in distinguishing pain caused by the prostate, from other causes of pelvic pain. The difficulty of this test is standardizing palpation pressure in all 4 areas.
GroupA n=11 Group B n=6 Group C n=10 p value between grpA and grp C
IIIa n=1, IIIb n=10 
 Mean SD Range Mean SD Range Mean SD Range 
Age5011.2(33-74)5113.4(33-65)5712.5(35-77)p=0.493 (1 way analysis of variance)
Symp/mo4687(6-300)5058(9-156)not applicable 
CPSI total226(15-32)169(3-30)65(1-13)*p<0.0001
VASP/cm6.42.0(3.0-10)3.51.9(1.3-7.0)2.81.7(0-5.1)*p=0.001
VASH/cm3.02.9(0-8.5)3.92.4(1.8-8.0)2.21.4(0-4.0)p=0.394
VASP-H/cm3.41.8(-0.7-5.5)-0.31.0(-1.5-1.0)0.60.8(-.3-2.2)*p<0.0001

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