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Third International Chronic Prostatitis Network

High incidence of bladder neck hyperplasia in patients with Chronic Pelvic Pain Syndrome


W.W. Hochreiter, P. Hruz , H. Danuser, U.E. Studer,
Department of Urology, University of Berne, Switzerland
Introduction & OBJECTIVES
Chronic Pelvic Pain Syndrome (CPPS) is notoriously difficult both to diagnose and to treat. These patients tend to have received several courses of antimicro-bials, anti-inflammatory agents and other therapeutic manoeuvres with little success. We conducted this study to analize endoscopic alterations in patients who failed to respond to medical treatment of CPPS.
Material & Interest
The 94 patients included in this study fulfilled the NIH criteria for chronic pelvic pain syndrome (male gender, discomfort or pain in the pelvic area for at least 3 months, no demonstrable infection). According to the presence or absence of white blood cells in the expressed prostatic secretions (EPS) they were classified as inflammatory CPPS (NIH category IIIa, n=52) or non-inflammatory CPPS (NIH-category IIIb, n=42). All patients had received multiple courses of antibiotics and/or anti-inflammatory drugs, never-theless they presented recurrent symptoms. At the time of endoscopic evaluation no patient was under medical treatment with a-blockers.
Results
When urethrocystoscopy was performed, no patient showed endoscopic signs of obstruction due to benign prostatic hyperlasia (BPH). Thirty patients (58%) in category IIIa and 24 patients (57%) in category IIIb were found to have a significant bladder neck hyper-plasia. Compared to the group with morphologically normal bladder neck these patients had a significantly reduced maximal urinary flow Qmax (14 vs. 25 ml/sec, p<0.05) and an increased post voiding residual urin (59 vs. 16 ml).
Conclusions
The presence of residual urin and decreased Qmax, which can be assessed by non-invasive methods, suggest anatomical alterations in form of bladder neck hyperplasia in patients with CPPS. The diagnosis can be confirmed endoscopically in order to avoid unnecessary antibiotic treatment and to consider a-adrenergic blockade.

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