Urinary Urgency in the Elderly.

The last 2 decades have brought an explosion of research, new products, and general attention to the problem of urinary urgency, and yet patients continue to be plagued by this symptom - especially the elderly. What is it? What does it mean? How can we guide patients successfully through this challenge? This paper presents a review of current thinking about urgency relevant to the practicing clinician, including the epidemiology, pathophysiology, evaluation, and treatment of these patients.

Male Pelvic Pain: Beyond Urology and Chronic Prostatitis.

Chronic pelvic pain in men has often been misdiagnosed as prostatitis. After excluding serious or acute urological, neurological or colorectal conditions, it is essential to approach these patients with a much more comprehensive criteria. Thoughtful interview and methodical physical examination can very often reveal pelvic floor muscle dysfunction, Myofascial pain syndromes, Functional Somatic Syndrome/Central Sensitization Syndromes and/or psychosocial distress. One must be aware that many of these syndromes frequently overlap. Acknowledgement of these conditions and validation of both their physical and psychological distress is paramount to creating trust and confidence in the patient. These are the cornerstones for empowerment and self-care required in the management of chronic pelvic pain.

Trends in PSA, age and prostate cancer detection among black and white men from 1990-2006 at a tertiary care center.

BACKGROUND: Prostate cancer is the most frequently diagnosed malignancy in men in the United States, with even higher prevalence and death rates among black men. The authors sought to compare trends in prostate-specific antigen (PSA), age, and prostate-cancer detection among black and white men in our region during a 16-year period. METHODS: This was a retrospective study of patient archives between 1990 through 2006. Data collection was accomplished by examining patients' charts and electronic medical records. Data from 5570 patients, of whom 911 were black, were analyzed statistically by testing and comparing parameters over time. RESULTS: During this 16-year period, mean age at the time of initial diagnostic prostate biopsy did not change in either group, despite what we had believed about the effects of patient education and screening campaigns. However, prostate-cancer detection rates did decrease during the time period studied. Over time, the authors also observed significant decreases in the sensitivity and specificity of PSA as a screening tool. Indeed, analysis of more recent cases demonstrated a positive predictive value comparable to a coin toss. While Gleason scores remained relatively stable over time, reporting of prostate intraepithelial neoplasia (PIN) and inflammation increased. CONCLUSIONS: Using lower PSA thresholds, promoting younger screening age, and increasing efforts to educate the public have not seemed to influence age at time of diagnostic testing, which may reflect other factors such as usefulness of screening, physician referral patterns, patient compliance, and other sociodemographic issues. The usefulness of PSA as a screening tool appears to be diminishing.

Nonpharmacological approaches for the treatment of urological chronic pelvic pain syndromes in men.

Chronic nonbacterial prostatitis, or urological chronic pelvic pain syndrome (UCPPS), remains a common and often challenging disorder to evaluate and treat. Employing a more holistic approach, including urological therapy, physical therapy, and psychosocial perspectives, may be more appropriate for most patients. Growing evidence supports the use of biofeedback, myofascial trigger point release, prescribed exercise regimens, relaxation techniques, and supportive counseling to treat men with UCPPS.

Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome.

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, a-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.

Influence of asymptomatic histologic prostatitis on serum prostate-specific antigen: a prospective study.

OBJECTIVES: To determine the influence of asymptomatic inflammatory processes of the prostate on serum prostate-specific antigen (PSA) levels. METHODS: A total of 51 patients with no evidence of prostate cancer or clinical prostatitis were prospectively studied. All subjects underwent 10 to 12 sector transrectal-ultrasound guided needle biopsies of the prostate. Serum PSA was measured 10 minutes before the biopsies. The fragments were stained and histologically analyzed. Two different classifications were used. One divided patients according to the number of specimens with inflammatory processes: 20% or less (group 1), more than 20% to 50% or less (group 2), and greater than 50% (group 3). Any kind of inflammatory process was considered positive. The second was the presence or absence of foreign body-type giant cells. Pearson's nonparametric test was used in the statistical analysis, with P <0.05 considered statistically significant. RESULTS: The number of specimens with an inflammatory process was statistically significant (P = 0.02), with a median PSA level of 4.96 ng/mL in group 1 patients, 7.40 ng/mL in group 2, and 8.03 ng/mL in group 3 patients. The presence of foreign body-type giant cells in the histologic analysis was not statistically significant, with a median PSA level of 10.21 ng/mL compared with 5.89 ng/mL in the group without these cells. CONCLUSIONS: The extension of the inflammatory process, as evaluated by the number of specimens involved, was directly related to elevations of serum PSA levels in asymptomatic patients. We could not find a statistically significant relationship between the presence of foreign body-type giant cells and serum PSA levels.

Chronic pelvic pain syndrome: a non-prostatocentric perspective.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urological diagnosis affecting young and middle aged men. Symptoms of genital or pelvic pain associated with voiding or sexual dysfunction were historically attributed to an inflamed prostate gland. A review of urological and non-urological literature pertaining to CPPS was conducted in order to devise a plausible alternative description of this syndrome. Due to publisher's criteria, only select articles are included and cited for this purpose. Evidence of a bacterial etiology is non-existent, while evidence of prostatic inflammation is conflicting and non-specific. More plausible causes of prostatitis-like symptoms include musculoskeletal pain, pelvic floor muscular dysfunction, myofascial pain syndromes or functional somatic syndromes. Thorough evaluation and appropriate therapy for patients has been seriously hindered by decades of a prostatocentric approach to CP/CPPS. The following article introduces an alternative perspective.

Diagnosing the prostatitis patient: the dilemma continues.

National Institutes of Health Category III prostatitis/chronic pelvic pain syndrome continues to pose a diagnostic and treatment challenge to most urologists. While this form of so-called prostatitis is the most prevalent and frustrating, little progress has been made in proving an etiology and consequently, in finding an effective remedy. The diagnostic dilemma is illustrated by the conflicting data employed to describe prostatitis. What is prostatitis? Is it a malady of the prostate gland itself? Is it a form of voiding dysfunction? Is it a myofascial pain syndrome? Or, is prostatitis urology's brand of functional somatic syndrome? It is time we address the dilemma by looking beyond the prostate gland and toward a multidisciplinary perspective.