Painful Bladder Filling and Painful Urgency are Distinct Characteristics in Men and Women with Urological Chronic Pelvic Pain Syndromes: A MAPP Research Network Study.

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.

Classification of male lower urinary tract symptoms using mathematical modelling and a regression tree algorithm of noninvasive near-infrared spectroscopy parameters.

BACKGROUND: Assessment of bladder outlet obstruction (BOO) is standard clinical practice in patients with lower urinary tract symptoms (LUTS). This is currently achieved through pressure-flow studies. Research indicates that progressive functional impairment of the bladder due to BOO is associated with haemodynamic changes. Near-infrared spectroscopy (NIRS) is an optical method of monitoring tissue oxygenation and haemodynamics via changes in concentration of the chromophores oxyhaemoglobin (O(2)Hb) and deoxyhaemoglobin (HHb). OBJECTIVE: To report a noninvasive technique and mathematic method of analysis for assessment of BOO in male subjects using NIRS and to test the independent ability of NIRS data to distinguish between patients with and without obstruction using a classification and regression tree algorithm (CART). DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study to evaluate subjects presenting for urodynamic assessment of LUTS using standard urodynamic studies with simultaneous transcutaneous NIRS monitoring. The NIRS data (magnitude and pattern of changes in O(2)Hb and HHb) were analysed, and a CART algorithm was constructed. Sixty-four males referred for evaluation of LUTS were studied at a tertiary care, university-based research and clinical facility. MEASUREMENTS: Clinical symptoms were classified using the International Prostate Symptom Score (IPSS). Pressure-flow studies were done with simultaneous transcutaneous NIRS monitoring of the detrusor. Pressure-flow studies were classified according to the Abrams-Griffiths nomogram. NIRS data documented changes in the concentration of the chromophores O(2)Hb and HHb. RESULTS AND LIMITATIONS: IPSS scores ranged from 12 to 34, with a mean of 19. The pressure-flow nomogram found 30 patients with BOO, 16 patients without BOO, and 18 patients with equivocal results. The CART found a misclassification error of 4% with 88% specificity and 94% precision. The NIRS instrument and algorithm were new; no asymptomatic subjects were studied. CONCLUSION: Using a CART algorithm, noninvasive NIRS data during voiding had independent discriminatory ability related to classification of BOO.