Role of urodynamic findings in revision of many concepts about chronic prostatitis syndrome

Objective: to evaluate urodynamic ally, patients with chronic prostatitis syndrome to define a specific urodynamic pattern in each prostatitis group that might add information about the pathogenesis of the syndrome and treating such patients more efficiently

Patients and Methods: fifty patients aged from 24-50 years with symptoms suggestive of chronic prostatitis, were evaluated by standard four-glass test using direct microscopy and culture for all specimens. Patients were classified according to National Institutes of Health Classifications System into non-inflammatory chronic pelvic pain syndrome [NiCPPS [Group1]], chronic bacterial prostatitis [CBP [Group 2]], and inflammatory chronic pelvic pain syndrome [ICPPS [Group 3]. Patients with documented urethritis urinary tract infection, lower urinary tract neuropathy or history of lower urinary tract surgery are excluded from the study. Furthermore all patients were evaluated by transrectal ultrasound and through urodynamic study including flowmetry, filling cystometry, pressure flow study [PFS] and electromyography of distal urethral sphincter [EMG]. Out of 50 patients pressure flow study [PFS] and EMG are conducted in only 27 patients, while the remainder cannot complete these urodynamic sturdies. Results were statistically analyzed rising F tests where P>0.05 was significant

Results: the common urodynamic finding represent decreased mean Q max the three groups of chronic prostatitis syndrome [l6 +/- 3 ml/sec]. However no significant difference between groups regarding the Q max [P value ~0.05] Out of the 50 who underwent filing cystometry, 30 patients [60%] had a first sensation of filling and 33 patients [66%] had a desire to void at low volumes [0.05]. Of 27 patients who underwent IPFS] and EMG, 16 patients had an obstructed pattern of micturition. However there was no significant difference between NICPPS and CBP group regarding [PFS] [P>0.05]. EMG study of distal urethral sphincter [27 patients] reveal that 9 patients from 16 patients with NICPPS and 2 patients from 11 with CBP show EMG activity during voiding, and there was a statistically significant difference between both groups [P <0.05, Chi square 3.9]

Conclusion: complaints, transrectal ultrasound and urodynamic findings were generally similar in the 3 groups of prostatitis syndrome. Therefore, the differentiation of the syndrome into 3 groups based on results of direct microscopic examination and cultures of the 4-glass test seem to be not logical. In addition, urodynamic evaluation explores sensory and motor dysfunctions, which may not only help in pathophysiological explanation of this syndrome but also in planning treatment