The Effect of Capsaicin on the Sensory Nerve of the Rat Prostate / 대한해부학회지

Prostatodynia is a common and chronic debilitating disease manifested by pain referable to the prostate such as perineal, inguinal, lower back, and suprapubic pain. It has been estimated that more than half of all men suffer from this entity sometime in their lives. Although infection, autoimmunity, and intraprostatic reflux are some of the candidates for its cause, the etiology and pathogenesis of prostatodynia remains unclear. This study investigated the effect of capsaicin, a selective nociception blocking agent, on the prostatic afferent, and determined the presence of capsaicin sensitive nerve fiber at the rat prostate. Adult male Sprague-Dawley rats were used for the experiment. Capsaicin (4mM) or vehicle (10% ethanol, 10% Tween 80, 80% normal saline) 0.125 ml each was injected directly into the right ventral prostate and sacrificed at 1, 2, 24 hours, 1 week and 1 month after injection. Five rats were sacrificed at each time interval. Calcitonin gene related peptide (CGRP) and neurofilament (NF) immunohistochemistry was performed at the L2 dorsal root ganglion (DRG). CGRP and substance P (SP) immunohistochemistry was performed at L2 and T8 dorsal horn, and the prostate. The change in the number of c-fos positive cells was determined at L2, L6, and T8 dorsal horn. Change in c-fos positive cells was also compared between those injected with xylene only and those injected with xylene 24 hours and 1 week after capsaicin pretreatment. The prostate was observed under hematoxylin-eosin (H-E) staining for histological change after capsaicin injection. The number of CGRP positive cells decreased nearly half at the L2 DRG 24 hours after capsaicin injection and remained decreased up until 1 month. However, the number of NF positive cells did not change suggesting the effect of capsaicin only on B-type neurons. Decrease in CGRP and SP at the dorsal horn was observed only at L2 after capsaicin injection. There was no change at T8 and after vehicle injection. The number of c-fos positive cells after capsaicin and vehicle injection reached a peak at 2 hours at L2 and at 2 and 1 hour, respectively, at L6. However, c-fos positive cell was not observed at T8 even after capsaicin injection. In animals pretreated with capsaicin, injection of xylene induced fewer c-fos positive cells at both L2 and L6 compared to animals injected with xylene only. H-E staining of the prostate did not reveal any significant histological change of the prostate after capsaicin injection. However, CGRP and SP positive nerve fibers was not observed 1 week after capsaicin treatment. Direct injection of capsaicin into the rat prostate induced depletion of CGRP and SP, neurotransmitters related to pain conduction, at the DRG, dorsal horn and prostate suggesting that the prostatic afferent is affected by capsaicin. The decreased c-fos positive cells observed after capsaicin pretreatment further supports this observation and demonstrates that capsaicin injection can desensitize nociception originating from the rat prostate.

Clinical Experience of Hydrodistension in Men Diagnosed as Prostatodynia / 대한비뇨기과학회지

PURPOSE: This study was designed to investigate that men with prostatodynia have petechiae in the bladder and improvement of symptoms after hydrodistension. MATERIALS AND METHODS: A total of 14 men with the diagnosis of prostatodynia underwent cystoscopy and hydrodistension under a general or regional anesthetic. Their charts were retrospectively reviewed. RESULTS: Of the 14 men 5(36%) had moderate to severe petechiae similar in appearance to women with interstitial cystitis after hydrodistension. Men with moderate to severe bladder petechiae had fewer leukocytes in expressed prostatic secretions and smaller bladder capacities than men with more normal appearing bladders after hydrodistension. Symptomatic improvement 2 to 6 weeks after hydrodistension was more common in men with moderate to severe petechiae than in those with fewer petechiae. CONCLUSIONS: We suggest that bladder petechiae after hydrodistension may be a diagnostic finding in men with prostatodynia as well as women with interstitial cystitis. Therefore, the diagnosis of interstitial cystitis should be considered in patients with prostatodynia.

Study of Prostatic Disease and Symptom between Special Occupation Groups(Taxi Driver, Barber) / 대한비뇨기과학회지

PURPOSE: To compare symptoms of prostatism and their causes between two occupation groups with different working environment and position: one group of tarsi drivers working mainly in sitting position under constant stress and another group of barbers working mainly in standing position. MATERIALS AND METHOD: 405 taxi drivers and 110 barber participated in prostatic disease screening program. 93 patients with prostatic symptom were also enrolled in this study. All participants underwent IPSS self-assessment, digital rectal examination, urinary flow rate, transrectal ultrasound and prostatic cancer screening test (PSA, and if necessary, prostatic biopsy). RESULTS: IPSS were similar in taxi drivers group and patient group, whereas it was significantly lower in barbers group. Mean maximal flow rate was similar in both taxi drivers and patient groups, but significantly higher in barbers group. Incidence of abnormal voiding pattern was significantly higher in taxi drivers group compared to other groups. TRUS showed higher incidence of calcification and ejaculatory duct abnormality in taxi drivers group compared to other groups. Prostatitis and prostatodynia combined were more prevalent in taxi drivers group than in barbers groups. CONCLUSIONS: Taxi drivers working in a constrained environment of prolonged sitting exposed to a lot of stress, pelvic floor tension and abstinence of urine had more diverse voiding symptoms and greater prevalence of prostatitis and prostatodynia than barbers group.

Prostatodynia: Characteristics of Uroflowmetries / 대한비뇨기과학회지

PURPOSE: Prostatodynia (PD) is a kind of syndrome by many causes and many patients with PD Are refractory to treatments of prostatitis. Considering a large part of complaints of PD patients are involving voiding symptoms, screening for voiding difficulty in patients with PD using uroflowmetry can be useful for selecting the following diagnostic method and choice of treatment. But characteristics of uroflowmetries in PD patients are not clarified. In this study, we analyzed data and types of curves from uroflowmetries in patients with PD to clarify and evaluate the characteristics of their voiding patterns. MATERIALS AND METHODS: Patients (n=48) and 11 healthy men under age 40 were selected. All the patients and controls underwent uroflowmetries. According to 5 types of uroflow curves by Jphirgensen et at, all the uroflow curves were classified, and maximum flow rate (Qmax; ml/sec) and average flow rate (Qave; ml/sec) were compared. RESULTS: Qmax (15.9 ml/sec) and Qave (9.0 ml/sec) in PD patients were all lower than those (24.5 ml/sec, 15.5 ml/sec) in controls (p<0.001, <0.001). By the classification of uroflow curves, uroflow curves of controls were all type 1. In PD patients, 12 (25%) were type 1, 6 (12.5%) were type 2, 13 (27.1%) were type 3, 17 (35.4%) were type 5, and none of them was type 4. Comparing RESULTS of each type PD patients with those of controls shows that there was no statistically significant difference between type 1 PD patients and controls, while Qmax and Qave of type 2, type 3, and type 5 PD patients were all lower than those of controls (statistically significant). Qmax and Qave were the lowest in type 5 (12.0 ml/sec, 7.2 ml/sec). CONCLUSION: From the RESULTS of our investigations, we suggest that a large part of PD patients have voiding problems and the uroflowmetry deserves to be a screening test for them. We think further studies are necessary to clarify the exact causes involving voiding symptoms in patients with PD.

Observation of the Therapeutic Effect of Pagosid on Prostatodynia / 中国药房

OBJECTIVE:To evaluate the therapeutic effect of pagosid on prostatodynia.METHODS:30patients with prostatodynia were evaluated;pagosid was taken orally1tablet t.i.d and NIH-CPSI was scored before treatment and q.w.4weeks after treatment.The results were evaluated.RESULTS:Effective rates from the first to the fourth week were16.7%,33.3%,40.0%,76.7%respectively.No obvious adverse reactions were found in the period of treatment.CONCLUSION:Pagosid has obvious effect on prostatodynia with pain as chief complaint,and few adverse reactions will develop.However it is slower to take effect,and therefore nonsteroid analgesic is recommended in the early stage of treatment.

Prostatodynia: Clinical and Urodynamic Characteristics / 대한비뇨기과학회지

Sixteen patients with prostatodynia underwent clinical studies including urodynamic study, MMPI, and endoscopy. As a control group, another 19 patients with nonbacterial prostatitis and 16 normal man of 20-40 years of age also underwent urodynamic study. The most characteristic urodynamic findings in patients with prostatodynia was a significant increase in maximum urethral closing pressure as compared to control group (mean, 140.9 : 92.1 : 84.1 cmH20). In prostatodynia group, peak urinary flow rate was also significantly decreased as compared to the control group (mean, 12.0: 17.8 : 23.9cc / sec). 11 of 16 patients with prostatodynia was found to have functional outlet obstruction, probably at sympathetically innervated urethral sphincter. And they were treated with minipress and diazepam, of whom 7 showed significant improvement both symptomatically and urodynamically. On MMPI 7patients with prostatodynia showed significant underlying psychiatric disorders, and were treated by psychiatric treatment, of whom 4 showed significant clinical improvement. 2 patients with prostatodynia showed vermontanal pseudopolyp suggestive of prostatitis, were treated with long term TMF-SMX administration, and showed significant improvement. It is suggested that prostatodynia may develop from urethral sphincter overactivity and underlying psychiatric disorders, and that at least some cases with prostatodynia are in fact prostatitis. Uroflowmetry, urethral pressure profile, MMPI study and repeated EPS study may be of help in deciding the treatment plan of prostatodynia.

The Effectiveness of Phenoxybenzamine on Prostatodynia / 대한비뇨기과학회지

Sixteen prostatodynia cases entered the study on a trial of phenoxybenzamine (PBZ). We administered the PBZ with daily 10 mg dosage for 5 days (l st 5-day-course) to 16 cases, and then re-administered the PBZ (2nd 5-day-course) to the clinically recurred 5 cases. We obtained the following results. 1. After 1 st 5-day-course of PBZ, 7 cases of the 16 cases produced improvements on prostatic symptoms and urine flow rate, but recurrence was appeared in 5 cases of these 7 cases after 1-3 months of 1st 5-day-courSe of PBZ. 2. After 2nd 5-day-course of PBZ, 2 cases of these recurred 5 cases produced improvements on prostatic symptoms and urine flow rate. 3. 2 cases after 1st 5-day-course and 2 cases after 2nd 5-day-course produced improvements for about 1 year after 1 year after PBZ administration. Conclusively, 4 cases of the 16 cases (25%) produced improvements. >From the above data, we thought that PBZ trial to prostatodynia has a relatively considerable value.