WHAT HAPPENS IN PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME WHO HAD BEEN LOST TO FOLLOW UP?
Taiwan
INTRODUCTION AND OBJECTIVES
Interstitial cystitis and bladder pain syndrome (IC/BPS) is considered as a chronic diseases which is difficult to cure. However, patients with IC/BPS also might be free of symptoms at long-term follow up. The objective of study is to investigate the long-term symptoms changes in IC/BPS patients with various treatments, especially in the patients who were lost to follow up.
METHODS
IC/BPS patients with history for more than 5 years and comprehensive baseline medical records in our hospital were enrolled into this study. A telephone interview was used to assess current IC/BPS symptoms. Questionnaires for IC/BPS, including Interstitial Cystitis Symptoms and Problem Index (ICSI and ICPI), O′Leary-Sant symptom score (OSS), and Visual Analogue Scale for pain (VAS), were complete during the interview. A 5-point scale (from -1 to 3) was also used to grade current treatment outcome (symptoms change from baseline, -1: worse, 0: 0-25% improved, 1: 25-50% improved, 2: 50% improved, 3: symptom free).
RESULTS
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CONCLUSIONS
At long-term follow up, most IC/BPS patients experienced symptoms improvement. Patient who had been lost to follow up also might have great improvement to IC/BPS symptoms. IC/BPS was possible to cure and sometimes may spontaneous remission
CASE SERIES OF LOW INTENSITY SHOCK WAVE THERAPY FOR MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Daniel Shoskes, Brandon Mooney
Cleveland, OH
INTRODUCTION AND OBJECTIVES
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a heterogeneous syndrome that is often challenging to treat. Low Intensity Shock Wave (LiSW) has emerged as a potential therapy and several sham controlled studies have shown efficacy. We wished to study the efficacy and safety of LiSW in CP/CPPS patients with clinical phenotyping to better understand who may best respond.
METHODS
Men were enrolled in this IRB approved study provided they had a diagnosis of CP/CPPS for at least 6 months and were able to return for weekly treatments. Those on multi-modal therapy continued other therapies as long as the dose was stable. LiSW was delivered with the Urogold 100 machine (Tissue Regeneration Technologies, Woodstock, GA) using the standard probe. There were 4 treatment sites, 2 on each side of the perineum at 500 shocks each for a total of 2000 shocks. Symptom severity was measured with the National Institute of Health Chronic Prostatitis Symptom Index (CPSI) at baseline and 1 month following the last treatment. Patients also self reported a General Response Assessment (GRA) ranging from 1 (significantly improved) to 5 (significantly worse). Patients were clinically phenotyped by the UPOINT system. Pre and post values were compared with the paired t test with significance set at p<0.05.
RESULTS
14 men enrolled with a mean age of 45.1 years (range 22-67) and median duration of 36 months (range 9-240). Men had a mean of 2.6 positive UPOINT domains (range 1-5) and all but 2 had pelvic floor tenderness (domain ″T″). Total CPSI improved from 27.7 +/- 5.4 to 19.4 +/- 7.5 (p=0.003). While the pain and quality of life scores improved significantly, there was no change in the urinary subscore. 9 patients (64.3%) had a >6 point drop in CPSI. By GRA, 7 patients said they were significantly improved, 2 was somewhat improved and 5 were unchanged. There were no significant differences in responders to non-responders for phenotype or symptom duration although responders had a higher starting pain score (14.0 vs 9.4, p=0.005) and both patients without pelvic floor spasm failed to improve.
CONCLUSIONS
LiSW with the Urogold 100 improved symptoms of CP/CPPS in the majority of patients. All responders had pelvic floor spasm, and shock wave therapy is well established in the treatment of pain from trigger points. While small numbers preclude meaningful subgroup analysis, there was no impact on urinary symptoms. In conclusion, once weekly low intensity shock wave lithotripsy improved the symptoms of CP/CPPS in the majority of patients without side effects.
PHYSICAL THERAPY FOR ORCHIALGIA (chronic testicle pain) EFFECTIVE IN PREVIOUSLY TREATED PATIENTS
Virginia Beach, VA
INTRODUCTION AND OBJECTIVES
Orchialgia and pelvic pain are challenging conditions to treat in urologic practice. Recent research and treatment programs have begun to focus on musculoskeletal dysfunction as a major contributor to pelvic pain and orchialgia. The objective of this study is to assess the clinically reported outcomes of patients who had past treatments for orchialgia and subsequently underwent physical therapy.
METHODS
A retrospective chart review was conducted on men who initially presented to our practice with orchialgia from January 2009 to June 2016 and referred for pelvic floor physical therapy. Each patient had a urologic assessment prior to physical therapy referral. Patients were evaluated and treated by our physical therapy team according to any presenting musculoskeletal impairments. Past treatments for orchialgia were assessed and NIH Chronic Prostatitis Symptom Index (NIH-CPSI) data was collected following pelvic floor physical therapy (PFPT).
RESULTS
A total of 392 patient charts were reviewed and 150 patients (38%) completed a NIH-CPSI questionnaire both pre and post treatment. One hundred and eight patients of these 150 patients (72%) had previous treatment for orchialgia. Average age was 44.6 years. Table 1 shows the number of patients previously treated with non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, surgery, nerve block, previous PFPT, and narcotics. Combination of these treatments was included. Previous surgeries were as follows: spermatocelectomy (1), hydrocelectomy (1), spermatic cord cyst removal (1), hernia repair (3), orchiopexy (2), vasectomy (2), varicocelectomy (5), spermatic cord stripping (1). Changes in pre and post NIH-CPSI pain, urinary and quality of life (QOL) categories are also shown in Table 1. Improvement was seen in NIH-CPSI pain and QOL categories for all patients who had previous treatment for orchialgia.
CONCLUSIONS
Physical therapy serves as a valid and effective treatment option for patients with orchialgia who have had previous medical and surgical interventions.
TRIGGER POINT DRY NEEDLING AS A TREATMENT FOR ORCHIALGIA
Virginia Beach, VA
INTRODUCTION AND OBJECTIVES
Orchialgia is a challenging condition to treat. Physical Therapy (PT) has been shown to be an effective treatment for orchialgia. We performed this study to assess outcomes in patients with orchialgia treated with pelvic floor trigger point dry needling (DN).
METHODS
A retrospective chart review of men who presented with orchialgia and treated with PT from January 2009 to June 2016 was performed. Treatment included pelvic alignment exercises, therapeutic stretching/strengthening, manual therapy modalities, dry needling and EMG biofeedback. Patients receiving DN as a part of multi-modal therapy were selected. Subjective global response was assessed based on patient self-reported improvement. NIH Chronic Prostatitis Symptom Index (NIH-CPSI) data was collected. Statistical analysis was performed where all p-values less than 0.05 were considered statistically significant.
RESULTS
Fifty-two out of 392 patients underwent DN as a component physical therapy and were included in this subset analysis. Average treatment duration was 6.4 months. 85% of patients indicated their orchialgia was better, 15% reported no improvement. Average number of DN treatments was 4.6 for those who improved; 6.5 for those who did not improve. All patients had both pre and post treatment NIH-CPSI data. There was no difference in pre treatment pain and urinary scores between the group that improved compared to the group with no improvement (p=0.32 and 0.25, respectively). Patients with no improvement had worse pre treatment quality of life (QOL) scores (p=0.016). NIH-CPSI pain scores decreased from 17.3 to 11.5 and QOL scores decreased from 8.8 to 5.2 in those who improved. Improvement in pain and QOL scores was demonstrated in those who underwent dry needling as a part of their treatment compared to those with no improvement (p=0.0009 and p=0.0003, respectively). Urinary scores were not improved (p=0.689). When comparing patients who underwent DN compared to those who did not have DN as a part of therapy, there was no significant improvement in NIH-CPSI pain/urinary/QOL scores (p>0.05 for each).
CONCLUSIONS
DN is an effective treatment for orchialgia and should be a part of multi-modal PT.
GENITAL PAIN IN UROLOGIC CHRONIC PELVIC PAIN SYNDROMES (UCPPS) – A MAPP RESEARCH NETWORK STUDY
Philadelphia, PA
INTRODUCTION AND OBJECTIVES
We used a genital pain map to characterize the location and distribution of genital pain among men and women with urologic chronic pelvic pain syndromes (UCPPS). We then compared the severity of pelvic pain, non-pelvic pain, psychosocial health and overall health among UCPPS patients with different genital pain patterns.
METHODS
233 women and 191 men with UCPPS enrolled in a multi-center, one-year observational study completed a battery of baseline measures, including a genital map describing the location of genital pain during the previous week. Female participants could report pain in any of four areas: labia, urethra, vagina or perineum. Male participants could report pain in any of four areas: glans of penis, shaft of penis, scrotum or perineum. Participants were categorized into three groups: those reporting no genital pain (0 of 4 genital areas), an intermediate group (1-2 genital areas), and a widespread genital pain group (3-4 genital areas).
RESULTS
Of the 424 UCPPS participants: 13% reported no genital pain, 68% reported intermediate pain, and 19% reported widespread genital pain. In both women and men, when the number of genital pain sites increased (from no genital pain to intermediate to widespread genital pain), participants reported greater intensity of pelvic and non-pelvic pain, were more likely to have chronic overlapping pain conditions (chronic fatigue syndrome in women, fibromyalgia and migraine headache in men), had poorer psychosocial health (higher perceived stress, depression, anxiety, pain catastrophizing, somatic symptoms, and fatigue), and worse overall health (SF-12 physical and mental health), see Table.
CONCLUSIONS
One out of five men and women with UCPPS reported widespread genital pain. These patients had more intense pelvic and non-pelvic pain, and poorer psychosocial and overall health, suggesting that widespread genital pain may be associated with central nervous system sensitization.
