Potassium Chloride Sensitivity Test and CPPS

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I completely disagree with the conclusion of this article. I find the explanation given by the study authors plausible, and I see no basis for Hanno's supposition that IC and CPPS have completely different "pathophysiology". Unfortunately, this has become a political and funding issue, with many researchers having vested interests in keeping IC/PBS and CP/CPPS apart.

Editorial - The Significance of Potassium Chloride Sensitivity Test and Urinary Uronic Acid Level in the Diagnosis of Chronic Pelvic Pain Syndrome

Written by Philip M. Hanno, MD
Monday, 16 March 2009
BERKELEY, CA (UroToday.com) -


Pain on Micturition After Potassium Chloride Bladder Instillation Found In Chronic Pelvic Pain Syndrome Category 3-B

Noninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. Dr. Bilal Alp and colleagues from Erzurum, Turkey evaluated the significance of potassium chloride sensitivity testing and urinary CTAB-precipitable urinate levels in patients with interstitial cystitis and nonbacterial prostatitis (CP). They compared 25 patients with IC and 30 patients with CP to 35 healthy controls. The authors’ goal was to evaluate the efficacy of potassium chloride sensitivity test and urinary CTAB-precipitable urinate level in these disorders, the interrelation between the 2 tests, and possible benefits of these tests in addition to urodynamics and cystoscopy in the evaluation of pelvic pain.

In patients with IC, visual analogue scores in KCl filling test were significantly higher than NaCl filling as might be expected. The difference in filling scores in patients with CP was not statistically significant. In CP patients, pain scores were significantly higher during voiding than filling with both saline and potassium solutions, though with potassium the pain scores were of a much higher magnitude.

In both IC and CP groups, urinary CT-precipitable urinate level was found to be significantly higher than controls and was higher in patients with IC than that of patients with CP. When all patients with chronic pelvic pain were considered, there was a direct relationship between the urinary CTAB-precipitable urinate level and pain scores at first referral and during KCl and NaCl tests. This relationship was statistically significant. However, the authors failed to show this relationship when IC and CP groups were evaluated separately.

The authors conclude that using the potassium test as a voiding sensitivity test rather than a filling sensitivity test for CP reveals increased pain on urination when compared with NaCl and KCl filling tests. They surmise that a loss of mucosal barrier in CP might be in a more distal part of the vesicourethral unit than the bladder urothelial deficit seen in IC.

Whether or not any of these test makes sense for diagnosis of IC or CP is for the reader to decide after looking at the data presented. This reader found the information interesting in that it seems to show that IC and CP are indeed different disorders based upon the findings presented, and probably not a manifestation of the same pathophysiology.

Alp BF, Akyol I, Adayener C, Senkul T, Gultepe M, Baykal K, Iseri C

Int Urol Nephrol. 2008 Sep 16. Epub ahead of print.
10.1007/s11255-008-9463-3

PubMed Abstract
PMID: 18792800

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