AUA 2017 Meeting, abstracts

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AUA 2017 Meeting, abstracts

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PD05-03
UTILITY OF TRIGGER POINT INJECTION AS AN ADJUNCT TO PHYSICAL THERAPY IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Anup Shah , Daniel Shoskes Cleveland, OH

INTRODUCTION AND OBJECTIVES
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is often associated with pelvic floor muscle spasm. While pelvic floor physical therapy (PT) is often effective, some men are unable to resolve their symptoms and have residual trigger points (TP). TP injection has been used for treatment in several neuromuscular pain syndromes. The objective of this study was to examine the efficacy and side effects of TP injection in men with CP/CPPS and pelvic floor spasm refractory to PT

METHODS
Using an IRB approved Men's Health Registry we reviewed the records of all men with a diagnosis of CP/CPPS who received at least 1 TP injection. Patients were phenotyped with UPOINT (all had the T domain for tenderness of muscle) and symptoms measured with the NIH Chronic Prostatitis Symptom Index (CPSI). Response was measured by a 5 point Global Response Assessment (GRA) and change in CPSI (paired t test). For pelvic TPs, a pudendal block was done in lithotomy position and then each TP was identified transrectally by palpation. A nerve block needle was passed through the perineum into the TP confirmed by palpation. Between 0.5-1 cc was injected into each TP of a local anesthetic mixture (30:70 of 2% lidocaine and 0.25% bupivacaine). For anterior TPs, an ultrasound guided ilioinguinal block was done first and then each TP injected by direct palpation through the abdominal skin. Men were offered up to 3 sets of injections separated by 6 weeks each.

RESULTS
We identified 37 patients who had a total of 68 procedures. 3 men had no followup after their first injection and were included for side effects but not for outcome. Indication was failure to progress on PT in 33, recurrent symptoms in 1 and refusal to do PT in 3. Mean age was 43.7 years (range 21-70) and median UPOINT domains was 3 (range 1-5). Initial total CPSI was 28.8+/-6.0. 16 men had 1 injection, 11 had 2 and 10 had 3. All had pelvic TPs injected and 9 also had anterior TPs. By GRA, 12 had significant improvement (35.3%), 10 had some improvement (29.4%), 11 had no change (32.3%) and 1 was worse (2.9%). Mean CPSI dropped from 28.7+/-6.1 to 21.8+/-7.2 (p<0.0001). 18 men had a drop of 6 or more points in CPSI (53%). Of note, none of 3 men who were noncompliant with PT had benefit. 3 men had temporary numbness in the lateral thigh after the injection (4.4%) and 1 had difficulty weight bearing on 1 leg for about 30 minutes.

CONCLUSIONS
TP injection in CP/CPPS patients as an adjunct to PT is well tolerated and leads to symptom improvement in about half, but is not a standalone cure. Durability and long term results are yet to be determined.

Source of Funding: None

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PD26-01
THE ASSOCIATION OF PTSD AND CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME IN YOUNG MALE VETERANS
Marah Hehemann , Michelle Van Kuiken Maywood, IL Bella Etingen , Frances M. Weaver Hines, IL Jeffrey Branch Maywood, IL

INTRODUCTION AND OBJECTIVES
Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are two times more likely to report mental health diagnoses such as anxiety and depression. Additionally, men reporting a history of sexual abuse are at increased risk for symptoms of CP/CPPS. Male veterans with mental health diagnoses are also at increased risk of lower urinary tract symptoms. We hypothesize that an association exists between CP/CPPS and post-traumatic stress disorder (PTSD) in young male veterans, and that these veterans may be more likely to report a history of sexual trauma or be subject to invasive urologic procedures.

METHODS
We reviewed VA administrative data from October 1, 2010 to September 30, 2015 for male veterans, ages 18-45 diagnosed with PTSD (ICD-9 code 309.81). Medical records were then examined for pelvic pain diagnoses including chronic pelvic pain (789.09; 338.29, 608.9, 625.5, 788.99, 788.99, 596.9, 599/599.8, 625.5), chronic prostatitis (601.0, 601.1, 601.9, 600.90-1, 600.0-1; 601.8, 602.8) and pain associated with voiding (788.1, 788.6). Veterans with diagnoses of spinal cord injury and neurogenic bladder were excluded. Records were examined for ICD-9 diagnoses of history of sexual trauma (general, military or any) and CPT codes for cystoscopic, urodynamic, bladder outlet and prostatic ultrasound procedures. Data were obtained for a preparatory-to-research pull.

RESULTS
Our initial database query yielded approximately 392,000 veterans with a diagnosis of PTSD and 1.3 million veterans without documented PTSD. Veterans with PTSD were more likely to have a diagnosis of CP/CPPS than their non-PTSD counterparts (18.5% vs. 8.7%, p<0.001). Veterans with PTSD were more likely to have a history of military sexual trauma (2.8% vs. 0.5%, p<0.001) or non-military sexual trauma (0.4% vs. <0.1%, p<0.001) compared to veterans without PTSD. Young veterans with PTSD were also more likely to have a cystoscopy (0.8% vs. 0.5%, p<0.001) and/or undergo urodynamics (1.0% vs. 0.5%, p<0.001) versus those without PTSD. Rates of transrectal ultrasound-guided prostate procedures and bladder outlet procedure were not significantly different between the two groups.

CONCLUSIONS
Young male veterans with PTSD are twice as likely to carry a diagnosis of CP/CPPS. Those with PTSD and CP/CPPS are six times more likely to report a history of sexual trauma and are twice as likely to undergo a certain urologic procedures. We recommend improved assessment for sexual trauma and consideration of referral to mental health providers by uroIogists treating young male veterans with CP/CPPS.

Source of Funding: None

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MP29-12
USE OF A BODY PAIN MAP TO CHARACTERIZE UROLOGIC CHRONIC PELVIC PAIN SYNDROME – A MAPP RESEARCH NETWORK STUDY
H. Henry Lai St Louis, MO Thomas Jemielita Philadelphia, PA Catherine S. Bradley Iowa City, IA Bruce Naliboff Los Angeles, CA Robert Gereau IV St Louis, MO David A. Williams Ann Arbor, MI Karl Kreder Iowa City, IA J. Quentin Clemens Ann Arbor, MI Larissa V. Rodriguez Los Angeles, CA John N. Krieger Seattle, WA John T. Supplierar , Nancy Robinson , J. Richard Landis Philadelphia, PA

INTRODUCTION AND OBJECTIVES
Patients with urologic chronic pelvic pain syndromes (UCPPS, interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome) suffer pelvic pain and pain in other body areas. The distribution of this pain in the body and its association with other factors has not been systematically studied. We characterized the location and distribution of pain among men and women with a body map and compared urinary symptoms, non-urological factors, and psychosocial measures between UCPPS patients who reported "pelvic pain only," "pelvic pain and beyond," and "widespread body pain."

METHODS
233 women and 191 men with UCPPS enrolled in a multi-center, one-year observational study completed a battery of measures at study entry, including a body map to report the location and distribution of their pain during the past week. Participants were categorized as having "pelvic pain only" if they reported pain in the abdomen and pelvis only, or "pelvic pain and beyond" if they reported pain outside the abdomen and pelvis. Those who reported "pelvic pain and beyond" were sub-grouped into the numbers of broader body regions affected by pain (1-2 regions versus 3-7 regions or "widespread body pain").

RESULTS
25% reported pelvic pain only. 38% reported widespread body pain outside the abdomen and pelvis. As we moved from 0 region ("pelvic pain only") to 1-2 regions to =3 body regions outside the abdomen/pelvis ("widespread body pain"), there is an increase in non-urologic pain (p<0.0001), more sleep disturbance (PROMIS, p=0.035), worse quality of life (SF-12 physical component: p=0.021; SF-12 mental component: p=0.001), more depression (HADS-D, p=0.005), higher anxiety (HADS-A, p=0.011), higher psychological stress (PSS, p=0.005), and higher negative affect scores (PANAS, p=0.0004), using Jonchkheere's trend test to test for 3-group gradient. Women (but not in men) with widespread pain also reported more fatigue (PROMIS, p<0.0001) than those with pelvic pain only. For both men and women, there was no difference between the three groups in terms of their urinary symptoms (e.g., severity of pelvic pain, urinary frequency, urgency ratings, Interstitial Cystitis Symptom and Problem Indexes, Genitourinary Pain Index, pain composite score, and urinary composite score).

CONCLUSIONS
Among MAPP participants, three out of four men and women with urologic chronic pelvic pain syndromes (UCPPS) also report pain outside the abdomen and pelvis. Widespread body pain was associated with worse quality of life and psychosocial impacts but not worse urinary symptoms.

Source of Funding: NIH/NIDDK MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Research Network

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PD05-07
ROLE OF PDE-5 INHIBITOR IN THE TREATMENT OF CHRONIC PELVIC PAIN SYNDROME: A RANDOMIZED CONTROL TRIAL
Prabhjot Singh , Abhishek Shukla , Prem Nath Dogra New Delhi, India

INTRODUCTION AND OBJECTIVES
Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is a common urological problem of young males. Alpha blockers, antibiotics and analgesics are commonly used drugs for CP/CPPS but there are no treatment guidelines available. We evaluated the effectiveness of PDE5-inhibitors in CP/CPPS.

METHODS
Total of 68 patients were randomized into two groups. Group A (n=32) received alfuzosin and levofloxacin (standard treatment) whereas group B (n= 36) received tadalafil 5mg (PDE 5 inhibitor) in addition to alfuzosin and levofloxacin for 6weeks.The groups were analyzed pre and post treatment with National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score(IPSS), scores and uroflowmetry.

RESULTS
Changes observed in the NIH-CPSI of group B at six weeks were greater than those at baseline (group A, -8.4 vs. group B, -18.0; p<0.05). The mean change in total IPSS from baseline was higher in group B than that in group A (group A, -3.4 vs. group B, -8.8; p <0.05). Change in IPSS-QOL index from baseline was significant in Group B (group A, -0.63 vs. group B,-2.03 ; p<0.05). Group B showed a significantly greater increase in the IIEF-EF score than group A (group A -0.7 vs. group B +6.4; p<0.05). Qmax pre and post therapy showed significant improvement in group B when adjusted for age (group A, -2.9 vs group B, +2.56; p<0.05).

CONCLUSIONS
PDE-5 inhibitor results in significant improvement in CP/CPPS symptoms and quality of life and is well tolerated.

Source of Funding: NONE

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MP86-08
USE OF A MOBILE APP FOR ECOLOGICAL MOMENTARY ASSESSMENT OF PAIN AND OTHER SYMPTOMS IN PATIENTS WITH UROLOGIC CHRONIC PELVIC PAIN SYNDROME
James Griffith Chicago, IL Ted Herman , Anthony Andrys Iowa City, IA Michael Bass , Bayley Taple , Brett Lloyd Chicago, IL Bradley Erickson Iowa City, IA

INTRODUCTION AND OBJECTIVES
Pain in patients with chronic pelvic pain varies widely by location, intensity, severity and by its intermittency. Static assessment of pain does not allow for a comprehensive description of this inherent heterogeneity of pain, potentially obscuring phenotypic differences in UCPPS patients that could help predict treatment response and disease course. Ecological Momentary Assessment (EMA) of pain is a way to describe pain more comprehensively. Mobile apps can communicate directly with patients at all times of the day in most locations and are thus, perfectly suited to collect EMA pain data. For the Multidisciplinary Approach to Pelvic Pain (MAPP) Research Network, we developed a mobile app to capture pain and associated symptoms in a time-efficient manner. We present the results from the app beta testing herein. We hypothesized that participants would find the app easy to use and that utilization of the app would reveal significant daily pain variability.

METHODS
A total of 22 participants completed beta testing for 14 days, locating and rating their pain and other symptoms. Mobile phone notifications that linked to and opened the app were sent at wake up, 4 and 8 hours after wake-up and bedtime. On Day 15 participants completed the NASA task load index to assess app usability and satisfaction. Participants then completed a qualitative exit interview to give us feedback on all aspects of the app and testing. Thus, we obtained both quantitative and qualitative information during the beta-testing period.

RESULTS
We created a summary score for pain using the maximum pain rating across different areas of the body at a particular time. Using a linear model with time of day, nested with testing day, we found that pain varied significantly during the day, F (37, 257) = 1.75, p = .007. Qualitative interviews and App ratings (see figure) suggested that the app was simple and easy to use (e.g. low mental demand, high app compliance)

CONCLUSIONS
Our quantitative and qualitative results show that our app is easy to use for participants and is able to capture intra-day variability in pain across multiple areas of the body. Moreover, our participants indicated that they would be willing to use this app going forward both for research and clinical/treatment purposes. Mobile apps appear to be well-suited to study chronic urologic conditions. Utilization of the app for EPA testing is currently underway within the MAPP Research Network.

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PD05-08
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION FOR TREATMENT OF REFRACTORY CHRONIC PELVIC PAIN SYNDROME IN MEN: A PROSPECTIVE STUDY.
Yassine EL Abiad Meknes, Morocco

INTRODUCTION AND OBJECTIVES
Chronic pelvic pain syndrome (CPPS) presents a therapeutic challenge since 20–65% of all CPPS patients are refractory to conventional therapies. Transcutaneous electrical nerve stimulation (TENS) is an established treatment for chronic musculoskeletal pain and may also be a valuable option in pelvic pain. The aim of this study is to evaluate the effect of TENS for treating men with refractory CPPS

METHODS
A consecutive series of 42 men treated with TENS for refractory CPPS was evaluated prospectively at 2 academic tertiary referral centers. The effects of treatment were evaluated using the National Institutes of Health Chronic Prostatitis Symptom Index (0-43) at baseline and after 12 weeks of TENS treatment. Subjective (need to continue treatment to sustain the effect) and objective (improvement of NIH-CPSI Index > 50%) responses were assessed after 12 weeks of treatment. Adverse events related to TENS were also assessed.

RESULTS
After 12 weeks of treatment, a subjective response was obtained in 27 (62%) patients and an objective one in 14 (33%) patients. 08 patients showed a final score < 10. Quality of life (QoL) and urinary symptoms also improved significantly in those patients (p<0.001; 95%, CI). No adverse events related to TENS were noted.

CONCLUSIONS
TENS may be an effective and safe treatment for refractory CPPS in men, warranting randomized, placebo-controlled trials.

Source of Funding: none
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johnnyblotter
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Re: AUA 2017 Meeting, abstracts

Post by johnnyblotter »

Great stuff. Thanks for posting this.
tryin to get through
Age: 41| Onset Age: 30 | Symptoms: rectal discomfort | Helped By:yoga ball | Worsened By: spicy food/poor diet| Other comments:i seem to have recurring episodes of this yearly
WS1234
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AUA 2017 abstracts

Post by WS1234 »

Webslave, I have a copy of the abstract summary of CPPS related studies that were presented at AuA 2017. Just emailed you at the webmaster address.
Age: 32 | Onset Age: 29 | Symptoms: Urethral Pain/Irritation | Helped By: | Worsened By: | Other comments:
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Re: AUA 2017 abstracts

Post by webslave »

Thanks, document received. There are reasons I have not included some of the papers you mention.

The paper Bacteria from Chronic Prostatitis Patients Produce Pelvic Pain in Mice has now been published here. I don't highlight this study because the same team from that university has been following their speculative bacterial line of reasoning for a long time, with no result. Experimental prostatitis in rats actually has nothing to do with CPPS. The connection is speculative, theoretical, and based on thin evidence. They talk about a new potential therapeutic role for commensal S. epidermidis NPI lipoteichoic acid in the treatment of prostatitis-associated pain. If and when they show that this helps humans, I'll be interested. But I'm not holding my breath, IOW I doubt very much this leads to anything. Until then, it simply unnecessarily worries our members and republishing it on the forum serves no good purpose.

The paper Reassesment Of Non-Traditional Uropathogens In CPPS is once again from the same source as the above, also very speculative, and IMO they are chasing a rabbit down a hole here. I generally avoid telling members about these spitballing exercises because they don't help anyone, in fact the opposite.

The paper Next-Generation Sequencing of Chronic Prostatitis: Preliminary Results is by yet another graduate of the same school (Northwestern University). It's also an absurd paper. Just because trace amounts of potentially pathogenic bacteria can be found (using exquisitely sensitive techniques) does not denote infection. Infection depends on numbers of bacteria, colony counts. Every pathologist knows that. It seems to be big news to some uros that tiny numbers of all sorts of bacteria can be found in hundreds of locations in the body ... but this does not mean there is a problem.

The above papers represent the last refuge of the bacterial infection theorists ... and they all come from one university. I'll start paying attention when they come up with something, anything, that helps our members. Until then, they are part of the problem, not the solution.

The SFPN paper concerns the female form of CPP (not CPPS) that's associated with endometriosis. It's not appropriate for our forum, although there may be a connection.

The paper Expression Of Inflammatory Mediators In Sensory Ganglia Innervating Lower Urinary Tract And Dysfunctional Voiding, while useful and illuminating, and in line with the discussions on this forum, is quite technical and based on rodent studies. I try to avoid re-publishing over-technical murine stuff unless it's a key paper.

The paper The Evolving Clinical Picture Of CPPS is a pointless discussion.

The paper Physical Therapy For Orchalgia I missed. Thanks for this. It's useful.

The Deprox 500 study I ignored because the product is not widely available and it is compared to Saw Palmetto, which we know is ineffective.

The rest of the papers are covered above, I believe.
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Re: AUA 2017 Meeting, abstracts

Post by WS1234 »

Webslave, appreciate that response. I responded to those abstracts exactly as you worried, so I understand your reasoning in excluding them. Has caused a huge flare up, of course.
Age: 32 | Onset Age: 29 | Symptoms: Urethral Pain/Irritation | Helped By: | Worsened By: | Other comments:
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