Lower Urinary Dysfunctional Epithelium

This is a theory that ties chronic prostatitis or chronic pelvic pain syndrome to interstitial cystitis. The theory originates with C. Lowell Parsons, MD, of UC San Diego.

According to Parsons, most patients with bladder pain syndrome/interstitial cystitis (BPS/IC) have urinary epithelial dysfunction, as indicated by a positive intravesical potassium sensitivity test. In a 2002 study Parsons administered the potassium sensitivity test to men with CPPS and found that 84% had positive reactions, a rate almost identical to that reported in patients with interstitial cystitis, suggesting that prostatitis and bladder pain syndrome/interstitial cystitis (BPS/IC) may be a continuum of lower urinary epithelial dysfunction. Dr Parsons suggests reclassifying the prostatitis-bladder pain syndrome/interstitial cystitis (BPS/IC) disease process as Lower Urinary Dysfunctional Epithelium (LUDE).

Dr Parsons maintains that if caught early, good control of symptoms can be achieved with heparinoid therapy (eg. Elmiron). However, Elmiron was found to be no better than placebo in a major study.

The question remains, what makes the epithelium dysfunctional? One possible explanation is that constantly stimulated pelvic nerves, which are known to release pro-inflammatory neuropeptides at their endings, are causing the inflammation that makes the epithelium permeable (or “dysfunctional”).

Parsons remains a lone voice in this area, and one wonders if he is dealing with a cause of the condition or merely a symptom.