What's new in urology.

Abstract

INFECTIOUS DISEASE AND CHRONIC PELVIC PAIN SYNDROME Interstitial cystitis, urethral syndrome, chronic pelvic pain syndrome, nonbacterial prostatitis, prostatodynia, and postejaculatory pain might all be different presentations of a single disease. The prevalence of these disease entities has an impact on the physician not only in the direct treatment of the diseases, but also in their relationship to other issues. A major issue for the urologist is the patient with the rising or elevated PSA, negative biopsies, and findings or symptoms compatible with prostatitis or chronic pelvic pain syndrome. A multicenter study was convened to determine if PSA or percent free PSA could be used as a marker for chronic pelvic pain syndrome or prostatitis. Another issue is whether PSA and percent free PSA values will be in the range associated with prostate cancer. In a study examining 424 patients with chronic prostatitis, etc, PSA values were compared with those from 114 age-matched asymptomatic controls. Findings showed total PSA in general was slightly higher in patients with chronic pelvic pain syndrome or prostatitis than in controls. But this slight elevation in level was not clinically significant, and although percent free PSA levels correlated with inflammation, the negative association was weak and not clinically significant. So the recommendation of the study was that male patients with chronic pelvic pain syndrome, etc, and abnormal PSA values should be evaluated for prostate cancer in accordance with current standard protocols. A study from France sought to determine the overlap between chronic pelvic pain syndrome and interstitial cystitis. Interstitial cystitis, per se, is poorly understood and is thought to predominate in women. It was noticed that a large percentage of men, when cystoscoped for their symptoms of nonbacterial prostatitis and prostatodynia, often have the cystoscopic appearance of interstitial cystitis by NIH-NIDDK criteria. This obviously raises the possibility that, in men, interstitial cystitis masquerades as nonbacterial prostatitis/prostatodynia or chronic pelvic pain syndrome. In this study, 300 men were identified who were diagnosed with chronic pelvic pain syndrome and were examined with cystoscopy and hydrodistension; 80% were found to have glomerulations that were believed to confirm the diagnosis of interstitial cystitis. Additionally, levels of nerve growth factors, tryptase, heparinbinding epidermal growth factor, and epidermal growth factor were evaluated in postprostatic massage urine and compared with these levels in controls. In these symptomatic young men, levels of nerve growth factor and tryptase were significantly elevated in those patients versus controls; heparin-binding epidermal growth factor levels were lower. All of these findings were statistically highly significant, raising the possibility that nerve growth factor, heparin-binding epidermal growth factor, and tryptase could serve as new markers for the evaluation of such patients. At the University of Pittsburgh, interesting research seeks to determine if gene therapy could be potentially useful for the treatment of interstitial cystitis patients. The investigators proposed that targeted and localized expression of endogenous opioid peptide in the bladder could be useful in treating bladder pain associated with interstitial cystitis. In one report from that institution, they described a gene gun method for the transfer of precursor molecules of endogenous opioid peptide in vivo and sought to investigate its therapeutic effect in rats using an acetic acid-induced bladder hyperactivity model. They found that, indeed, the proopiomelanocortin gene can be transferred to the bladder of these rats using the gene gun and the increased secretion of endorphin seemed to suppress bladder pain in the model. In a second study, they investigated the effects of enkephalin gene therapy using a replication deficient herpes simReceived June 11, 2003, Accepted June 12, 2003. From the Department of Urology, Eastern Virginia Medical School, Norfolk, VA. Correspondence address: Gerald H Jordan, MD, FACS, FAAP, Suite 100, 400 W Brambleton Ave, Norfolk, VA 23510.