A A Ghobish1. 1. Suez Canal University Faculty of Medicine, Ismailia, Egypt.
Abstract
OBJECTIVES: Prostatodynia (type III-B according to the classification of the National Institute of Diabetes and Digestive and Kidney Diseases) represents a major part of all chronic prostatitis syndromes. Uroflowmetry changes in these patients were rarely described, and discrepancies exist about the prevalence of urodynamic abnormalities. The aim of this study was to describe both qualitative and quantitative flowmetrogram characteristics in these patients. METHODS: Two hundred and thirty-eight flowmetrograms from patients diagnosed as having prostatodynia and 71 flowmetrograms from control males with matched age but without lower urinary tract problems were evaluated. Two to three flowmetric analyses were done for each individual, and the best one, i.e., representing the individual's voiding and no artefact (e.g., wag artefact), was chosen. A minimal voided volume of 150 ml was required to be included. Diagnosis of prostatodynia followed the routine criteria. For all patients the postvoiding residual urine was assessed by ultrasound (Bladder Scan). Qualitative study was done according to a classification using flow-time ratio (T(Qm)/T100x100) and flow ratio (Q(ave)/Q(max)x100) for continuous flow. Interrupted flow was classified separately. Descriptive statistical analysis was used. RESULTS: The age range was 18-49 (mean +/- SD, 34.2+/-7.8) years. The symptom duration ranged from 3 to 84 (16.5+/-27.7) months. Out of 238 patients 196 had uninterrupted flow. Thirty-six patients showed interrupted flow due to external sphincter contraction < or =2 s, and 6 patients showed interrupted flow with abdominal muscle straining. Out of the 196 patients, 73 showed Q(max) >15 ml/s, and 67 showed a voided volume <200 ml. For this group the Q(max) was 13. 3+/-5.3 ml/s, Q(ave) was 7.6+/-3.0 ml/s, and the mean postvoiding residual urine was 29.9 (range 0-234) ml. Type I flowmetry pattern was present in 39.7%, type II in 38.7%, type III in 5%, type IV in 16%, and type V in 0.5% of the patients with continuous flow (see Patients and Methods). The control group showed a Q(max) of 19.5+/-3. 8 ml/s, a Q(ave) of 11.1+/-2.6 ml/s, a voided volume of 311.9+/-106. 9 ml, and a postvoiding residual urine of 14.3+/-29.3 ml/s. Pattern I was seen in 89%, pattern II in 8%, and pattern IV in 3% of the controls. CONCLUSION: Most patients with prostatodynia had abnormal flowmetry parameters, and different patterns were shown, confirming that many have urinary flow disorders. Flowmetry should be part of the prostatodynia patient diagnostic workup, as this might add to the understanding of patient problems and may help in the selection of more appropriate methods in order to define the pathophysiologic basis of the symptoms and to perform treatment accordingly.
OBJECTIVES: Prostatodynia (type III-B according to the classification of the National Institute of Diabetes and Digestive and Kidney Diseases) represents a major part of all chronic prostatitis syndromes. Uroflowmetry changes in these patients were rarely described, and discrepancies exist about the prevalence of urodynamic abnormalities. The aim of this study was to describe both qualitative and quantitative flowmetrogram characteristics in these patients. METHODS: Two hundred and thirty-eight flowmetrograms from patients diagnosed as having prostatodynia and 71 flowmetrograms from control males with matched age but without lower urinary tract problems were evaluated. Two to three flowmetric analyses were done for each individual, and the best one, i.e., representing the individual's voiding and no artefact (e.g., wag artefact), was chosen. A minimal voided volume of 150 ml was required to be included. Diagnosis of prostatodynia followed the routine criteria. For all patients the postvoiding residual urine was assessed by ultrasound (Bladder Scan). Qualitative study was done according to a classification using flow-time ratio (T(Qm)/T100x100) and flow ratio (Q(ave)/Q(max)x100) for continuous flow. Interrupted flow was classified separately. Descriptive statistical analysis was used. RESULTS: The age range was 18-49 (mean +/- SD, 34.2+/-7.8) years. The symptom duration ranged from 3 to 84 (16.5+/-27.7) months. Out of 238 patients 196 had uninterrupted flow. Thirty-six patients showed interrupted flow due to external sphincter contraction < or =2 s, and 6 patients showed interrupted flow with abdominal muscle straining. Out of the 196 patients, 73 showed Q(max) >15 ml/s, and 67 showed a voided volume <200 ml. For this group the Q(max) was 13. 3+/-5.3 ml/s, Q(ave) was 7.6+/-3.0 ml/s, and the mean postvoiding residual urine was 29.9 (range 0-234) ml. Type I flowmetry pattern was present in 39.7%, type II in 38.7%, type III in 5%, type IV in 16%, and type V in 0.5% of the patients with continuous flow (see Patients and Methods). The control group showed a Q(max) of 19.5+/-3. 8 ml/s, a Q(ave) of 11.1+/-2.6 ml/s, a voided volume of 311.9+/-106. 9 ml, and a postvoiding residual urine of 14.3+/-29.3 ml/s. Pattern I was seen in 89%, pattern II in 8%, and pattern IV in 3% of the controls. CONCLUSION: Most patients with prostatodynia had abnormal flowmetry parameters, and different patterns were shown, confirming that many have urinary flow disorders. Flowmetry should be part of the prostatodynia patient diagnostic workup, as this might add to the understanding of patient problems and may help in the selection of more appropriate methods in order to define the pathophysiologic basis of the symptoms and to perform treatment accordingly.