- Email: [email protected]
chronic pelvic pain syndrome
REFERENCES 1. Tsivian A, and Sidi AA: Port site metastases in urological laparoscopic surgery. J Urol 169: 1213–1218, 2003. 2. Pautler SE, Harrington FS, McWilliams GW, et al: A novel laparoscopic specimen entrapment device to facilitate morcellation of large renal tumors. Urology 59: 591–593, 2002. 3. User HM, and Nadler RB: Novel technique of renal entrapment for morcellation. J Urol 169: 2287–2288, 2003.
Yoshihiko Wakabayashi, M.D. Department of Urology Shiga University of Medical Science Otsu, Shiga, Japan
protection program that decreases trauma to the pudendal nerve. Later, perineural injections of bupivacaine and corticosteroids are used.8 When indicated, decompression surgery of the pudendal nerve is performed via a transgluteal approach. Typical of tunnel syndromes, treatments progress only as necessary and each can be successful. In a presentation to the 2002 North Central Section of the American Urological Association, “self-care”9 was demonstrated to produce results similar to those noted by the authors of the present paper. It is encouraging to see the authors presenting a paradigm shift to a neuropathic basis for the CP/CPPS. As Zermann et al.10 have noted, “. . . by far the majority of lower urinary tract symptoms-overcontinence and pelvic pain syndromes remain unexplained by existing theories.”
doi:10.1016/S0090-4295(03)00697-6
Acupuncture Ameliorates Symptoms in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome TO THE EDITOR:
The encouraging article by Chen and Nickel,1 which demonstrates neuromodulation producing relief of the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), parallels our experience with pudendal nerve protection. The authors suggest that the “end stage of CP/CPPS may be a neuropathic pain syndrome.” However the symptoms may not be the “end stage,” but may represent the “disease entity” itself. Successful symptomatic neuromodulation of irritable bladder has been demonstrated by posterior tibial nerve stimulation (acupuncture)2 and sacral nerve root stimulation. Robert et al.,3 Shafik,4 Ricchiutu et al.,5 Amarenco et al.,6 Tetzschner et al.,7 and other authors describe pudendal neuralgia/entrapment/compression. Pudendal neuropathy can be measured using neurophysiologic tests.3,5–7 In observations of more than 400 patients meeting criteria of CP/CPPS, the patients also meet the definition of Robert et al.,3 suggesting that “prostatitis-like” pains represent pudendal neuralgia. The pains may be accompanied by voiding, erectile, ejaculatory and rectal dysfunction. Sensory examinations of the pudendal distribution, pudendal nerve terminal motor latency testing, and electromyogram (EMG) of the bulbocavernosus and ischiocavernosus muscles corroborate the neuropathic basis of the symptoms. Similar to the authors’ experience, patients treated with self-care demonstrated significant relief of pain and voiding symptoms, and improvement in quality of life as measured by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Self-care is a perineal
212
REFERENCES 1. Chen R, and Nickel JC: Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 61: 1156 –1159, 2003. 2. Van Balken MR, Vandoninck V, Gisolf WH, et al: Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166: 914 –918, 2001. 3. Robert R, Prat-Pradat D, Labat JJ, et al: Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20: 93–98, 1998. 4. Shafik A: Pudendal canal syndrome: a new etiological factor in prostadynia and its treatment by pudendal canal [de]compression. Pain Digest 8: 32–36, 1998. 5. Ricchiutu VS, Haas CA, Seftel AD, et al: Pudendal nerve injury associated with avid bicycling. J Urol 162: 2099 –2100, 2000. 6. Amarenco G, Kerdraon J, Bouju P, et al: Efficacy and safety of different treatments of perineal neuralgia due to compression of the pudendal nerve within the ischio-rectal fossa or by ischiatic spine. Rev Neurol 153: 331–334, 1997. 7. Tetzschner T, Sorensen M, Lose G, et al: Pudendal nerve function during and after delivery. Int Urogynecol J Pelvic Floor Dysfunct 8: 66 –68, 1997. 8. Bensignor MF, Labat JJ, Robert R, et al: Diagnostic and therapeutic nerve blocks for patients with perineal non-malignant pain (abstract). Eighth World Congress on Pain, 1996, p 56. 9. Antolak SJ: Perineal hyperprotection: II. Improvement in NIH chronic prostatitis symptom index voiding domain using a self-care, noninvasive treatment. Presented at the North Central Section of the American Urological Association, April 2002. 10. Zermann DH, Ishagooka M, and Schmidt RA: Pathophysiology of the hypertonic sphincter, in Corcos J (Ed): The Urinary Sphincter. Marcel Dekker, New York, 2001, p 218.
Stanley J. Antolak, Jr, M.D. Woodbury, Minnesota doi:10.1016/j.urology.2003.09.037
UROLOGY 63 (1), 2004
Yoshihiko Wakabayashi, M.D. Department of Urology Shiga University of Medical Science Otsu, Shiga, Japan
protection program that decreases trauma to the pudendal nerve. Later, perineural injections of bupivacaine and corticosteroids are used.8 When indicated, decompression surgery of the pudendal nerve is performed via a transgluteal approach. Typical of tunnel syndromes, treatments progress only as necessary and each can be successful. In a presentation to the 2002 North Central Section of the American Urological Association, “self-care”9 was demonstrated to produce results similar to those noted by the authors of the present paper. It is encouraging to see the authors presenting a paradigm shift to a neuropathic basis for the CP/CPPS. As Zermann et al.10 have noted, “. . . by far the majority of lower urinary tract symptoms-overcontinence and pelvic pain syndromes remain unexplained by existing theories.”
doi:10.1016/S0090-4295(03)00697-6
Acupuncture Ameliorates Symptoms in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome TO THE EDITOR:
The encouraging article by Chen and Nickel,1 which demonstrates neuromodulation producing relief of the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), parallels our experience with pudendal nerve protection. The authors suggest that the “end stage of CP/CPPS may be a neuropathic pain syndrome.” However the symptoms may not be the “end stage,” but may represent the “disease entity” itself. Successful symptomatic neuromodulation of irritable bladder has been demonstrated by posterior tibial nerve stimulation (acupuncture)2 and sacral nerve root stimulation. Robert et al.,3 Shafik,4 Ricchiutu et al.,5 Amarenco et al.,6 Tetzschner et al.,7 and other authors describe pudendal neuralgia/entrapment/compression. Pudendal neuropathy can be measured using neurophysiologic tests.3,5–7 In observations of more than 400 patients meeting criteria of CP/CPPS, the patients also meet the definition of Robert et al.,3 suggesting that “prostatitis-like” pains represent pudendal neuralgia. The pains may be accompanied by voiding, erectile, ejaculatory and rectal dysfunction. Sensory examinations of the pudendal distribution, pudendal nerve terminal motor latency testing, and electromyogram (EMG) of the bulbocavernosus and ischiocavernosus muscles corroborate the neuropathic basis of the symptoms. Similar to the authors’ experience, patients treated with self-care demonstrated significant relief of pain and voiding symptoms, and improvement in quality of life as measured by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Self-care is a perineal
212
REFERENCES 1. Chen R, and Nickel JC: Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 61: 1156 –1159, 2003. 2. Van Balken MR, Vandoninck V, Gisolf WH, et al: Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166: 914 –918, 2001. 3. Robert R, Prat-Pradat D, Labat JJ, et al: Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20: 93–98, 1998. 4. Shafik A: Pudendal canal syndrome: a new etiological factor in prostadynia and its treatment by pudendal canal [de]compression. Pain Digest 8: 32–36, 1998. 5. Ricchiutu VS, Haas CA, Seftel AD, et al: Pudendal nerve injury associated with avid bicycling. J Urol 162: 2099 –2100, 2000. 6. Amarenco G, Kerdraon J, Bouju P, et al: Efficacy and safety of different treatments of perineal neuralgia due to compression of the pudendal nerve within the ischio-rectal fossa or by ischiatic spine. Rev Neurol 153: 331–334, 1997. 7. Tetzschner T, Sorensen M, Lose G, et al: Pudendal nerve function during and after delivery. Int Urogynecol J Pelvic Floor Dysfunct 8: 66 –68, 1997. 8. Bensignor MF, Labat JJ, Robert R, et al: Diagnostic and therapeutic nerve blocks for patients with perineal non-malignant pain (abstract). Eighth World Congress on Pain, 1996, p 56. 9. Antolak SJ: Perineal hyperprotection: II. Improvement in NIH chronic prostatitis symptom index voiding domain using a self-care, noninvasive treatment. Presented at the North Central Section of the American Urological Association, April 2002. 10. Zermann DH, Ishagooka M, and Schmidt RA: Pathophysiology of the hypertonic sphincter, in Corcos J (Ed): The Urinary Sphincter. Marcel Dekker, New York, 2001, p 218.
Stanley J. Antolak, Jr, M.D. Woodbury, Minnesota doi:10.1016/j.urology.2003.09.037
UROLOGY 63 (1), 2004