- Email: [email protected]
Imaging
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IMAGING pain, disability, catastrophizing, control over pain, pain-contingent rest, social support, and solicitous responses from a significant other. Regressions showed that urinary symptoms (beta ⫽ .20), depression (beta ⫽ .24), and helplessness catastrophizing (beta ⫽ .29) predicted overall pain. Further, affective pain was predicted by depression (beta ⫽ .39) and helplessness catastrophizing (beta ⫽ .44), whereas sensory pain was predicted by urinary symptoms (beta ⫽ .25) and helplessness catastrophizing (beta ⫽ .37). With regard to disability, urinary symptoms (beta ⫽ .17), pain (beta ⫽ .21), and pain-contingent rest (beta ⫽ .33) were the predictors. These results suggest cognitive/behavioral variables (ie, catastrophizing, paincontingent rest) may have significant impact on patient adjustment in CP/CPPS. Findings support the need for greater research of such pain-related variables in CP/CPPS. Perspective: This article explores predictors of patient adjustment in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Cognitive/behavioral variables of catastrophizing and pain-contingent rest respectively predicted greater pain and disability. Catastrophic helplessness was a prominent pain predictor. These findings inform clinicians and researchers on several new variables in CP/CPPS outcomes and suggest future research. Editorial Comment: Catastrophizing is the process by which people either magnify the negative or minimize the positive. They usually do both. Catastrophizing has been associated with decreased quality of life and disability associated with numerous pain syndromes. The trait has even been associated with shortening of life span. This type of thinking represents a serious roadblock to recovery, since the slightest setback is seen as catastrophic, and a reason to stop therapy and get off the sometimes long road to recovery. It is more often practiced by women than men, and is even seen in children. Cognitive therapy has been shown to decrease catastrophizing by making the patient more aware of this destructive pattern, and teaching ways to control unproductive thoughts and behaviors. In this article catastrophizing was a strong predictor of overall pain scores in men with CP/CPPS. Men and women who exhibit catastrophic thinking about their urological pain should be strongly encouraged to see a psychologist familiar with treating patients with pain. Many individuals are reluctant but I try to indicate that it may take a long time to control their pain, and in the meantime they can get help with coping with the pain and improving their life. Richard E. Berger, M.D.
IMAGING Magnetic Resonance Urethrography in Comparison to Retrograde Urethrography in Diagnosis of Male Urethral Strictures: Is It Clinically Relevant? Y. Osman, M. A. El-Ghar, O. Mansour, H. Refaie and T. El-Diasty, Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt Eur Urol 2006; 50: 587–594. Objective: To compare the clinical relevance of retrograde urethrography (RUG) and magnetic resonance (MR) urethrography in evaluating male urethral strictures. Methods: Between January and April 2004, 20 men were referred to our institute for management of urethral strictures. The patients were investigated by conventional RUG and multiformat MR urethrography. The patients were examined by urethroscopy under anesthesia to be followed by definitive endoscopic or open operative intervention. The radiologic data were compared by endoscopic as well as operative findings in all the patients. Results: Ten patients were managed by visual internal urethrotomy (VIU) and two by dilatation under anesthesia; two showed normal urethral caliber. Four patients required open urethral reconstructive procedures. Two patients underwent radical cystectomy and cutaneous diversion because of associated bladder or urethral malignancy. Although overall accuracy for diagnosis of urethral strictures was equal between both modalities (85%), MR urethrography provided extra clinical data in seven patients (35%). It was superior to RUG in judging the urethral stricture length in three patients, diagnosing a urethral tumor in one, detecting associated bladder mass in one, characterizing the site of urethra-rectal fistula in one, and accurately delineating the proximal urethra in the last patient. Unlike RUG, MR urethrography provided adequate information about the degree of spongiofibrosis in all patients. Conclusion: MR urethrography is a promising tool for defining male urethral strictures and can provide extra guidance for treatment planning that cannot be obtained with RUG.
IMAGING
159
Editorial Comment: This study looks at 20 men with urethral strictures. The men underwent retrograde urethrography and magnetic resonance urethrography. Before the MR examination the patients were injected with a sterile gel into the urethra, with subsequent application of a soft clamp to the penile orifice to prevent the gel from leaking out. High resolution T2-weighted images of the urethra and bladder were performed, and stricture length was measured. All patients underwent subsequent urethroscopy. Although this is a small study, it shows nice correlation between retrograde urethrography and MR urethrography. This technique is similar to sonourethrography, where sterile gel (or sterile saline) is injected into the urethra. This method may also provide important information on spongiofibrosis, which cannot be assessed on the retrograde urethrogram. Magnetic resonance urethrography should be considered an additional and promising technique complementing sonourethrography for evaluation of the male urethra. Cary Siegel, M.D.
IMAGING pain, disability, catastrophizing, control over pain, pain-contingent rest, social support, and solicitous responses from a significant other. Regressions showed that urinary symptoms (beta ⫽ .20), depression (beta ⫽ .24), and helplessness catastrophizing (beta ⫽ .29) predicted overall pain. Further, affective pain was predicted by depression (beta ⫽ .39) and helplessness catastrophizing (beta ⫽ .44), whereas sensory pain was predicted by urinary symptoms (beta ⫽ .25) and helplessness catastrophizing (beta ⫽ .37). With regard to disability, urinary symptoms (beta ⫽ .17), pain (beta ⫽ .21), and pain-contingent rest (beta ⫽ .33) were the predictors. These results suggest cognitive/behavioral variables (ie, catastrophizing, paincontingent rest) may have significant impact on patient adjustment in CP/CPPS. Findings support the need for greater research of such pain-related variables in CP/CPPS. Perspective: This article explores predictors of patient adjustment in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Cognitive/behavioral variables of catastrophizing and pain-contingent rest respectively predicted greater pain and disability. Catastrophic helplessness was a prominent pain predictor. These findings inform clinicians and researchers on several new variables in CP/CPPS outcomes and suggest future research. Editorial Comment: Catastrophizing is the process by which people either magnify the negative or minimize the positive. They usually do both. Catastrophizing has been associated with decreased quality of life and disability associated with numerous pain syndromes. The trait has even been associated with shortening of life span. This type of thinking represents a serious roadblock to recovery, since the slightest setback is seen as catastrophic, and a reason to stop therapy and get off the sometimes long road to recovery. It is more often practiced by women than men, and is even seen in children. Cognitive therapy has been shown to decrease catastrophizing by making the patient more aware of this destructive pattern, and teaching ways to control unproductive thoughts and behaviors. In this article catastrophizing was a strong predictor of overall pain scores in men with CP/CPPS. Men and women who exhibit catastrophic thinking about their urological pain should be strongly encouraged to see a psychologist familiar with treating patients with pain. Many individuals are reluctant but I try to indicate that it may take a long time to control their pain, and in the meantime they can get help with coping with the pain and improving their life. Richard E. Berger, M.D.
IMAGING Magnetic Resonance Urethrography in Comparison to Retrograde Urethrography in Diagnosis of Male Urethral Strictures: Is It Clinically Relevant? Y. Osman, M. A. El-Ghar, O. Mansour, H. Refaie and T. El-Diasty, Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt Eur Urol 2006; 50: 587–594. Objective: To compare the clinical relevance of retrograde urethrography (RUG) and magnetic resonance (MR) urethrography in evaluating male urethral strictures. Methods: Between January and April 2004, 20 men were referred to our institute for management of urethral strictures. The patients were investigated by conventional RUG and multiformat MR urethrography. The patients were examined by urethroscopy under anesthesia to be followed by definitive endoscopic or open operative intervention. The radiologic data were compared by endoscopic as well as operative findings in all the patients. Results: Ten patients were managed by visual internal urethrotomy (VIU) and two by dilatation under anesthesia; two showed normal urethral caliber. Four patients required open urethral reconstructive procedures. Two patients underwent radical cystectomy and cutaneous diversion because of associated bladder or urethral malignancy. Although overall accuracy for diagnosis of urethral strictures was equal between both modalities (85%), MR urethrography provided extra clinical data in seven patients (35%). It was superior to RUG in judging the urethral stricture length in three patients, diagnosing a urethral tumor in one, detecting associated bladder mass in one, characterizing the site of urethra-rectal fistula in one, and accurately delineating the proximal urethra in the last patient. Unlike RUG, MR urethrography provided adequate information about the degree of spongiofibrosis in all patients. Conclusion: MR urethrography is a promising tool for defining male urethral strictures and can provide extra guidance for treatment planning that cannot be obtained with RUG.
IMAGING
159
Editorial Comment: This study looks at 20 men with urethral strictures. The men underwent retrograde urethrography and magnetic resonance urethrography. Before the MR examination the patients were injected with a sterile gel into the urethra, with subsequent application of a soft clamp to the penile orifice to prevent the gel from leaking out. High resolution T2-weighted images of the urethra and bladder were performed, and stricture length was measured. All patients underwent subsequent urethroscopy. Although this is a small study, it shows nice correlation between retrograde urethrography and MR urethrography. This technique is similar to sonourethrography, where sterile gel (or sterile saline) is injected into the urethra. This method may also provide important information on spongiofibrosis, which cannot be assessed on the retrograde urethrogram. Magnetic resonance urethrography should be considered an additional and promising technique complementing sonourethrography for evaluation of the male urethra. Cary Siegel, M.D.