Evaluation of intravesical potassium sensitivity test and bladder biopsy in patients with chronic prostatitis/chronic pelvic pain syndrome

Abstract

Aim:We evaluated the possibility that patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) might have similar histological and physiological bladder changes as that documented in patients with painful bladder syndrome/interstitial cystitis (PBS/IC). Methods: Thirty-five known patients of CP/CPPS according to the clinical criteria of National Institutes of Health (NIH) were evaluated. The severity of the symptoms was evaluated according the NIH-Chronic Prostatitis Symptom Index. All patients underwent a potassium sensitivity test (PST) and bladder cystoscopy. Bladder biopsy was obtained from 17 patients with prostatitis and four control patients. Results: Urinary symptoms were present in 31 (88.6%) patients. Pelvic pain was reported in all patients. PST was positive in 26 (84%) of 31 patients that presented with urinary symptoms in its filling phase. In the voiding phase, 10 (28.5%) patients experienced urethral pain. Of these patients, five had negative filling PST. There were only two (5.7%) patients that had negative PST in both of its phases for an overall positive PST rate of 94.3%. The severity of PST was not correlated with the total symptom score (P = 0.37). However, patients with severe urinary symptoms were more likely to score higher grades with PST (P = 0.01). Of the 17 patients who underwent bladder biopsy, a significant increase in the number of mast cells (MC) was present in 11 (64.7%) patients. Glomerulations with bladder cystoscopy was observed in 24 (68.6%) patients. Conclusions:The data of the present study support the opinion that PBS/IC is under-diagnosed in male patients that present with urgency, frequency and/or pain. In some patients diagnosed as CP/CPPS, the symptoms might be related to bladder dysfunction rather than prostatic inflammation.

The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

“…In a subsequent study in 50 patients with prostatitis, 77% were potassium‐positive compared with 0% in 14 asymptomatic controls [29]. An additional study reported 84% positive PSTs in 31 patients [22]. There was a report that mistakenly performed the PST using a 100 mL volume of fluid instead of 40 mL.…”

“…Patients with IC were tested and compared with asymptomatic control subjects. To date, the international literature contains over 35 published reports on potassium testing in over 3000 patients with IC/painful bladder syndrome (PBS) and the data are very robust, with 80% of patients with IC testing positive [19–25]. Furthermore, several reports included data on about 200 normal subjects and the test was negative in 98.3%[14,18,26,27].…”

Stress and Chronic Pelvic Pain

“…1,3,29,207 In fact, the significant overlap of presenting signs and symptoms between IC/PBS and CP/CPPS has led several investigators to propose that they are different manifestations of the same underlying syndrome. 206,[208][209][210] Recurrent infection, leaky epithelium, neurogenic inflammation, and autoimmunity have all been surmised as potential underlying causes of IC/PBS and CP/CPPS, as well as mast cell activation and degranulation. 208 Expressed prostatic secretions from men with CP/CPPS had increased mast cell tryptase and NGF levels, 211 and a later study confirmed that tryptase and carboxypeptidase A (CPA3), a marker of mast cell activation, were also increased in the urine of CP/CPPS patients.…”

The significance of potassium chloride sensitivity test and urinary uronic acid level in the diagnosis of chronic pelvic pain syndrome

“…The discrepancy might be due to the inhomogeneity of the groups and individual sociocultural variability. As a matter of fact, recent studies suggested that KCl sensitivity test lacks discriminating power and should be used as a diagnostic aid rather than a specific test on which to base the diagnosis, and for research purposes only [29][30][31]. The fact that potassium sensitivity test is not welltolerated among patients with severe symptoms also supported this suggestion [32].…”