Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS

Background: We wished to determine if there were differences in pelvic and non-pelvic tenderness between men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) Type III and men without pelvic pain. Methods: We performed the Manual Tender Point Survey (MTPS) as described by the American College of Rheumatology on 62 men with CP/CPPS Type IIIA and IIIB and 98 men without pelvic pain. We also assessed tenderness of 10 external pelvic tender points (EPTP) and of 7 internal pelvic tender points (IPTP). All study participants completed the National Institutes of Health Chronic Prostatitis Symptom Inventory (NIH CPSI). Results: We found that men with CPPS were significantly more tender in the MTPS, the EPTPS and the IPTPS. CPSI scores correlated with EPTP scale but not with IPTP scale or prostate tenderness. Prostatic tenderness was present in 75% of men with CPPS and in 50% of men without CPPS. Expressed prostatic fluid leukocytosis was not associated with prostatic tenderness. Conclusion: Men with CP/CPPS have more tenderness compared to men without CPPS. Tenderness in men with CPPS is distributed throughout the pelvis and not specific to the prostate

Advances in the role of sacral nerve neuromodulation in lower urinary tract symptoms

Sacral neuromodulation has been developed to treat chronic lower urinary tract symptoms, resistant to classical conservative therapy. The suspected mechanisms of action include afferent stimulation of the central nervous system and modulation of activity at the level of the brain. Typical neuromodulation is indicated both in overactivity and in underactivity of the lower urinary tract. In the majority of patients, a unilateral electrode in a sacral foramen and connected to a pulse generator is sufficient to achieve significant clinical results also on long term. In recent years, other urological indications have been explored

Guidelines for the rehabilitation of patients with prostatic cancer: a multidisciplinary consent

Background: Even though several specialist groups, including the German Pension Insurance ("Deutsche Rentenversicherung") and health insurance funds participate in the rehabilitation of patients with prostate carcinoma, there is no standardized rehabilitation program available for these patients. Consequently, there is no transparency regarding the services provided within the scope of rehabilitation for the referring physicians to uro-oncological rehabilitation, in particular for the physicians at the urological acute care clinics, nor for the patients concerned. Rehabilitation clinics are rather left to their own devices as to which services they provide in the treatment of the respective disease, in social situations, but also with regard to the consulting services offered.Problem: Development of a standard for the rehabilitation of patients with prostate carcinoma, taking into account both the specialist circles and the self-help groups relevant to this matter.Methods: For this reason, specialist groups, including self-help groups participating in the rehabilitation of patients with prostate cancer, have formed an expert group and developed the present standard. To this end, a thematic unsystematic literature review was carried out in advance to provide an evidence-based foundation.Results: Views were given in particular with regard to rehabilitation diagnostics, the therapy of urinary incontinence and erectile dysfunction, sport and physical exercise therapy, psycho-oncology, social- and disease-related consulting. In this context, the focus was set on classification as well as on the consensus strength of the respective recommendations.Conclusion: All parties involved in the rehabilitation of prostate cancer patients as well as the patients themselves and the responsible cost bearers can now use the standard as an orientation guide.Hintergrund: Obwohl sich zahlreiche Fachgruppen als auch die Deutsche Rentenversicherung und die Krankenkassen an der Rehabilitation von Patienten mit Prostatakarzinom beteiligen, existiert für diese Patienten kein standardisiertes Rehabilitationsprogramm. Daher ist es für die Zuweiser zur uro-onkologischen Rehabilitation, insbesondere die Ärzte in den urologischen Akutkliniken, aber auch für die Betroffenen selbst nicht transparent, welche Leistungen im Rahmen der Rehabilitation angeboten werden. Zurzeit ist es den Rehakliniken noch weitgehend selbst überlassen, welche Leistungen sie zur Behandlung welcher Beschwerden und sozialer Situationen sowie welche Beratungsangebote sie anbieten.Fragestellung: Entwicklung eines Standards für die Rehabilitation von Patienten mit Prostatakarzinom unter Einbeziehung der dafür relevanten Berufsgruppen als auch die Selbsthilfe.Methodik: Aus diesem Grund haben die an der Rehabilitation von Patienten mit Prostatakarzinom beteiligten Fachgruppen unter Beteiligung der Selbsthilfe eine Expertengruppe gebildet und den hier vorliegenden Standard entwickelt. Als evidenzbasierte Grundlage dafür wurde im Vorfeld eine themenspezifische unsystematische Literaturanalyse durchgeführt.Ergebnisse: Stellung wurde dabei insbesondere im Hinblick auf die Rehadiagnostik, die Therapie der Harninkontinenz und der erektilen Dysfunktion, Sport und Bewegungstherapie, Psychoonkologie, Sozial- und krankheitsspezifische Beratung genommen. Dabei wurden eine Graduierung und eine Konsensusstärke der jeweiligen Empfehlungen konzertiert.Schlussfolgerung: Anhand des Standards können sich nun alle an der Rehabilitation von Patienten mit Prostatakarzinom Beteiligten, als auch die Betroffenen selbst und die zuständigen Kostenträger orientieren