Multidisciplinary Approach Recommended for Pelvic Pain

University of Wisconsin urologist says multidisciplinary network offers hope for progress

22 july 2009 -- In a commentary on three diverse studies in the August Journal of Urology, a leading urologist advocates a multidisciplinary approach to unravel the complex pathologies of pelvic pain, prostatitis, painful bladder syndrome, and interstitial cystitis.

Timothy D. Moon, M.D., of the University of Wisconsin in Madison, takes issue with Ali Tekin, M.D., of Duzce University School of Medicine in Turkey, and colleagues who studied 161 asymptomatic patients with elevated prostate-specific antigen tests. The researchers compared the efficacy of biopsy versus voided bladder 3 urine samples to detect prostatitis, benign prostatic hyperplasia, and prostate cancer in the study group. Relying on urine samples alone would result in 13 percent of cancers not being diagnosed, Moon argues. He also comments on studies by Chao-Zhao Liang, M.D., of Anhui Medical University in Hefei, China, on the incidence of prostatitis in China, and by Mary P. FitzGerald, M.D., of Loyola University Medical Center in Maywood, Ill., on myofascial physical therapy versus global therapeutic massage for pelvic pain linked to pelvic floor muscle abnormalities.

Moon applauds the funding of the Multidisciplinary Approach to Chronic Pelvic Pain Network, a multidisciplinary group of investigators planning diverse studies of the complex of pelvic pain diseases, including studies in epidemiology, neurobiology, urological and non-urological phenotyping, disease biomarkers, and organ cross-talk pathways.

"In conclusion, progress is being made but perhaps bladder and prostate are words that should be omitted from the current diagnostic label if we are to truly understand the pathophysiological process," Moon writes.

Authors of the FitzGerald study reported financial relationships with the pharmaceutical industry.

Commentary - Moon (subscription or payment may be required)
Abstract - Tekin
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Abstract - Liang
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Abstract - FitzGerald
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Common treatment for men's pelvic pain proves ineffective, Queen's-led study shows

'Now researchers can focus on more promising therapies'

Kingston, ON, 19 dec 2008– A commonly-prescribed drug for men suffering from a painful pelvic condition failed to significantly reduce patients' symptoms in an international study led by Queen's University professor and urologist at Kingston General Hospital, Curtis Nickel.

The drug, called Alfuzosin, is regularly prescribed by more than half of family doctors to treat chronic prostititis/chronic pelvic pain syndrome. This affliction is estimated to affect from six to 12 per cent of the population.

Sponsored by the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, the study is published today in the prestigious New England Journal of Medicine.

"The results of our study will inform not only future clinical trials of alpha-blockers, but also other potential therapies," says Dr. Nickel, who is Canada Research Chair in Urologic Pain and Inflammation.

"Although the evidence for using alpha-blockers to treat new cases of chronic prostatitis/chronic pelvic pain syndrome is weak, some physicians have advocated use of this class of drug in men with this condition," he adds. "Our findings do not support this recommendation and should prompt reconsideration of use of an alpha-blocker as the first drug of choice for these patients."

Prostatitis is a common and costly medical condition, with chronic prostatitis/chronic pelvic pain syndrome the most frequent type seen by physicians. Men with this condition experience pain in the genital and urinary tract area and also report lower urinary tract symptoms and sexual problems that negatively affect their quality of life.

In the Queen's-led study, 233 men diagnosed with chronic prostatitis/chronic pelvic pain syndrome were randomly assigned to either alfuzosin or an identical-looking placebo. None of the men had received prior treatment with a beta-blocker.

Over the 12-week trial, participants were asked to rate improvements in pain perception, problems with urination, and their quality of life. The rates of response in both groups were the same.

"In medical research, it is as important to find out which treatments are effective, as well as those which are not beneficial," notes NIDDK Director Griffin Rodgers. "Now researchers can focus their efforts on more promising therapies."

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Also participating in the study were researchers from: University of Washington, Massachusetts General Hospital, Stanford University, Temple University, the Glickman Urologic Institute in Cleveland, University of California, Los Angeles, University of Maryland, and University of Mississippi.