Adult urology: CME articleBiofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome
Section snippets
Material and methods
Between July 1995 and July 1998, 19 patients were treated with the biofeedback regimen described below. Mean age was 38 years (range 18 to 67). All patients were diagnosed with nonbacterial CPPS based on the presence of symptoms with a negative expressed prostatic fluid (EPF) or VB3 urine culture. Symptoms included pain (perineal, testicular, suprapubic, scrotal, ejaculatory, abdominal) and voiding complaints (frequency, urgency, nocturia, decreased force of stream, hesitancy, sense of
Results
Fourteen of the 19 patients underwent pretreatment urodynamics in our laboratory. Five exhibited detrusor instability (DI) and an additional 4 had diminished bladder capacity. No patients were obstructed based on Abrams-Griffiths criteria,8 but 6 patients demonstrated dysfunctional voiding as evidenced by incomplete relaxation of the external urethral sphincter with voiding (pseudodyssynergia). Despite these findings, no postvoid residual urine volume was more than 60 mL. Three patients had a
Comment
The connection between pelvic pain and voiding dysfunction is poorly understood. In a recent study of 103 men with pelvic pain, Zermann et al.9 found pathologic tenderness of the pelvic floor muscles associated with the inability to contract and relax the pelvic floor muscles in 88%. Urodynamic testing on 84 of these men demonstrated abnormal pelvic floor function, including increased urethral sensitivity and tonicity, and pseudodyssynergia during attempted voiding. They hypothesized that
Conclusions
At 6 months’ follow-up, a structured program of biofeedback-assisted pelvic floor exercises and timed voiding resulted in significant improvement in voiding symptoms and pain in a group of men with CPPS refractory to other treatments. Measurable effects were seen following as few as two treatments. Our results suggest that this treatment approach may benefit CPPS patients with dysfunctional voiding, detrusor instability, and/or chronic pelvic pain. The long-term durability of these outcomes is
References (17)
- et al.
Prostatosis, prostatitis or pelvic floor tension myalgia?
J Urol
(1979) - et al.
Neurourological insights into the etiology of genitourinary pain in men
J Urol
(1999) Effective office management of chronic prostatitis
Urol Clin North Am
(1998)- et al.
Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option
J Urol
(1997) - et al.
Etiology of voiding dysfunction in men less than 50 years of age
Urology
(1996) - et al.
Unsuspected proximal urethral obstruction in young and middle-aged men
J Urol
(1986) - et al.
Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck
J Urol
(1994) - Executive summary: NIH Workshop on Chronic Prostatitis. Bethesda, National Institutes of Health,...
Cited by (105)
Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy
2022, Sexual Medicine ReviewsCitation Excerpt :This may have biased the findings towards a positive outcome. In four studies muscle resting tone and function was established using more objective measures such as s-EMG,44,45,47,48 but caution is warranted in clinical use and interpretation of this measure as well. Many factors influence amplitude, skin conductance and artefacts.
Comparing electromagnetic stimulation with electrostimulation plus biofeedback in treating male refractory chronic pelvic pain syndrome
2017, Urological ScienceCitation Excerpt :Biofeedback is frequently recommended as a treatment for CPPS, based on the principle that maximum muscle contraction promotes maximum muscle relaxation. Consequently, the relaxation phase is a mediative state between muscle contractions.14 Nadler28 reported some improvements in the NIH-CPSI scores of eight out of 11 patients with CPPS treated by this method.
Anorectal and Pelvic Pain
2016, Mayo Clinic ProceedingsThe Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain
2016, Sexual Medicine ReviewsTherapeutic strategies for the treatment of chronic prostatitis / chronic pelvic pain syndrome
2016, Revista Internacional de Andrologia