1 Introduction

2 Materials and methods

Twenty-one patients, 17-40 years of age, and 17 normal volunteers, 18-37 years of age, were recruited and AM and CMG were performed. Presenting symptoms of the patients included: (1) pelvic pain: perineal, penile, suprapubic, scrotal, or urethral pain; (2) urge syndrome: urgency, frequency, nocturia, and dysuria; and (3) obstructive dysfunction: hesitancy, weakened stream, and interrupted flow.

The Meares and Stamey localization studies and quantitative bacteriologic culture of the urethra and bladder urine, and expressed prostatic secretions, were employed to distinguish bacterial prostatitis from nonbacterial and to establish the diagnosis of chronic bacterial prostatitis. Neurologic examinations were all normal.

A full standard CMG was performed according to the International Continence Society (ICS) standards^[14]. CMG tests, including uroflowmetry, urethral pressure profilometry, filling cystometry, and pressure-flow study, were done using Dantec Menuet urodynamics system. Urodec 500 AM system was used to carry out AM. The memory in the recorder was sufficient for up to 24 hours of ambulatory measurement. At the end of the test the stored data were transferred to a personal computer for definitive storage, processing, and plotting clinical report and traces. Urodec 500 system consisted of an ambulatory solid state monitor, a single sensor micro-transducer catheter (for rectal), a double sensor micro-transducer catheter (for bladder and urethral), a fiber optic cable, a control key and an application software. The methodology has been described by van Waalwijk van Doorn et al^[13]. Briefly, the patient is instructed to lie down on a bed in the supine position. The rectal catheter is inserted first and the micro-tip should be penetrated into the rectum about 10 cm, the double sensor catheter is inserted into the bladder then. With two transducers in the bladder and one in the rectum, the patient is asked to relax and lie still for 1 min. The pressure transducers are zeroed automatically after inserting a battery. Then the second sensor of the urethral catheter is positioned in the region of maximum urethral pressure; this can be done with the help of a urethral pressure profile. The catheter is fixed to the penis with the help of brown plaster. The starting and ending times of the procedure are registered and patients are requested to keep a diary of important events, such as micturition, drinking, urge, urine loss, and remarks. Then the patient leaves the hospital and returns to normal daily activities; at the end of the test period, the patient returns to the hospital and the catheters are removed. The monitor is connected to a personal computer by means of an interface unit and with the help of a software package, the data from the monitor memory are transmitted to the computer. The patient and diary data are entered via the keyboard. Two extreme shapes of the curve during voiding can be recognized: one with a complete urethral pressure decrease in combination with a detrusor contraction, and the other on the contrary shows the intravesical pressure also in the urethral pressure curve. Any shape in between is possible. Uninhibited detrusor contractions (UDC) and urethral relaxations (UR) are identified with a cursor, and the amplitude and duration of UDC and UR are automatically calculated. Finally, a report is generated with a summary of drinking, micturition behavior and activities of detrusor and sphincter.  

3 Results

The mean duration of AM was (4.21.1) h. The recorded curves showed that EUS pressure provided a useful tract to interpret EUS activities during filling and voiding. From the recorded curves, one could find some indices to show the behaviors of EUS in CP patients and normal volunteers. The resting maximum urethral closure pressure (MUCP) and voiding MUCP in CP patients were increased, with a mean of (121.510.3) and (85.63.5) cm water, respectively (Table 1). Both the resting and voiding MUCP in CP patients were significantly higher than those of normal volunteers, (77.611.4) and (10.31.6) cm water, respectively (Table 1).

Table 1. Maximum urethral closure pressures (MUCP) using AM and CMG in chronic prostatitis patients and normal volunteers. means. ^cP<0.01 vs volunteer group.

5 Conclusion

References

[1] Meares EM. Prostatitis and related disorders. In: Walsh, Gittes, Perlmutter, Stamey, editors. Campbell's Urology; v 1. 15th ed. Philadelphia: Saunders; 1986. 868-87.
[2] Drach GW, Fair WR, Meares EM Jr, Stamey TA. Classification of benign diseases associated with prostatic pain: prostatitis or prostatodynia? J Urol  1978; 120: 266.
[3] Liao LM, Shi BY, Liang CHQ. Uroflowmetry study in patients with chronic prostatitis and prostatodynia. Chin J Urol  1994; 15: 370-2.
[4] Meares EM Jr, Barbalias GA. Prostatitis: bacterial, nonbacterial, and prostatodynia. Semin Urol  1983; 1: 146-54.
[5] Barbalias GA, Meares EM Jr, Sant GR. Prostatodynia: clinical and urodynamic characteristics. J Urol  1983; 130: 514.
[6] Neal DE. Ambulatory urodynamics. In: Mundy AR, Stephenson TP, Wein AJ, editors. Urodynamics: principles, practice and application. 2nd ed. New York: Churchill Livingstone; 1994. p 133-44.
[7] Griffiths CJ, Assi MS, Styles RA, Ramsden PD, Neal DE. Ambulatory monitoring of bladder and detrusor pressure during natural filling. J Urol 1989; 142: 780-4.
[8] Styles RA, Neal DE, Griffiths CJ, Ramsden PD. Long-term monitoring of bladder pressure in chronic retention of urine: the relationship between detrusor activity and upper tract dilation. J Urol  1988; 140: 330-4.
[9] McInerney  PD, Vanner TF, Harris SAB, Stephenson TP. Ambulatory urodynamics. Br J Urol  1991; 67: 272-4.
[10] Webb RJ, Griffiths CJ, Ramsden PD, Neal DE. Measurement of voiding pressure on ambulatory monitoring: comparison with conventional cystometry. Br J Urol  1990; 65: 152-4.
[11] Styles RA, Neal DE, Ramsden PD. Comparison of long-term monitoring and standard cystometry in chronic retention of urine. Br J Urol  1986; 58: 652-6.
[12] Webb RJ, Styles RA, Griffiths CJ, Ramsden PD, Neal DE. Ambulatory monitoring of bladder pressures in patients with low compliance as a result of neurogenic bladder dysfunction. Br J Urol 1989; 64: 150-4.
[13] van Waalwijk van Doorn ES, Remmers A, Janknegt RA. Extramural ambulatory urodynamic monitoring during natural filling and normal daily activities: evaluation of 100 patients. J Urol 1991; 146: 124-31.
[14] International Continence Society. Sixth report on the standardisation of terminology of lower urinary tract function. Br J Urol  1987; 59: 300-4.
[15] Rugendorff EW, Weidner W, Ebeling L, Buck AC. Results of treatment with pollen extract in chronic prostatitis and prostatodynia. Br J Urol  1993; 71: 433-8.