Physical Examination for Men and Women with Urological Chronic Pelvic Pain Syndromes: a MAPP Network Study

To examine the feasibility of implementing a standardized, clinically relevant genitourinary examination for both men and women and to identify physical examination findings characteristic of urological chronic pelvic pain syndromes (UCPPS).

This study analyzed two samples: men and women with UCPPS who participated in the MAPP Research Network Epidemiology and Phenotyping (EP) Study, and age-matched controls who were either positive for chronic fatigue syndrome or healthy (pain-free). We compared physical examination findings in both positive and healthy controls to UCPPS cases, findings from both the EP examinations and from an extended genitourinary examination.

EP and extended examinations were performed on 143 participants: 62 UCPPS cases (30 women, 32 men), 42 positive controls (15 women, 27 men), and 39 healthy controls (22 women, 17 men). EP examinations showed that pelvic floor tenderness was more prevalent in cases (55.0%) than in positive (14.6%) or healthy controls (10.5%). Extended examinations revealed specific areas of tenderness in the pelvic floor musculature. Cases were also more likely than healthy controls to report tenderness in multiple areas, including suprapubic, symphysis pubis, and posterior superior iliac spine, and on bimanual examination. No comparative findings were specific to biological sex, and no evidence of pudendal neuropathy was observed on extended examination of cases or controls.

The extended genitourinary examination is an easily administered addition to the assessment of men and women during evaluation for UCPPS. Physical findings may help to better categorize UCPPS patients into clinically relevant subgroups for optimal treatment.

Urology. 2018 Mar 28 [Epub ahead of print]

Claire C Yang, Jane L Miller, Adam Omidpanah, John N Krieger

Department of Urology, University of Washington, Seattle, WA USA. Electronic address: ., Department of Urology, University of Washington, Seattle, WA USA., Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA USA.