Pseudodyssynergia (Contraction of the External Sphincter During Voiding) Misdiagnosed as Chronic Nonbacterial Prostatitis and the Role of Biofeedback as a Therapeutic Option

Abstract

These results indicate that some men who are categorized as having and empirically treated for chronic nonbacterial prostatitis are misdiagnosed and, in fact, have functional bladder outlet obstruction. Urodynamics are helpful in diagnosing and predicting success with behavior modification and biofeedback in these patients.

Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic floor biofeedback treatment

“…Urethrography shows complete or partial closure of the membranous urethra. Kaplan et al [1] reported a decrease in Q max and increase in Pdet.max in DV. Moreover, Liao et al [5] confirmed an increase in MUP and MUCP in patients with CP.…”

“…[2]. Kaplan et al [1] thought that the psychological stress was related to voiding disorders in men with nonbacterial CP, and some of those who in fact had a contraction of the external urinary sphincter during voiding had been misdiagnosed and empirically treated for nonbacterial CP. Our previous research [3] also analysed the possible mechanism that increased the mental burden caused by pelvic floor dysfunction, and then increased the prostatic urethral pressure, which caused LUTS in some patients with CP, manifested as voiding symptoms and mostly classified as IIIB (leukocytosis with no proof of bacterial infection); Hinman and Baumann [4] had a similar view.…”

“…The diagnosis of CP conformed to the recommendations of the National Institutes of Health (NIH) criteria: symptoms for > 3 months, including urinary frequency and urgency, voiding difficulty, upper abdominal or perineal discomfort, etc. ; scores of ≥ 1 for the first and second part of NIH CP Symptom Index (CPSI); treated once by antibiotics and α -blockers for > 6 months, with poor effects [1]. Bacterial prostatitis, urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded from the analysis through detailed medical history-taking, systematic physical examination, urine culture, analysis of expressed prostatic secretion, cystourethrography and cystoscopy.…”

Management of prostatitis

“…Multiple disorders that have been proposed to be causally associated include bladder neck obstruction, urethral stricture, detrusor sphincter dyssynergia and dysfunctional voiding. 5,9 CPSS may be multifactorial and part of a more generalized pain disorder. Microbiologic, immunologic, neurologic, chemical, psychologic and anatomic factors are believed to be involved in its etiopathogenesis.…”

Prostatitis

“…53Y43 Biofeedback has been used as a therapeutic option in cases misdiagnosed as NBP with urodynamic evidence of pseudodyssynergia (contraction of the external sphincter during voiding), but it must be emphasized that the authors do not provide information on long-term follow up. 65 Finally, in cases of clinical prostatodynia with urodynamic evidence of obstruction at the level of bladder neck, endoscopic unilateral bladder neck incision offers a good alternative for subjective and objective long-term relief of symptoms, with the reservation of occurrence of possible diminished ejaculate. This should be taken into serious consideration in relatively young males, who constitute the vast majority in this group of patients.…”