Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment

The National Institutes of Health (NIH) chronic prostatitis symptom index was used to determine the prevalence of prostatitis-like symptoms among men (age 20 to 74 years) at risk in a community based study. The study was a cross-sectional postal survey of men age 20 to 74 years in Lennox and Addington counties, which included a large rural area, 1 major town and a suburban area with a stable population of men representative of Canadian demographics. The questionnaire collected information on 2 domains of chronic prostatitis identified in the NIH chronic prostatitis symptom index, including pain (location, severity and frequency), voiding function (irritative, obstructive), demographics, quality of life, general health and health seeking behavior. The self-reported pain score was used to identify prostatitis-like symptoms in the most discriminating domain. Based on analysis of the index final validation study comparing patients with prostatitis to normal controls and those with benign prostatic hyperplasia, the 2 questions most specific for prostatitis, including perineal and/or ejaculatory pain/discomfort, and a total pain score (0 to 21) 4 or greater were used to identify men with significant prostatitis-like symptoms. A total of 2,987 eligible men received the survey, and it was completed by 868 (29%). Of the men 84 (9.7%) were identified as having chronic prostatitis-like symptoms (mean NIH chronic prostatitis symptom index pain score 9.1 +/- 0.3). The average age of the prostatitis population was 50 years compared with 52 years for men without prostatitis-like symptoms. Prevalence was 11.5% in men younger than 50 years and 8.5% in men 50 years or older. Of the sampled population 57 (6.6%) men had prostatitis-like symptoms and an index pain score 8 or greater (moderate to severe). The index voiding score (0 to 10) was 4.1 +/- 0.5 in men younger than 50 years compared with 1.5 +/- 0.1 for normal controls, and 4.7 +/- 0.4 in those 50 years or older compared with 1.9 +/- 0.1 for normal controls. Of the prostatitis group 60% sought medical help for their symptoms. In our opinion this community based study using the new prostatitis symptom index confirms that chronic prostatitis-like symptoms are common.

Quantitative sensory testing has become commonplace in clinical neurophysiology units. Measurement of the thermal and vibratory senses provides an estimate on function of sensory small and large fibers, respectively. Being psychophysical parameters, sensory threshold values are not objective, and various test algorithms have been developed aiming at optimized results. In this review the various test algorithms are screened, and their relative advantages and disadvantages are discussed. Considerations of quality control are reviewed, and the main fields of clinical application are described.

To assess the frequency and duration of symptoms suggesting peripheral nerve compression after long distance cycling. A questionnaire based cross sectional study among 260 participants in a Norwegian annual bicycle touring race of 540 km. Thirty-five of 160 responding males (22%) reported symptoms from the innervation area of the pudendal or cavernous nerves. Thirty-three had penile numbness or hypaesthesia after the tour. In 10, the numbness lasted for more than one week. Impotence was reported by 21 (13%) of the males. It lasted for more than one week in 11, and for more than one month in three. Both genital numbness and impotence were correlated with weakness in the hands after the ride, a complaint reported by 32 (19%) of all 169 respondents. Forty-six cyclists (30%) indicated paraesthesia or numbness in the fingers, half of them from the ulnar nerve area only. The frequency of impotence, numbness of the penis, hand weakness and sensory symptoms from the fingers in bicycle sport may be higher than hitherto recognized. It afflicts both experienced cyclists and novices. In some, the complaints may last up to eight months. Besides changing the hand and body position on the bike, restricting the training intensity, and taking ample pauses may also be necessary in prolonged and vigorous bicycle riding to prevent damage to peripheral nerves.