Quaghebeur Jörgen, Wyndaele Jean-Jacques, De Wachter Stefan
a Department of Urology , University Hospital Antwerp , Edegem , Belgium.
b Department of Urology , University of Antwerp , Antwerp , Belgium.
Scand J Urol. 2017 Oct;51(5):414-419. doi: 10.1080/21681805.2017.1339291. Epub 2017 Jul 5.
A thorough clinical assessment including physical examination is crucial in a diagnostic work-up, including in patients with chronic pelvic pain syndrome (CPPS). This study investigated the prevalence of pain areas and the mechanosensitivity of peripheral nerves in patients with CPPS and compared the findings with a healthy control group.
Healthy volunteers and patients diagnosed with CPPS were assessed with physical examinations and neurodynamic testing.
The CPPS group (n = 26) and the control group (n = 28) showed no statistical differences between males and females for age and body mass index (Mann-Whitney U test). The patients in the CPPS group were significantly older and had a significantly higher weight compared to controls. Healthy volunteers did not show any pain area or mechanosensitivity of the examined peripheral nerves of the lumbosacral plexus. Patients with CPPS showed a variety of pain from different musculoskeletal origins. Neurodynamic testing demonstrated significant mechanosensitivity in at least one nerve of the lumbosacral plexus in 88% of the patients with CPPS, suggesting minor nerve injuries. Pudendal nerve mechanosensitivity was found in 85% of patients, while 42% had multiple nerves involved. Unilateral or bilateral pudendal channel palpatory pain was present in 62% of the CPPS group and not in controls.
This study shows musculoskeletal pain and a high prevalence of minor nerve injuries in CPPS patients, indicating the presence of abnormal impulse generation sites that can help in understanding the clinical picture in CPPS patients and guiding their treatment.
全面的临床评估，包括体格检查，在诊断检查中至关重要，对于慢性盆腔疼痛综合征（CPPS）患者亦是如此。本研究调查了CPPS患者疼痛区域的患病率以及周围神经的机械敏感性，并将结果与健康对照组进行比较。
对健康志愿者和诊断为CPPS的患者进行体格检查和神经动力测试。
CPPS组（n = 26）和对照组（n = 28）在年龄和体重指数方面，男性与女性之间无统计学差异（曼-惠特尼U检验）。与对照组相比，CPPS组患者年龄显著更大，体重也显著更高。健康志愿者未表现出任何疼痛区域或所检查的腰骶丛周围神经的机械敏感性。CPPS患者表现出多种源自不同肌肉骨骼的疼痛。神经动力测试显示，88%的CPPS患者至少有一条腰骶丛神经存在显著的机械敏感性，提示存在轻微神经损伤。85%的患者发现阴部神经有机械敏感性，42%的患者有多条神经受累。CPPS组62%的患者存在单侧或双侧阴部通道触压痛，而对照组未出现。
本研究表明CPPS患者存在肌肉骨骼疼痛且轻微神经损伤患病率较高，这表明存在异常冲动产生部位，有助于理解CPPS患者的临床表现并指导其治疗。
