University of California Los Angeles, Los Angeles, California.
University of Michigan, Ann Arbor, Michigan.
J Urol. 2021 Jun;205(6):1698-1703. doi: 10.1097/JU.0000000000001595. Epub 2021 Feb 4.
We sought to determine the time-lagged, bidirectional relationships among clinical variables of pelvic pain, urinary symptoms, negative mood, nonpelvic pain and quality of life in men and women with urological chronic pelvic pain syndrome, incorporating interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome.
A total of 204 female and 166 male patients were assessed up to 24 times over a 48-week period on the 5 primary outcomes. A lagged autoregressive analysis was applied to determine the directional relationship of one variable to another 2 weeks later, beyond that of the concurrent relationships at each time point and autocorrelations and trends over time.
The results show clear evidence for a bidirectional positive relationship between changes in pelvic pain severity and urinary symptom severity. Increases in either variable predicted significant increases in the other 2 weeks later, beyond that explained by their concurrent relationship at each time point. Pelvic pain and to a lesser degree urinary frequency also showed similar bidirectional relationships with negative mood and decreased quality of life. Interestingly, neither pelvic pain or urinary symptom severity showed lagged relationships with nonpelvic pain severity.
Results document for the first time specific short-term positive feedback between pelvic pain and urinary symptoms, and between symptoms of urological chronic pelvic pain syndrome, mood and quality of life. The feedforward aspects of these relationships can facilitate a downward spiral of increased symptoms and worsening psychosocial function, and suggest the need for multifaceted treatments and assessment to address this possibility in individual patients.
我们旨在确定患有下尿路症状、盆腔疼痛、负性情绪、非盆腔疼痛和生活质量的男性和女性患者中，泌尿科慢性盆腔疼痛综合征的临床变量（包括间质性膀胱炎/膀胱疼痛综合征和慢性前列腺炎/慢性盆腔疼痛综合征）之间的时滞、双向关系。
在 48 周的时间内，总共对 204 名女性和 166 名男性患者进行了 24 次评估，主要结果为 5 个。应用滞后自回归分析来确定一个变量对另一个变量的方向关系，这种关系在每个时间点的同时关系之外，以及随时间的自相关和趋势。
结果清楚地表明，盆腔疼痛严重程度和尿症状严重程度的变化之间存在双向正相关关系。任一变量的增加都预示着 2 周后另一个变量的显著增加，这超出了每个时间点同时关系的解释。盆腔疼痛，在较小程度上，也显示出与负性情绪和生活质量下降相似的双向关系。有趣的是，盆腔疼痛或尿症状严重程度与非盆腔疼痛严重程度均无滞后关系。
结果首次记录了盆腔疼痛和尿症状之间、泌尿科慢性盆腔疼痛综合征症状与情绪和生活质量之间特定的短期正反馈。这些关系的前馈方面可以促进症状和心理社会功能恶化的恶性循环，并表明需要多方面的治疗和评估来解决个别患者的这种可能性。
