There is evidence to suggest that prostatitis may be pathologically linked to interstitial cystitis in men as both of these conditions share common symptoms. In a survey of 92 men with interstitial cystitis confirmed by the National Institute for Diabetes and Digestive and Kidney Diseases criteria, the most commonly reported initial symptoms were mild suprapubic discomfort (33%), nocturia (15%), urgency (15%), dysuria (11%), and frequency (11%); however, after 2.5 years these symptoms had become more severe and 89% reported dysuria, 85% had urinary frequency, 82% had severe suprapubic discomfort and/or urgency, and 56% had sexual dysfunction.67 The overlap between prostatitis and interstitial cystitis has led researchers to consider that they have underlying causes. In a recent study of 50 patients with prostatitis, the majority of patients were also symptomatic on an interstitial cystitis questionnaire known as the pelvic pain and urgency/frequency questionnaire, and 77% with a score more than 7 also tested positive for the potassium-sensitivity test. It has been established that bladder epithelial dysfunction can develop in interstitial cystitis, allowing irritative substances such as potassium from the urine to penetrate the epithelium and provoke symptoms. These findings suggest that bladder dysfunction, commonly associated with interstitial cystitis, may be a key source of symptoms in prostatitis.72
Another classic form of incontinence known as urinary urge incontinence (UUI), which is a complaint of involuntary leakage of urine accompanied by or immediately preceded by urgency, is more common in males than females, accounting for 40-80% of male cases.73 UUI is usually caused by detrusor overactivity in men. It is thought that obstruction caused by BPH can affect the local or ventral detrusor control, which results in overactivity, and this explains the higher prevalence in males. The presence of detrusor overactivity can also affect bladder contraction strength, and greater bladder contractions can lead to higher urge severity. It is possible that both UUI and overactive bladder can have similar underlying mechanisms to those observed in BPH patients with detrusor overactivity, which leads some authors to question whether BPH is part of a larger syndrome involving prostatitis (inflammatory), intersititial cystitis, UUI, and overactive bladder.
Other abnormalities of the prostate such those associated with the anterior fibromuscular stroma (AFMS) can also contribute to urinary disturbances. There is evidence to suggest that age-related urinary problems can be associated with poor movement of the AFMS in patients without evidence of BPH or bladder neck obstruction.74 For more information on urological diseases, see Chapter 6.23.
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