Correlation Between Ultrasound Alterations of the Preprostatic Sphincter and Symptoms in Patients With Chronic Prostatitis-Chronic Pelvic Pain Syndrome Marco Dellabella, Giulio Milanese and Giovanni Muzzonigro From the Department of Urology and Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I.-G. M. Lancisi-G. Salesi, Polytechnic University of the Marche Region, School of Medicine, Ancona, Italy Purpose: We investigated ultrasound alterations of the preprostatic sphincter in patients with chronic prostatitis-chronic pelvic pain syndrome. We evaluated the frequency of these alterations, standardized their ultrasound measurement and correlated them with symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome. Materials and Methods: In 37 patients with chronic prostatitis-chronic pelvic pain syndrome and 23 healthy volunteers certain parameters were measured by transrectal ultrasound, including prostate volume, hypoechoic periurethral zone volume, posterior prostate lip thickness, bladder neck thickness, detrusor thickness and the degree of echogenicity of the anterior fibromuscular stroma. All patients were evaluated with the International Prostate Symptom Score and National Institutes of Health Chronic Prostatitis Symptom Index. Urinary flow rate and post-void residual urine volume were also considered in each patient. All assessments were done independently and consecutively by 3 operators. Results: A hypoechoic periurethral zone volume was found in 36 of 37 patients with chronic prostatitis-chronic pelvic pain syndrome. No significant intra-observer and interobserver differences were found in ultrasound parameter measurements. In the chronic prostatitis-chronic pelvic pain syndrome group ultrasound findings showed greater post-void residual urine volume, detrusor thickness and hypoechoic periurethral zone volume, increased posterior prostate lip thickness and bladder neck thickness, and greater anterior fibromuscular stroma hyperechogenicity. On multivariate analysis hypoechoic periure- thral zone volume was an independent predictive factor for worse National Institutes of Health Chronic Prostatitis Symptom Index pain, urinary and total scores. Posterior prostate lip thickness was the only factor predictive of a worse International Prostate Symptom Score in patients with chronic prostatitis-chronic pelvic pain syndrome. A hypoechoic periurethral zone volume, posterior prostate lip thickness and bladder neck thickness with calculated threshold values revealed fair to excellent accuracy for identifying a patient with chronic prostatitis-chronic pelvic pain syndrome. Conclusions: Ultrasound evaluation of the bladder neck-posterior urethra in patients with chronic prostatitis-chronic pelvic pain syndrome led us to identify a set of lesions that cannot be found in healthy subjects. The measurement of hypoechoic periurethral zone volume, posterior prostate lip thickness and bladder neck thickness could be useful for following patients with chronic prostatitis-chronic pelvic pain syndrome and maybe for better understanding the complicated pathophysiological mechanisms of chronic nonbacterial prostatitis. Key Words: prostate, prostatitis, pain, bladder, urethra C hronic prostatitis-chronic pelvic pain syndrome is a clinical condition with a still unknown etiology for which various pathophysiological mechanisms have been suggested. The only certainty in this disease is that it leads to a significant decrease in patient quality of life by causing pelvic pain, urinary disorders and sexual dysfunc- tion with important psychological implications. Currently transrectal prostate ultrasound is not one of the recom- mended examinations for diagnosing chronic prostatitis. 1 Some groups have indicated that some ultrasound find- ings (peripheral hypoechoic rim, intraprostatic calcifica- tion, seminal vesical abnormalities, color Doppler in- creased blood flow, etc) are frequently associated with chronic prostatitis. 2–4 However, the use of these ultra- sound alterations for diagnostic purpose or during clini- cal-therapeutic followup has had no relevance in clinical practice because of the low specificity of these findings and the poor correlation shown with symptoms. In prior stud- ies some groups described a poorly echoic periurethral zone in patients with prostatitis. 2,3 This ultrasound alter- ation has been found in the proximal urethra. According to the anatomical descriptions of McNeal the wall of the proximal urethra has anatomical continuity with the bladder neck and anterior fibromuscular stroma, thus, forming the fibromuscular smooth structure defined as the preprostatic sphincter. 5–7 In this prospective study we investigated ultrasono- graphically the anatomical region of the preprostatic sphinc- ter in patients with CP-CPPS. Therefore, these patients were evaluated for the frequency with which the hypoechoic periurethral area was identifiable. Ultrasound measure- ment of the components in the bladder neck-proximal ure- thra was standardized and the correlations between these ultrasound findings and the symptoms of this disease were analyzed. Submitted for publication July 6, 2005. Infection/Inflammation 0022-5347/06/1761-0112/0 Vol. 176, 112-118, July 2006 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2006 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/S0022-5347(06)00567-2 112