From the Research
The most likely urodynamic study (UDS) finding in this 29-year-old healthy man with perineal pain, constipation, intermittent dysuria, and pelvic muscle tenderness on digital rectal examination (DRE) is A. Low peak flow rate. This patient's presentation is consistent with chronic pelvic pain syndrome (CPPS) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which is characterized by pelvic floor muscle dysfunction and spasm. The pelvic floor muscle spasm can lead to functional bladder outlet obstruction, resulting in a low peak flow rate on urodynamic testing. The normal urinalysis rules out infection as a cause of his symptoms. Patients with pelvic floor dysfunction typically have difficulty relaxing their pelvic floor muscles during voiding, which creates increased urethral resistance and subsequently reduces urinary flow rates. The other options are less likely: detrusor overactivity would present with urgency and frequency, poor compliance would cause storage symptoms, detrusor sphincter dyssynergia is typically seen in neurological conditions, and large bladder capacity is not characteristic of CPPS. As noted in the most recent study 1, detrusor sphincter dyssynergia (DSD) is typically associated with spinal cord lesions, which is not indicated in this patient's presentation. Therefore, based on the patient's symptoms and the absence of neurological conditions, low peak flow rate is the most likely UDS finding. Key points to consider in this diagnosis include:
- Pelvic floor muscle dysfunction and spasm
- Functional bladder outlet obstruction
- Normal urinalysis ruling out infection
- Difficulty relaxing pelvic floor muscles during voiding
- Increased urethral resistance and reduced urinary flow rates. It is essential to prioritize the patient's morbidity, mortality, and quality of life when making this diagnosis, and low peak flow rate is the most appropriate diagnosis based on the provided evidence 1.