Evidence for Overlap Between Urological and Nonurological Unexplained Clinical Conditions

Purpose

Unexplained clinical conditions share common features such as pain, fatigue, disability out of proportion to physical examination findings, inconsistent laboratory abnormalities, and an association with stress and psychosocial factors. We examined the extent of the overlap among urological and nonurological unexplained clinical conditions characterized by pain. We describe the limitations of previous research and suggest several possible explanatory models.

Materials and Methods

Using hallmark symptoms and syndromes as search terms a search of 12 databases identified a total of 1,037 full-length published articles in 8 languages from 1966 to April 2008. The search focused on the overlap of chronic pelvic pain, interstitial cystitis, painful bladder syndrome, chronic prostatitis/chronic pelvic pain syndrome or vulvodynia with fibromyalgia, chronic fatigue syndrome, temporomandibular joint and muscle disorders or irritable bowel syndrome. We abstracted information on authorship, type of case and control groups, eligibility criteria, case definitions, study methods and major findings.

Results

The literature suggests considerable comorbidity between urological and nonurological unexplained clinical conditions. The most robust evidence for overlap was for irritable bowel syndrome and urological unexplained syndromes with some estimates of up to 79% comorbidity between chronic pelvic pain and symptoms of irritable bowel syndrome. However, most studies were limited by methodological problems, such as varying case definitions and selection of controls.

Conclusions

The overlap between urological and selected nonurological unexplained clinical conditions is substantial. Future research should focus on using standardized definitions, and rigorously designed, well controlled studies to further assess comorbidity, clarify the magnitude of the association and examine common pathophysiological mechanisms.

Key Words: urogenital system, fatigue syndrome, chronic, fibromyalgia, irritable bowel syndrome, temporomandibular joint disorders

Abbreviations and Acronyms: CFS, chronic fatigue syndrome, CP, chronic prostatitis, CPP, chronic pelvic pain, CPPS, CPP syndrome, CWP, chronic widespread pain, FM, fibromyalgia, IBD, inflammatory bowel disease, IBS, irritable bowel syndrome, IC, interstitial cystitis, NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases, PBS, painful bladder syndrome, TMD, temporomandibular joint and muscle disorders