Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome

Alisa Stephens; J. Quentin Clemens; Thomas Jemielita; John T. Farrar; Siobhan Sutcliffe; Xiaoling Hou; J. Richard Landis; Philip Hanno; Ziya Kirkali; John W. Kusek; M. Scott Lucia; Robert M. Moldwin; Chris Mullins; Michel A. Pontari; David J. Klumpp; Anthony J. Schaeffer; Apkar (Vania) Apkarian; David Cella; Melissa A. Farmer; Colleen Fitzgerald; Richard Gershon; James W. Griffith; Charles J. Heckman; Mingchen Jiang; Laurie Keefer; Darlene S. Marko; Jean Michniewicz; Todd Parrish; Frank Tu; Emeran A. Mayer; Larissa V. Rodríguez; Jeffry Alger; Cody P. Ashe-McNalley; Ben Ellingson; Nuwanthi Heendeniya; Lisa Kilpatrick; Cara Kulbacki; Jason Kutch; Jennifer S. Labus; Bruce D. Naliboff; Fornessa Randal; Suzanne R. Smith; Karl J. Kreder; Catherine S. Bradley; Mary Eno; Kris Greiner; Yi Luo; Susan K. Lutgendorf; Michael A. O’Donnell; Barbara Ziegler; Daniel J. Clauw; Suzie As-Sanie; Sandra Berry; Clara Grayhack; Megan E. Halvorson; Richard Harris; Steve Harte; Eric Ichesco; Ann Oldendorf; Katherine A. Scott; David A. Williams; Dedra Buchwald; Niloofar Afari; John Krieger; Jane Miller; Stephanie Richey; Kelly Robertson; Susan O. Ross; Roberta Spiro; TJ Sundsvold; Eric Strachan; Claire C. Yang; Gerald L. Andriole; H. Henry Lai; Rebecca L. Bristol; Graham Colditz; Georg Deutsch; Vivien C. Gardner; Robert W. Gereau; Jeffrey P Henderson; Barry A. Hong; Thomas M. Hooton; Timothy J. Ness; Carol S. North; Theresa M. Spitznagle; Jennifer Anger; Michael Freeman; Jayoung Kim; Karyn Eilber; Jennifer Van Eyk; Wei Yang; Vincent Funari; Jeena Cha; Ted Barrell; Ro- Pauline Doe; Laura Gallagher; Tamara Howard; Nancy Robinson; Sandra Smith; Alisa Stephens; Yanli Wang; Xingmei Wang; Adrie van Bokhoven; Andrea A. Osypuk; Robert Dayton; Karen R. Jonscher; Holly T. Sullivan; R. Storey Wilson; Marsha A. Moses; Andrew C. Briscoe; David Briscoe; Adam Curatolo; John Froehlich; Richard S. Lee; Monisha Sachdev; Keith R. Solomon; Hanno Steen; Sean Mackey; Epifanio Bagarinao; Lauren C. Foster; Emily Hubbard; Kevin A. Johnson; Katherine T. Martucci; Rebecca L. McCue; Rachel R. Moericke; Aneesha Nilakantan; Noorulain Noor; J. Curtis Nickel; Garth D. Ehrlich; Tamara G. Bavendam

doi:10.1016/j.juro.2016.04.070

Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome

Alisa Stephens, J. Quentin Clemens, Thomas Jemielita, John T. Farrar, Siobhan Sutcliffe, Xiaoling Hou, J. Richard Landis, Philip Hanno, Ziya Kirkali, John W. Kusek, M. Scott Lucia, Robert M. Moldwin, Chris Mullins, Michel A. Pontari, David J. Klumpp, Anthony J. Schaeffer, Apkar (Vania) Apkarian, David Cella, Melissa A. Farmer, Colleen FitzgeraldRichard Gershon, James W. Griffith, Charles J. Heckman, Mingchen Jiang, Laurie Keefer, Darlene S. Marko, Jean Michniewicz, Todd Parrish, Frank Tu, Emeran A. Mayer, Larissa V. Rodríguez, Jeffry Alger, Cody P. Ashe-McNalley, Ben Ellingson, Nuwanthi Heendeniya, Lisa Kilpatrick, Cara Kulbacki, Jason Kutch, Jennifer S. Labus, Bruce D. Naliboff, Fornessa Randal, Suzanne R. Smith, Karl J. Kreder, Catherine S. Bradley, Mary Eno, Kris Greiner, Yi Luo, Susan K. Lutgendorf, Michael A. O’Donnell, Barbara Ziegler, Daniel J. Clauw, Suzie As-Sanie, Sandra Berry, Clara Grayhack, Megan E. Halvorson, Richard Harris, Steve Harte, Eric Ichesco, Ann Oldendorf, Katherine A. Scott, David A. Williams, Dedra Buchwald, Niloofar Afari, John Krieger, Jane Miller, Stephanie Richey, Kelly Robertson, Susan O. Ross, Roberta Spiro, TJ Sundsvold, Eric Strachan, Claire C. Yang, Gerald L. Andriole, H. Henry Lai, Rebecca L. Bristol, Graham Colditz, Georg Deutsch, Vivien C. Gardner, Robert W. Gereau, Jeffrey P Henderson, Barry A. Hong, Thomas M. Hooton, Timothy J. Ness, Carol S. North, Theresa M. Spitznagle, Jennifer Anger, Michael Freeman, Jayoung Kim, Karyn Eilber, Jennifer Van Eyk, Wei Yang, Vincent Funari, Jeena Cha, Ted Barrell, Ro- Pauline Doe, Laura Gallagher, Tamara Howard, Nancy Robinson, Sandra Smith, Alisa Stephens, Yanli Wang, Xingmei Wang, Adrie van Bokhoven, Andrea A. Osypuk, Robert Dayton, Karen R. Jonscher, Holly T. Sullivan, R. Storey Wilson, Marsha A. Moses, Andrew C. Briscoe, David Briscoe, Adam Curatolo, John Froehlich, Richard S. Lee, Monisha Sachdev, Keith R. Solomon, Hanno Steen, Sean Mackey, Epifanio Bagarinao, Lauren C. Foster, Emily Hubbard, Kevin A. Johnson, Katherine T. Martucci, Rebecca L. McCue, Rachel R. Moericke, Aneesha Nilakantan, Noorulain Noor, J. Curtis Nickel, Garth D. Ehrlich, Tamara G. Bavendam

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Abstract

PURPOSE We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability. MATERIALS AND METHODS Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts. RESULTS Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants. CONCLUSIONS Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.

Original language	English (US)
Pages (from-to)	1450-1455
Number of pages	6
Journal	The Journal of Urology
Volume	196
Issue number	5
DOIs	https://doi.org/10.1016/j.juro.2016.04.070
State	Published - 2016

Keywords

cystitis
epidemiologic research design
interstitial
pain
prostate
symptom assessment

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10.1016/j.juro.2016.04.070

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Stephens, A., Clemens, J. Q., Jemielita, T., Farrar, J. T., Sutcliffe, S., Hou, X., Landis, J. R., Hanno, P., Kirkali, Z., Kusek, J. W., Lucia, M. S., Moldwin, R. M., Mullins, C., Pontari, M. A., Klumpp, D. J., Schaeffer, A. J., Apkarian, A., Cella, D., Farmer, M. A., ... Bavendam, T. G. (2016). Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome. The Journal of Urology, 196(5), 1450-1455. https://doi.org/10.1016/j.juro.2016.04.070

Stephens, A, Clemens, JQ, Jemielita, T, Farrar, JT, Sutcliffe, S, Hou, X, Landis, JR, Hanno, P, Kirkali, Z, Kusek, JW, Lucia, MS, Moldwin, RM, Mullins, C, Pontari, MA, Klumpp, DJ, Schaeffer, AJ, Apkarian, A, Cella, D, Farmer, MA, Fitzgerald, C, Gershon, R, Griffith, JW, Heckman, CJ, Jiang, M, Keefer, L, Marko, DS, Michniewicz, J, Parrish, T, Tu, F, Mayer, EA, Rodríguez, LV, Alger, J, Ashe-McNalley, CP, Ellingson, B, Heendeniya, N, Kilpatrick, L, Kulbacki, C, Kutch, J, Labus, JS, Naliboff, BD, Randal, F, Smith, SR, Kreder, KJ, Bradley, CS, Eno, M, Greiner, K, Luo, Y, Lutgendorf, SK, O’Donnell, MA, Ziegler, B, Clauw, DJ, As-Sanie, S, Berry, S, Grayhack, C, Halvorson, ME, Harris, R, Harte, S, Ichesco, E, Oldendorf, A, Scott, KA, Williams, DA, Buchwald, D, Afari, N, Krieger, J, Miller, J, Richey, S, Robertson, K, Ross, SO, Spiro, R, Sundsvold, TJ, Strachan, E, Yang, CC, Andriole, GL, Lai, HH, Bristol, RL, Colditz, G, Deutsch, G, Gardner, VC, Gereau, RW, Henderson, JP, Hong, BA, Hooton, TM, Ness, TJ, North, CS, Spitznagle, TM, Anger, J, Freeman, M, Kim, J, Eilber, K, Van Eyk, J, Yang, W, Funari, V, Cha, J, Barrell, T, Doe, RP, Gallagher, L, Howard, T, Robinson, N, Smith, S, Stephens, A, Wang, Y, Wang, X, van Bokhoven, A, Osypuk, AA, Dayton, R, Jonscher, KR, Sullivan, HT, Wilson, RS, Moses, MA, Briscoe, AC, Briscoe, D, Curatolo, A, Froehlich, J, Lee, RS, Sachdev, M, Solomon, KR, Steen, H, Mackey, S, Bagarinao, E, Foster, LC, Hubbard, E, Johnson, KA, Martucci, KT, McCue, RL, Moericke, RR, Nilakantan, A, Noor, N, Nickel, JC, Ehrlich, GD & Bavendam, TG 2016, 'Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome', The Journal of Urology, vol. 196, no. 5, pp. 1450-1455. https://doi.org/10.1016/j.juro.2016.04.070

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title = "Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome",

abstract = "PURPOSE We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability. MATERIALS AND METHODS Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts. RESULTS Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants. CONCLUSIONS Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.",

keywords = "cystitis, epidemiologic research design, interstitial, pain, prostate, symptom assessment",

author = "Alisa Stephens and Clemens, {J. Quentin} and Thomas Jemielita and Farrar, {John T.} and Siobhan Sutcliffe and Xiaoling Hou and Landis, {J. Richard} and Philip Hanno and Ziya Kirkali and Kusek, {John W.} and Lucia, {M. Scott} and Moldwin, {Robert M.} and Chris Mullins and Pontari, {Michel A.} and Klumpp, {David J.} and Schaeffer, {Anthony J.} and Apkarian, {Apkar (Vania)} and David Cella and Farmer, {Melissa A.} and Colleen Fitzgerald and Richard Gershon and Griffith, {James W.} and Heckman, {Charles J.} and Mingchen Jiang and Laurie Keefer and Marko, {Darlene S.} and Jean Michniewicz and Todd Parrish and Frank Tu and Mayer, {Emeran A.} and Rodr{\'i}guez, {Larissa V.} and Jeffry Alger and Ashe-McNalley, {Cody P.} and Ben Ellingson and Nuwanthi Heendeniya and Lisa Kilpatrick and Cara Kulbacki and Jason Kutch and Labus, {Jennifer S.} and Naliboff, {Bruce D.} and Fornessa Randal and Smith, {Suzanne R.} and Kreder, {Karl J.} and Bradley, {Catherine S.} and Mary Eno and Kris Greiner and Yi Luo and Lutgendorf, {Susan K.} and O{\textquoteright}Donnell, {Michael A.} and Barbara Ziegler and Clauw, {Daniel J.} and Suzie As-Sanie and Sandra Berry and Clara Grayhack and Halvorson, {Megan E.} and Richard Harris and Steve Harte and Eric Ichesco and Ann Oldendorf and Scott, {Katherine A.} and Williams, {David A.} and Dedra Buchwald and Niloofar Afari and John Krieger and Jane Miller and Stephanie Richey and Kelly Robertson and Ross, {Susan O.} and Roberta Spiro and TJ Sundsvold and Eric Strachan and Yang, {Claire C.} and Andriole, {Gerald L.} and Lai, {H. Henry} and Bristol, {Rebecca L.} and Graham Colditz and Georg Deutsch and Gardner, {Vivien C.} and Gereau, {Robert W.} and Henderson, {Jeffrey P} and Hong, {Barry A.} and Hooton, {Thomas M.} and Ness, {Timothy J.} and North, {Carol S.} and Spitznagle, {Theresa M.} and Jennifer Anger and Michael Freeman and Jayoung Kim and Karyn Eilber and {Van Eyk}, Jennifer and Wei Yang and Vincent Funari and Jeena Cha and Ted Barrell and Doe, {Ro- Pauline} and Laura Gallagher and Tamara Howard and Nancy Robinson and Sandra Smith and Alisa Stephens and Yanli Wang and Xingmei Wang and {van Bokhoven}, Adrie and Osypuk, {Andrea A.} and Robert Dayton and Jonscher, {Karen R.} and Sullivan, {Holly T.} and Wilson, {R. Storey} and Moses, {Marsha A.} and Briscoe, {Andrew C.} and David Briscoe and Adam Curatolo and John Froehlich and Lee, {Richard S.} and Monisha Sachdev and Solomon, {Keith R.} and Hanno Steen and Sean Mackey and Epifanio Bagarinao and Foster, {Lauren C.} and Emily Hubbard and Johnson, {Kevin A.} and Martucci, {Katherine T.} and McCue, {Rebecca L.} and Moericke, {Rachel R.} and Aneesha Nilakantan and Noorulain Noor and Nickel, {J. Curtis} and Ehrlich, {Garth D.} and Bavendam, {Tamara G.}",

year = "2016",

doi = "10.1016/j.juro.2016.04.070",

language = "English (US)",

volume = "196",

pages = "1450--1455",

journal = "The Journal of Urology",

issn = "0022-5347",

publisher = "Elsevier Inc.",

number = "5",

}

TY - JOUR

T1 - Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome

AU - Stephens, Alisa

AU - Clemens, J. Quentin

AU - Jemielita, Thomas

AU - Farrar, John T.

AU - Sutcliffe, Siobhan

AU - Hou, Xiaoling

AU - Landis, J. Richard

AU - Hanno, Philip

AU - Kirkali, Ziya

AU - Kusek, John W.

AU - Lucia, M. Scott

AU - Moldwin, Robert M.

AU - Mullins, Chris

AU - Pontari, Michel A.

AU - Klumpp, David J.

AU - Schaeffer, Anthony J.

AU - Apkarian, Apkar (Vania)

AU - Cella, David

AU - Farmer, Melissa A.

AU - Fitzgerald, Colleen

AU - Gershon, Richard

AU - Griffith, James W.

AU - Heckman, Charles J.

AU - Jiang, Mingchen

AU - Keefer, Laurie

AU - Marko, Darlene S.

AU - Michniewicz, Jean

AU - Parrish, Todd

AU - Tu, Frank

AU - Mayer, Emeran A.

AU - Rodríguez, Larissa V.

AU - Alger, Jeffry

AU - Ashe-McNalley, Cody P.

AU - Ellingson, Ben

AU - Heendeniya, Nuwanthi

AU - Kilpatrick, Lisa

AU - Kulbacki, Cara

AU - Kutch, Jason

AU - Labus, Jennifer S.

AU - Naliboff, Bruce D.

AU - Randal, Fornessa

AU - Smith, Suzanne R.

AU - Kreder, Karl J.

AU - Bradley, Catherine S.

AU - Eno, Mary

AU - Greiner, Kris

AU - Luo, Yi

AU - Lutgendorf, Susan K.

AU - O’Donnell, Michael A.

AU - Ziegler, Barbara

AU - Clauw, Daniel J.

AU - As-Sanie, Suzie

AU - Berry, Sandra

AU - Grayhack, Clara

AU - Halvorson, Megan E.

AU - Harris, Richard

AU - Harte, Steve

AU - Ichesco, Eric

AU - Oldendorf, Ann

AU - Scott, Katherine A.

AU - Williams, David A.

AU - Buchwald, Dedra

AU - Afari, Niloofar

AU - Krieger, John

AU - Miller, Jane

AU - Richey, Stephanie

AU - Robertson, Kelly

AU - Ross, Susan O.

AU - Spiro, Roberta

AU - Sundsvold, TJ

AU - Strachan, Eric

AU - Yang, Claire C.

AU - Andriole, Gerald L.

AU - Lai, H. Henry

AU - Bristol, Rebecca L.

AU - Colditz, Graham

AU - Deutsch, Georg

AU - Gardner, Vivien C.

AU - Gereau, Robert W.

AU - Henderson, Jeffrey P

AU - Hong, Barry A.

AU - Hooton, Thomas M.

AU - Ness, Timothy J.

AU - North, Carol S.

AU - Spitznagle, Theresa M.

AU - Anger, Jennifer

AU - Freeman, Michael

AU - Kim, Jayoung

AU - Eilber, Karyn

AU - Van Eyk, Jennifer

AU - Yang, Wei

AU - Funari, Vincent

AU - Cha, Jeena

AU - Barrell, Ted

AU - Doe, Ro- Pauline

AU - Gallagher, Laura

AU - Howard, Tamara

AU - Robinson, Nancy

AU - Smith, Sandra

AU - Stephens, Alisa

AU - Wang, Yanli

AU - Wang, Xingmei

AU - van Bokhoven, Adrie

AU - Osypuk, Andrea A.

AU - Dayton, Robert

AU - Jonscher, Karen R.

AU - Sullivan, Holly T.

AU - Wilson, R. Storey

AU - Moses, Marsha A.

AU - Briscoe, Andrew C.

AU - Briscoe, David

AU - Curatolo, Adam

AU - Froehlich, John

AU - Lee, Richard S.

AU - Sachdev, Monisha

AU - Solomon, Keith R.

AU - Steen, Hanno

AU - Mackey, Sean

AU - Bagarinao, Epifanio

AU - Foster, Lauren C.

AU - Hubbard, Emily

AU - Johnson, Kevin A.

AU - Martucci, Katherine T.

AU - McCue, Rebecca L.

AU - Moericke, Rachel R.

AU - Nilakantan, Aneesha

AU - Noor, Noorulain

AU - Nickel, J. Curtis

AU - Ehrlich, Garth D.

AU - Bavendam, Tamara G.

PY - 2016

Y1 - 2016

N2 - PURPOSE We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability. MATERIALS AND METHODS Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts. RESULTS Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants. CONCLUSIONS Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.

AB - PURPOSE We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability. MATERIALS AND METHODS Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts. RESULTS Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants. CONCLUSIONS Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.

KW - cystitis

KW - epidemiologic research design

KW - interstitial

KW - pain

KW - prostate

KW - symptom assessment

U2 - 10.1016/j.juro.2016.04.070

DO - 10.1016/j.juro.2016.04.070

M3 - Article

SN - 0022-5347

VL - 196

SP - 1450

EP - 1455

JO - The Journal of Urology

JF - The Journal of Urology

IS - 5

ER -

Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome

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