Reply by the Authors

Abstract

We appreciate the thoughtful commentary on our article. As is well known, there is no single test as a diagnostic tool for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). 1 McNaughton Collins M. MacDonald R. Wilt T.J. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med. 2000; 133: 367-381 Crossref PubMed Scopus (120) Google Scholar According to the National Institutes of Health Classification System, CP/CPPS is characterized by symptoms of chronic pelvic pain and possibly voiding symptoms in the absence of urinary tract infection and commonly manifested as pain in areas including the perineum, rectum, prostate, penis, testicles, and abdomen. 2 Litwin M.S. McNaughton Collins M. Fowler F.J. et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999; 162: 369-375 Abstract Full Text Full Text PDF PubMed Scopus (769) Google Scholar , 3 Schaeffer A.J. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006; 355: 1690-1698 Crossref PubMed Scopus (165) Google Scholar However, in clinical trial, there is no objective consensus on the definition of CP/CPPS. In our study, the diagnosis of CP/CPPS was mainly based on a detailed history, including the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. We enrolled patients who reported a total score of at least 15 on NIH-CPSI and a score of at least 1 on item 1 and/or item 2 on NIH-CPSI that means that they had pain or discomfort with moderate or greater degree as symptoms of CP/CPPS. Although pain and/or discomfort is essential symptom of CP/CPPS, many patients have lower urinary tract symptoms at the same time. When we designed this study, we included transrectal ultrasound in the initial evaluation to confirm the possibility of combined benign prostatic hyperplasia (BPH), and the results showed that the lower urinary tract symptoms of our study cohort were rarely related with BPH. In real practice, it might be reasonable to consider transrectal ultrasound after evaluating uroflowmetry in suspicious patients for CP/CPPS. However, it is quite difficult to perform a step-by-step evaluation in clinical trials. Furthermore, transrectal ultrasound can provide a lot of useful information about the prostate, including prostatic volume, shape, possibility of cancer, existence of stone, and inflammatory lesion inside the prostate. In our study, baseline characteristics including prostatic volume were helpful to provide a great deal of understanding of our treatment cohort and rule out patients who deemed to have any other abnormality that would affect the study. Re: Kim et al.: The Efficacy of Extracorporeal Magnetic Stimulation for Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome Patients Who Do Not Respond to Pharmacotherapy (Urology 2013;82:894-898)UrologyVol. 83Issue 4PreviewIn the October issue of Urology, Kim et al1 reported their prospective study of extracorporeal magnetic stimulation for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). On the basis of their findings, the investigators demonstrated that extracorporeal magnetic stimulation is effective in terms of the primary endpoint, total and pain scores of the National Institutes of Health Chronic Prostatitis Symptom Index. This is an important finding because CP/CPPS is one of the most difficult conditions in urologic practice. Full-Text PDF