Chronic Prostatitis Symptom Index Research Articles

The chronic prostatitis/chronic pelvic pain syndrome and pain catastrophizing: A vicious combination

This study aimed to evaluate the presence and importance of pain catastrophizing among men diagnosed with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a routine clinical setting. 61 men, mean age 46 ± 11 years, with a mean CP/CPPS history of 11 ± 11 years, completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Short-Form McGill Pain Questionnaire (SF-MPQ) and Coping Strategies Questionnaire (CSQ) to evaluate pain catastrophizing, and the International Index of Erectile Function (IIEF-5). They were also scored according to the UPOINT system. The patients' mean scores were: IEEF-5 17.6 ± 7.3, NIH-CPSI pain subscale 11.1 ± 4.4, quality of life question 2.7 ± 1.6, quality of life impact subscale 6.9 ± 2.7 and CSQ catastrophizing score 15.3 ± 9.1. Patients with a high tendency for catastrophizing (CSQ score ≥20) (28%) had higher UPOINT and pain scores, worse quality of life and quality of life impact, but did not stand out regarding voiding dysfunction and ejaculatory pain. Two distinctly different cohorts could be identified: a smaller cohort with a high degree of catastrophizing, severe pain and poor quality of life, and a larger one with a low degree of catastrophizing, less severe pain and moderately reduced quality of life. It is important in clinical practice to distinguish between the two groups since they require different therapeutic approaches.

Pain associated with the chronic pelvic pain syndrome is strongly related to the ambient temperature

There are indications suggesting that the pain associated with the chronic pelvic pain syndrome (CPPS) may be related to cold. The purpose of the present study was to evaluate how the symptom intensity reported by the patient relates to the time of the year in a temperate climate, i.e. to the ambient temperature and to weather changes. Thirty-one patients, mean age 51 years (range 35-66 years), with CPPS for 17 ± 10 years (3-42 years) were asked to complete a set of questionnaires including questions concerning how they experienced their symptom intensity during the different seasons using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. The total NIH-CPSI score was 22.2 ± 8.2. There was a highly marked relationship between season and pain intensity as reported by the informants: it was experienced to be three times more intense during the winter months. All subjects reported that a temperature drop was associated with deterioration. The strong relationship between the ambient temperature, a drop in temperature and the pain experienced by men with CPPS confirms the association between cold and symptom intensity in the Scandinavian countries, where the seasonal temperature variation spans a long range and the winters are long. The cause of this relationship is still to be established. Muscular spasm/stiffness is a possibility that remains to be explored.

¿Evita la antibioterapia biopsias de próstata en pacientes con valores elevados de PSA?

IntroductionWe investigated if antibiotherapy has any role on total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. Material and MethodsA total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA >2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, “The International Prostate Symptom Score” (IPSS) and “National Institutes of Health Chronic Prostatitis Symptom Index” (NIH-CPSI) questinories are performed and serum tPSA, fPSA and fPSA/tPSA values were obtained. ResultsTPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. ConclusionsAntibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist.

Depression, Anxiety, Stress Perception, and Coping Strategies in Korean Military Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

PurposeThe objective of this study was to examine the psychological features and coping strategies of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).Materials and MethodsThe participants consisted of 55 military personnel suffering from CP/CPPS and 58 military personnel without CP/CPPS symptoms working at the Military Capital Hospital. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to assess CP/CPPS symptoms. The Responses to Hospital Anxiety and Depression (HAD) scale, Social Readjustment Rating Scale, and Global Assessment of Recent Stress (GARS) scale were compared between the two groups. The Weisman Coping Strategy Scale was used to assess coping ability with CP/CPPS.ResultsThe NIH-CPSI score of the CP/CPPS group was significantly higher than that of the control group for all domains including pain, urinary symptoms, quality of life, and summed score. The Anxiety and Depression domain of the HAD showed significant differences between the two groups. There were no significant differences in the Social Readjustment Rating Scale between the two groups, but the sum of the GARS score was higher in the CP/CPPS group than in the control group. These were correlated with the pain, quality of life, and sum domains of the NIH-CPSI. The Weisman Coping Strategy Scale showed that intellectualization, redefinition, and flexibility were higher in frequency in descending order, and that fatalism, externalization, and self-pity were lower in frequency.ConclusionsThe CP/CPPS patients had depression, anxiety, and higher perception of stress. In particular, these were closely related to the pain and quality of life of the patients.

Research of Correlation Between the Amount of Leukocyte in EPS and NIH-CPSI: Result From 1242 Men in Fangchenggang Area in Guangxi Province

To investigate the correlation between the leukocyte in expressed prostatic secretion (EPS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) in a large Chinese male population. Data were collected from 1242 men who participated in the population-based Fangchenggang Area Male Health and Examination Survey (FAMHES), which was carried out in Guangxi, China from September 2009 to December 2009. The severity and symptoms of chronic prostatitis were accessed by the National Institutes of Health Chronic Prostatitis Symptom Index. Meanwhile, the leukocyte in EPS was counted. Demographic information, lifestyle characteristic, and medical history were also obtained through questionnaire. There was no linear correlation between the leukocyte in EPS and NIH-CPSI scores in all subjects (n=1242) (P>.05). Regardless of whether subjects had prostatitis-like symptoms (n=107), there was no linear correlation between the leukocyte in EPS and NIH-CPSI scores (P>.05). After using chi-square tests linear-by-linear association, there were also no linear correlation between the leukocyte in EPS and NIH-CPSI scores (P>.05). The results of this study have demonstrated that either in all subjects or in the subjects with prostatitis-like symptoms, there was no linear correlation between the leukocyte in EPS and the severity symptom. So the amount of leukocyte in EPS was unsuitable to apply as the only index of diagnosis, evaluating and observing curative effect. The index should be taken into account for a variety of factors. The improvement of clinical symptom and quality of life were the key points.

The Effects of Transrectal Radiofrequency Hyperthermia on Patients With Chronic Prostatitis and the Changes of MDA, NO, SOD, and Zn Levels in Pretreatment and Posttreatment

To assess the effect of transrectal radiofrequency hyperthermia (TRFH) in 159 patients with chronic prostatitis (CP) and explore the changes of reactive oxygen species in CP patients pretreatment and posttreatment. Patients diagnosed with CP were randomized to 6 weeks of tamsulosin plus clarithromycin, TRFH, or TRFH with tamsulosin plus clarithromycin group. The primary outcome measure was evaluated by the National Institutes of Health Chronic Prostatitis Symptom Index. Malondiadehyde (MDA), superoxide dismutase (SOD), and nitrogen monoxide (NO) were measured by biochemical assay. Zinc (Zn) content was assayed by atomical spectrophotography. All 105 patients in the TRFH or TRFH with tamsulosin plus clarithromycin group showed statistically significant improvement of pain, quality of life, and micturition domains compared with the tamsulosin plus clarithromycin group. Regardless of type IIIa or type IIIb CP, there was a significant improvement in the TRFH or TRFH with tamsulosin plus clarithromycin group compared with tamsulosin plus clarithromycin group (P<.05). Compared with pretreatment, MDA, NO, and Zn were decreased in type II and IIIa, whereas SOD was only increased significantly in type II (P<.05). Our study reveals TRFH as an effective therapy option for CP, especially type IIIa or type IIIb CP. The results of TRFH with tamsulosin plus clarithromycin group was superior to the TRFH group or the tamsulosin plus clarithromycin group alone. In comparison with pretreatment, differences in reactive oxygen species levels and Zn in CP patients suggest that these factors could be used as a biomarker to evaluate the symptoms of CP and the effects of treatment.

Use of Pelvic Floor Ultrasound to Assess Pelvic Floor Muscle Function in Urological Chronic Pelvic Pain Syndrome in Men

An important cause or maintaining factor for pain in Urological Chronic Pelvic Pain Syndrome (UCPPS) may be pelvic floor muscle (PFM) dysfunction, which may also be implicated in sexual dysfunction and influenced by psychosocial factors. Pelvic floor ultrasound is a noninvasive, reliable, and relatively simple method to assess PFM morphology and function and can be assessed by the anorectal angle (ARA) and levator plate angle (LPA). The aim of the present study was to examine PFM morphology in men with UCPPS as compared with controls and to examine the correlation with pain and psychosocial measures. Our participants were 24 men with UCPPS and 26 controls. A GE Voluson E8 ultrasound probe was placed on the perineum, and three-dimensional images were taken at rest and during PFM contraction. The main outcomes were ARA and LPA at rest and contraction. Participants also completed the National Institute of Health (NIH) Chronic Prostatitis Symptom Index, Male Sexual Health Questionnaire, State Anxiety Inventory, and Pain Catastrophizing Scale. Men with UCPPS had more acute ARAs than controls both at rest and during contraction. The two groups did not differ in LPA at rest; however, men with UCPPS had significantly more acute angles during contraction and LP excursion. Acute ARAs were positively correlated with greater pain report and sexual dysfunction. Anxiety was correlated with more acute ARAs and more obtuse LPAs. Three implications can be drawn from the findings. First, ARA at rest and during contraction as well as LP angle during contraction and LPA excursion separates men with UCPPS from controls. Second, ARA at rest and during contraction was correlated with pain and sexual dysfunction, while LPA at rest was related to anxiety. Third, pelvic floor ultrasound has the potential to be a useful and objective method of assessing PFM morphology in UCPPS.

Influence of Environmental Factors on Prevalence, Symptoms, and Pathologic Process of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Northwest China

To compare the prevalence, symptoms, and pathologic changes related to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with significant prostatitis-like symptoms between 2 altitude areas in northwest China. From October 2009 to March 2010 community male residents at 3000 m (Delingha) and 400 m (Xi'An) constituted the population base for the present cross-sectional study. All participants completed a detailed questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index, and the subjects who met our definition were invited to undergo clinical evaluation. After screening, the subjects considered to have CP/CPPS were separated into 2 groups: those with type IIIa and those with type IIIb CP/CPPS. The prevalence of CP/CPPS with significant prostatitis-like symptoms was significantly different between the 2 groups. Moreover, the National Institutes of Health Chronic Prostatitis Symptom Index of patients with type IIIa and IIIb in 2 groups differed significantly, indicating the aggravation of symptoms of CP/CPPS at a high altitude. Additional investigations showed that reactive oxygen species were increased, accompanied by a decrease in the total antioxidant capacity in the expressed prostatic secretions of patients with type IIIa at a higher altitude. In addition, the tumor necrosis factor-α, interleukin-8, and interleukin-10 levels in the expressed prostatic secretions of patients with type IIIa in Delingha were increased compared with that in the patients with type IIIa in Xi'An. Notably, the interleukin-6 level in the expressed prostatic secretions was greater in those with type IIIa and IIIb at a higher altitude than in those with type IIIa and IIIb at a low altitude. At a high altitude, the symptoms of CP/CPPS were aggravated. Oxidative stress and cytokines might involve in the pathologic process and the aggravation of symptoms. In addition, in a high altitude area the pathomechanisms of type IIIa and IIIb CP/CPPS differed.

A feasibility trial of a cognitive-behavioural symptom management program for chronic pelvic pain for men with refractory chronic prostatitis/chronic pelvic pain syndrome

Our objective was to determine the feasibility of a cognitive behavioural symptom management program for the acute improvement of psychosocial risk factors of diminished quality of life (QoL) in men suffering from chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We assessed CP/CPPS symptoms and impact (i.e., chronic prostatitis symptom index [CPSI] pain, urinary, QoL domains), psychosocial risk factors were assessed at baseline and weekly for 8 weeks. We included the following psychosocial risk factors: catastrophizing (Pain Catastrophizing Scale, PCS), mood (Center for Epidemiological Studies in Depression Scale, CES-D), social support (Multidimensional Scale of Perceived Social Support, MSPSS) and general pain (McGill Pain Questionnaire). Patient sessions dispute and replace pessimistic thinking with health-focused thinking and behaviour. Eleven men completed the psychosocial management program (mean age = 51.3, standard deviaton [SD] = 12.49). Mean CPSI baseline total score was 25.2 (SD = 10.21). Repeated measures ANOVAs showed the program was associated with significant linear reductions for pain (p = 0.051), disability (p= 0.020) and catastrophizing (p = 0.005), but no changes in depressive symptoms or social support. The CPSI baseline scores compared to follow-up scores (n = 8) were significantly reduced (p = 0.007), with CPSI pain (p = 0.015) and QoL impact (p = 0.013) reduced, but not for urinary scores. Correlations between change scores at the baseline and at 8 weeks for CPSI and psychosocial risk factors indicated that reductions in catastrophizing were most strongly associated with score reductions for the CPSI; these reductions, however, were not significant. The psychosocial management program targets and significantly reduces several empirically supported psychosocial risk factors associated with poorer CP/CPPS outcomes. Psychosocial management for CP/CPPS is feasible, but requires a randomized controlled trial with longitudinal follow-up.

Self Management Activation Randomised Trial for Prostatitis (SMART-P): study protocol for a randomised controlled trial

BackgroundChronic prostatitis otherwise known as chronic pelvic pain syndrome is a common urological diagnosis that causes many men significant morbidity and has a detrimental effect on their quality of life. Standard treatment with antibiotics and simple analgesia are often ineffective and many patients are managed by the chronic pain services.Cognitive behavioural therapy has been shown to be helpful in the management of many chronic diseases and has recently been proposed as an effective treatment for chronic prostatitis. Furthermore, a self management programme administered to groups of men with lower urinary tract symptoms has been shown to be more effective than standard treatments including surgery.Therefore, we have developed a cognitive behavioural therapy programme specifically for men with chronic prostatitis. This novel treatment approach will be compared to conventional therapy in the pain clinic such as atypical analgesia and local anaesthetic injections in the context of a randomised controlled trial.Methods/DesignMen will be recruited from general urology outpatient clinics following the exclusion of other diagnoses that could be responsible for their symptoms. Men will be randomised to attend either a self management healthcare and education programme or to pain clinic referral alone. The self management programme will be administered by a clinical psychologist to small groups of men over six consecutive weekly sessions each lasting two hours. Patients will be taught techniques of problem-solving and goal-setting and will learn coping mechanisms and how to modify catastrophic cognition.The primary outcome will be change from baseline in the National Institute of Health Chronic Prostatitis Symptom Index, a validated instrument for the assessment of men with chronic prostatitis. Secondary outcomes include generic quality of life scores and analgesic and drug usage. Outcomes will be assessed at 2, 6 and 12 months.DiscussionIf this group administered self management programme is shown to be effective in the treatment of men with chronic prostatitis it may become the new standard of care for these patients. Furthermore, it may be adapted for use in women with interstitial cystitis, a condition which is analogous to chronic prostatitis in men.Trial RegistrationCurrent Controlled Trials ISRCTN21012555

Validación psicométrica del instrumento índice internacional de función eréctil en pacientes con disfunción eréctil en Perú

To perform the psychometric validation of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction. Prospective case series to evaluate the validity and the reliability of the scale. More than 90 % of experts considered that the IIEF questions evaluated the domains and the construct (content validity). There was a perfect concordance between the expert evaluation and the IIEF results (criteria validity, Kappa = 1). Significant differences were found in the score media by domains between patients with and without ED but when severity was evaluated, only differences in the erectile function domain were found (discriminatory validity). The Chronic Prostatitis Symptom Index (ISPC) and the IIEF showed divergent results (Kappa < 0.01, p = 0.44) in relation with the severity and the total scores showed no correlation (divergent validity) (r(s) = -0.22, p = 0.16). The correlation coefficients by domains were mild to moderate and the correlation between the total scores was high (rs = 0.8, p < 0.001) (test retest repeatability). A high degree of internal consistency with Cronbach's alpha values > 0.8 in the five domains was found. The cross-culturally validated IIEF in Peru is a valid and reliable instrument for its local use in the fields of clinics and research.

Efficacy of anticholinergics for chronic prostatitis/chronic pelvic pain syndrome in young and middle-aged patients: a single-blinded, prospective, multi-center study.

PurposeChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) exhibits variable lower urinary tract symptoms (LUTS). The aim of this study was to evaluate the incidence of LUTS and the efficacy of an anticholinergic agent in young and middle-aged CP/CPPS patients.MethodsNinety-six men with CP/CPPS were randomly assigned in a single-blind fashion and received either ciprofloxacin (group 1, 49 patients) or ciprofloxacin and solifenacin (5 mg/day; group 2, 47 patients) for 8 weeks. The National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), the International Prostate Symptom Score (IPSS), and the International Index of Erectile Function-5 (IIEF-5) were used to grade the patients' symptoms and the quality of life impact at the start of the study, and at 4 and 8 weeks from the initiation of the study.ResultsThere was no significant difference between groups 1 and 2 with respect to age, duration of disease, or sub-domains of the IPSS, NIH-CPSI, or IIEF-5 at baseline. Of these patients, 67.4% had LUTS. Statistically significant differences were determined via the NIH-CPSI for total score and the pain and urinary domain scores. Statistically significant differences were determined via the IPSS for total score and the storage domain score. The total score of the IIEF-5 increased, but the change was not significant. There was no statistically significant difference in residual urine.ConclusionsMany CP/CPPS patients had LUTS. Solifenacin in CP/CPPS demonstrated improvements in the NIH-CPSI and the IPSS total score and storage score. Storage factors significantly improved via the NIH-CPSI and IPSS assessments in the solifenacin treatment group.

Dutasteride Reduces Prostatitis Symptoms Compared With Placebo in Men Enrolled in the REDUCE Study

Men at risk for prostate cancer may concurrently experience chronic prostatitis or pelvic pain. We evaluated the effect of dutasteride on prostatitis-like symptoms in the REDUCE study population. REDUCE was a 4-year, randomized, double-blind, placebo controlled study of prostate cancer risk reduction with 0.5 mg dutasteride vs placebo in men 50 to 75 years old with prostate specific antigen 2.5 to 10 ng/ml and a negative prostate biopsy in the previous 6 months. In this analysis we investigated change from baseline in Chronic Prostatitis Symptom Index in men with prostatitis-like pain (Chronic Prostatitis Symptom Index pain subscore 5 or greater) and prostatitis-like syndrome (perineal or ejaculatory pain plus Chronic Prostatitis Symptom Index pain subscore 4 or greater), the proportion of subjects with at least a moderate Chronic Prostatitis Symptom Index response (6-unit or greater improvement) and reports of new onset clinical prostatitis. Of 5,379 men with a total baseline Chronic Prostatitis Symptom Index score 678 (12.6%) had prostatitis-like pain and 427 (7.9%) had prostatitis-like syndrome. Chronic Prostatitis Symptom Index total score decreased significantly at 48 months in the dutasteride group vs placebo in men with prostatitis-like pain (p <0.0001) and with prostatitis-like syndrome (t test p = 0.03). There were significantly more Chronic Prostatitis Symptom Index responders with dutasteride vs placebo in the prostatitis-like pain (49% vs 37%, respectively, p = 0.0033) and prostatitis-like syndrome (46% vs 35%, Fisher's exact test p = 0.0265) subgroups. Prostatitis was reported as an adverse event by significantly more men randomized to placebo (3.6%) than to dutasteride (2.5%, p = 0.003). Long-term dutasteride therapy resulted in improvement in prostatitis related symptoms in older men with an increased prostate specific antigen.

Greater Endothelial Dysfunction and Arterial Stiffness in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome—A Possible Link to Cardiovascular Disease

Men with chronic prostatitis/chronic pelvic pain syndrome have higher self-reported rates of cardiac disease than controls. Peripheral arterial tone abnormalities correlate with cardiac disease and mortality. We studied vascular dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome and controls. A total of 21 men with chronic prostatitis/chronic pelvic pain syndrome and 14 asymptomatic controls were tested with an Endo-PAT®2000 machine which assessed the augmentation index, a measure of arterial stiffness, and reactive hyperemia index, a measure of endothelial vasodilation. Symptoms were measured with the National Institutes of Health Chronic Prostatitis Symptom Index and patient phenotype was characterized by the UPOINT (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles) system. Statistical significance was set at p<0.05. Age was similar in the chronic prostatitis/chronic pelvic pain syndrome group (range 22 to 63 years, median 40) and controls (range 19 to 57, median 40). Patients had median symptom duration of 24 months (range 3 to 440), a mean Chronic Prostatitis Symptom Index score of 24.7±5.1 and mean UPOINT domains of 2.9±1.1 (range 1 to 5). The augmentation index was significantly higher (greater arterial stiffness) in patients with chronic pelvic pain syndrome vs controls (5.0%±2.3 vs -6.0%±3.0, p=0.006). The reactive hyperemia index was significantly lower (more endothelial dysfunction) in patients with chronic pelvic pain syndrome (1.76±1.2 vs 2.21±1.7, p=0.03). There was no correlation between symptom duration, severity or phenotype (number or type of UPOINT domains) and reactive hyperemia index or augmentation index. Men with chronic prostatitis/chronic pelvic pain syndrome have evidence of increased arterial stiffness and vascular endothelial dysfunction. This is the first mechanistic correlation found that links the higher incidence of self-reported cardiac disease in these patients. Noninvasive Endo-PAT testing may allow stratification of cases of chronic prostatitis/chronic pelvic pain syndrome by vascular dysfunction, which may require specific treatment or at least further assessment of cardiac risk.

Elevated body mass index correlates with higher seminal plasma interleukin 8 levels and ultrasonographic abnormalities of the prostate in men attending an andrology clinic for infertility.

Obesity is associated with a systemic, low-grade inflammatory state. Although the relationship between obesity and semen parameters or prostate diseases has been previously investigated, the association between body mass index (BMI), prostate inflammatory diseases and color- Doppler ultrasound (CDU) of the male genital tract (MGT) has been poorly studied. To evaluate the association between BMI and CDU features of the MGT, signs and symptoms of prostate inflammation, semen parameters. We studied 222 men seeking medical care for couple infertility. According to the World Health Organization classification, subjects were divided into 3 groups: normal weight (no.=131, BMI=18.5-24.9 kg/m2), overweight (no.=71, BMI=25.0-29.9 kg/m2), obese (no.=20, BMI≥30.0 kg/m2). All patients underwent simultaneous testosterone evaluation and seminal analysis, including interleukin 8 (sIL-8), along with scrotal and transrectal CDU, before and after ejaculation. Prostatitis symptoms were evaluated by National Institutes of Health- Chronic Prostatitis Symptom Index questionnaire. After adjusting for age and testosterone levels, higher BMI was significantly related to higher prostate volume and several CDU features of the prostate, including macro-calcifications, inhomogeneity, higher arterial peak systolic velocity (the latter adjusted also for blood pressure), but not with abnormalities of testis, epididymis, seminal vesicles. Furthermore, higher BMI and BMI class were significantly related to higher sIL-8, a reliable surrogate marker of prostate inflammatory diseases, even after adjustment for age. Conversely, no associations among BMI, clinical symptoms of prostatitis or semen parameters were observed. Subjects with higher BMI might develop CDU and biochemical signs suggestive of prostate inflammation, although not clinically overt.

Inclusion of Erectile Domain to UPOINT Phenotype Does Not Improve Correlation With Symptom Severity in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

To evaluate the addition of an erectile dysfunction (ED) domain to the UPOINT (Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness) system in our patients. The UPOINT system classifies men with chronic prostatitis/chronic pelvic pain syndrome into 6 domains. The domain number correlates with the symptom severity, and UPOINT-guided therapy has been shown to significantly improve symptoms. This was recently confirmed in a large Italian cohort, but was only true in a German cohort if an ED domain was added ("S," resulting in "UPOINTS"). A total of 100 recent patients with chronic prostatitis/chronic pelvic pain syndrome were classified using the UPOINT system. An additional "S" domain was retrospectively added for men with bothersome ED. Symptom severity was assessed using the National Institutes of Health Chronic Prostatitis Symptom Index. The "S" domain was positive in 28% of the patients. A stepwise positive correlation was found between the number of positive UPOINT domains and symptom severity (Pearson r=.27, P=.006). The "S" domain reduced this correlation (Pearson r=.25, P=.01). ED had no effect on the total Chronic Prostatitis Symptom Index (24.8 vs 24.7) or on the subscores for pain (11.5 vs 11.6) or quality of life (8.8 vs 8.9). On multivariate analysis, the number of UPOINT domains was the strongest predictor of the total Chronic Prostatitis Symptom Index (relative increase 4.1, 95% confidence interval 1.5-6.7, P=.002), a relationship lost with UPOINTS (relative increase 1.0, 95% confidence interval -2.1-4.2, P=.53). In our patients, ED did not independently affect the chronic pelvic pain syndrome symptom severity or quality of life. Although ED should be elicited and appropriately treated in men with chronic prostatitis/chronic pelvic pain syndrome, our data do not support the utility of using ED as an independent UPOINT domain.

Silodosin for Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of a Phase II Multicenter, Double-Blind, Placebo Controlled Study

We evaluated the efficacy and safety of 2 doses of silodosin vs placebo in men with moderate to severe abacterial chronic prostatitis/chronic pelvic pain syndrome who had not been treated previously with α-blockers for chronic prostatitis/chronic pelvic pain syndrome. In this multicenter, randomized, double-blind, phase II study, men 18 years old or older with chronic prostatitis/chronic pelvic pain syndrome, a total National Institutes of Health Chronic Prostatitis Symptom Index score of 15 or greater and a National Institutes of Health Chronic Prostatitis Symptom Index pain score of 8 or greater received 4 or 8 mg silodosin, or placebo once daily for 12 weeks. The primary efficacy end point was change from baseline to week 12 in National Institutes of Health Chronic Prostatitis Symptom Index total score. Of 151 patients (mean age 48 years) 52 received 4 mg silodosin, 45 received 8 mg silodosin and 54 received placebo. Silodosin 4 mg was associated with a significant decrease in total National Institutes of Health Chronic Prostatitis Symptom Index score (mean ± SD change -12.1 ± 9.3) vs placebo (-8.5 ± 7.2, p = 0.0224), including a decrease in urinary symptom (-2.2 ± 2.7, placebo -1.3 ± 3.0, p = 0.0102) and quality of life (-4.1 ± 3.1, placebo -2.7 ± 2.5, p = 0.0099) subscores. The 4 mg dose of silodosin also significantly increased Medical Outcomes Study Short Form 12 physical component scores (4.2 ± 8.1, placebo 1.7 ± 9.0, p = 0.0492). During global response assessment 56% of patients receiving 4 mg silodosin vs 29% receiving placebo reported moderate or marked improvement (p = 0.0069). Increasing the dose of silodosin to 8 mg resulted in no incremental treatment effects. Silodosin 4 mg relieved symptoms and improved quality of life in men with chronic prostatitis/chronic pelvic pain syndrome but its efficacy requires confirmation in additional studies.

1428 GREATER ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME-A POSSIBLE LINK TO CARDIOVASCULAR DISEASE

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111428 GREATER ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME-A POSSIBLE LINK TO CARDIOVASCULAR DISEASE Daniel Shoskes, Dona Prots, Jeffrey Karns, Aaron Shoskes, and Joi Horhn Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author , Dona ProtsDona Prots Cleveland, OH More articles by this author , Jeffrey KarnsJeffrey Karns Cleveland, OH More articles by this author , Aaron ShoskesAaron Shoskes Cleveland, OH More articles by this author , and Joi HorhnJoi Horhn Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have a significantly higher rate of self reported cardiac disease than controls but no mechanism for an association is known. Endothelial dysfunction and peripheral arterial stiffness correlate with cardiac disease and mortality. We wished to study these markers of vascular dysfunction in men with CP/CPPS compared to asymptomatic controls. METHODS Twenty one men with symptomatic, untreated CP/CPPS and 14 asymptomatic controls were tested with an Endo-PAT machine (Itamar Medical, Israel) that assessed the Augmentation Index(AI), a measure of arterial stiffness and Reactive Hyperemia Index (RHI), a measure of nitric oxide mediated endothelial vasodilation. Both elevated AI and diminished RHI suggest vascular and endothelial disease. Symptom severity in patients was measured by the NIH Chronic Prostatitis Symptom Index (CPSI) and patient phenotype characterized by the UPOINT system. All values except symptom duration met the D'Agostino test for normality and therefore parametric statistics were used with significance set at p<0.05. RESULTS Ages were similar in the CP/CPPS group (22–63 years, median 40) and controls (19–57, median 40). Patients had median symptom duration of 24 months (range 3–440), mean CPSI scores of 24.7+/−5.1 (range 18–37) and mean UPOINT domains of 2.9+/−1.1 (range 1–5). AI was significantly higher (greater arterial stiffness) in CPPS patients vs controls (5.0% +/−2.3 vs. −6.0%+/−3.0, p=0.006). RHI was significantly lower (more endothelial dysfunction) in CPPS patients (1.76+/−1.2 vs 2.21+/−1.7, p=0.03). Age had a negative correlation to RHI (Spearman R −0.48, p=0.03) but not AI. There was no correlation between symptom duration, severity or phenotype (number or type of UPOINT domains) and RHI or AI. CONCLUSIONS Men with CP/CPPS have evidence for increased arterial stiffness and vascular endothelial dysfunction. This is the first mechanistic correlation found to explain the higher incidence of self reported cardiac disease in these patients. Plausible mechanisms include chronic pain affecting vascular function and chronic stress and catecholamine release predisposing both to vascular changes and CP/CPPS. Noninvasive Endo-PAT testing may allow stratification of CP/CPPS patients by vascular dysfunction, which may require specific treatment, or at least further assessment of cardiac risk. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e572 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Shoskes Cleveland, OH More articles by this author Dona Prots Cleveland, OH More articles by this author Jeffrey Karns Cleveland, OH More articles by this author Aaron Shoskes Cleveland, OH More articles by this author Joi Horhn Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1429 IS THERE EVIDENCE FOR ESWT THERAPY IN MEN WITH CHRONIC NONBACTERIAL PROSTATITIS/CHRONIC PELVIC SYNDROME? PRELIMINARY RESULTS OF A CONTROLLED STUDY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111429 IS THERE EVIDENCE FOR ESWT THERAPY IN MEN WITH CHRONIC NONBACTERIAL PROSTATITIS/CHRONIC PELVIC SYNDROME? PRELIMINARY RESULTS OF A CONTROLLED STUDY Michael Mathers, Stephan Degener, Stephan Roth, and Theodor Klotz Michael MathersMichael Mathers Remscheid, Germany More articles by this author , Stephan DegenerStephan Degener Wuppertal, Germany More articles by this author , Stephan RothStephan Roth Wuppertal, Germany More articles by this author , and Theodor KlotzTheodor Klotz Weiden, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1341AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic prostatitis/pelvic pain syndrome (CPPS) is a common condition of unclear aetiology. Treatment modalities are often empirical with an uncertain outcome. Prostatic calcifications are often found, but a link to symptoms is controversial. There is a need for new treatment alternatives. Extra corporal shock wave lithotripsy (ESWT) might be a possible treatment option. METHODS A total of 24 men with CPPS refractory to multiple prior therapies were treated by extra corporal shock wave lithotripsy (ESWT). 14 men (verum group) were treated with ultrasound controlled ESWT of the prostate, 10 patients (sham group) with the ESWT focused to the filled bladder. The treatments were performed once weekly for at least three times in a prone position with a filled bladder on an classical shock wave lithotriptor (Modulith Storz CPX). 4 patients of the sham group changed to the verum group after three ESWT treatments. The first 5 patients were treated with an antibiotic for 5 days. The national Institute of health chronic prostatitis symptom index (NIH-CPSI), the International prostatic symptoms Score (IPSS), transrectal ultrasound and blood tests were performed at the beginning, after 4 weeks and after 3 months of therapy. Urine tests were performed before and after each ESWT treatment. Two patients (one patient in the verum, and one patient of the sham group) were lost to follow up. RESULTS Mean NiH-CPSI total score +/− SD decreased from 26.1 +/− 1,8 to 12.0 +/− 1.5 (p<0,0001) in the verum group after 3 months. Significant improvement was seen in each sub score domain. The sham group showed a lesser decrease of NIH-CPSI score: 26.4 +/− 1.7 to 18.3 +/− 1.7 (p<0,01). The IPSS score showed a similar improvement. 9 patients of the verum group however only 1 patient of the sham group reported on an immediate improvement of symptoms within 24 hours after the first ESWT. In three patients of the verum group and two patients of the sham group bacterial growth was found after ESWT. 2 patients of the verum group reported on a slight gross hematuria for several hours. After three to six months 7 patients of the verum group received a new series of ESWT treatment because of the reoccurrence of symptoms. CONCLUSIONS ESWT of the prostate in patients with CPPS seems to be a promising effective treatment. More prospective placebo controlled trials are required. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e572 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Mathers Remscheid, Germany More articles by this author Stephan Degener Wuppertal, Germany More articles by this author Stephan Roth Wuppertal, Germany More articles by this author Theodor Klotz Weiden, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

P01-406 - Normal 0 14 general punitiveness and direction of hostility in chronic prostatitis patients

IntroductionChronic prostatitis has been long considered a psychosomatic illness. We have previously studied alexithymic and obsessive-compulsive features in chronic prostatitis patients.AimsTo evaluate introverted, extroverted and total hostility in patients with chronic prostatitis.MethodsPatients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated with the Hostility and Direction of Hostility Questionnaire (HDHQ), a questionnaire with 5 subscales designed to assess total hostility or punitiveness and direction of hostility. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.Results82 patients (median age 37.5 yrs old; IQR 30-45.5 yrs) were evaluated. According to the NIH Prostatitis Classification patients were categorized as type II: 45.1%, IIIa: 9.7%, IIIb: 39%, IV: 2.4%. Median CPSI score was 19.5 (IQR: 14.5-24.3). Median introverted, extroverted and total hostility scores were 3 (IQR: 2-6), 9 (IQR: 7-13) and 13 (IQR: 9-18) respectively. Results from the Extroverted Hostility HDHQ subscale correlated (r squared = −0.25, p = 0.024) with subscales of the TAS (Toronto Alexithymia Scale). These results were independent of CPSI scores.ConclusionsChronic prostatitis patients’ total hostility scores are similar to those of the general population reported by other studies. However, chronic prostatiitis patients show more outward directed hostility. The relationship between TAS subscale scores and measures of extroverted hostility needs further elucidation. Patients with chronic prostatitis are potentially at risk for psychiatric disturbances and thus may need psychiatric counseling and therapy.