National Institutes Of Health Chronic Prostatitis Symptom Index Research Articles

The prevalence of and risk factors for prostatitis-like symptoms and its relation to erectile dysfunction in Chinese men.

The aim of this study was to describe the prevalence of and risk factors for prostatitis-like symptoms and its relation to erectile dysfunction (ED) among southern Chinese men. Data were collected from 2790 men attending the Fangchenggang Area Male Healthy and Examination Survey from September 2009 to December 2009. The prostatitis-like symptoms were assessed by the NIH Chronic Prostatitis Symptom Index and ED was assessed using the 5-item International Index of Erectile Function. Lifestyle and demographic characteristics were obtained through a questionnaire. Prevalence of prostatitis-like symptoms was 12.4% among 2790 Chinese men aged 20-84 years. In smokers who smoked ≥20 cigarettes per day (age-adjusted OR = 1.29; 95% CI = 1.00-1.66; p = 0.04), physical inactivity (age-adjusted OR = 1.31; 95% CI = 1.03-1.66; p = 0.02) was a significant risk factor for prostatitis-like symptoms. Alcohol consumption (daily drinking) also was a risk factor for prostatitis-like symptoms, although the differences were not statistically significant (age-adjusted OR = 1.36; 95% CI = 0.96-1.92; p = 0.07). Those with diabetes may also be at higher risk for prostatitis-like symptoms (age-adjusted OR = 1.37; 95% CI = 0.85-2.21; p = 0.19). In addition, men with ED were more likely to have had prostatitis-like symptoms (age-adjusted OR = 1.86; 95% CI = 0.47-2.36; p < 0.0001), and the ORs increased with increasing severity of ED status (mild ED, mild to moderate ED, and moderate to severe ED were 1.57, 2.62, and 3.24, respectively. Test for trend, p = 0.0001). Our results show that prostatitis-like symptoms are prevalent in Southern China affecting men of all ages. Smoking, drinking, lack of physical activity, and elevated plasma glucose level were associated with an increased risk of prostatitis-like symptoms. In addition, our results reveal that ED accounted for a large proportion (61.5%) among men with prostatitis-like symptoms; we also confirm the magnitude of ED associated with prostatitis-like symptoms. Thus, interventions to evaluate and improve ED might help ameliorate prostatitis-like symptoms and vice versa.

The associations between prostatitis-like symptoms and serum level of immunoglobulin

Objective To investigate the association between serum level of immunoglobulin and prostatitis-like symptoms. Methods Data were collected from the People's Hospital of Laiwu City and Shandong provincial Qianfoshan Hospital(Random sampling)from June 2012 to November 2012, and 1500 subjects were included finally.Data on demographic characteristics and lifestyle characteristics were collected using a standardized questionnaire.Blood samples were obtained,and serum levels of immunoglobulin G(IgG), immunoglobulin A(Ig A) and immunoglobulin M(Ig M) were measured.Prostatitis-like symptoms were defined based upon the National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI).The statistical analyses were performed by SPSS 13. 0. Results The prevalence of prostatitis-like symptoms was 10. 1% in our study.After adjustments for potential confounding factors(age, smoking, alcohol drinking, physical activity and education)in the logistic regression model, with increased level of Ig A, the higher risk of moderate and severe prostatitis-like symptoms[odds ratio(OR)= 1. 61, 95% confidence interval(CI):1. 09-2. 38;OR= 1. 90,95% CI:1. 30-2. 78] could be observed.In addition, the highest Ig A significantly increased the pain symptoms(OR= 1. 89,95% CI:1. 13-3. 13)and voiding symptoms(OR= 2. 16, 95% CI:1. 36-3. 45). However, there was no statistically significant correlations between serum IgG and Ig M levels with overall prostatitis-like symptoms or individual symptoms. Conclusion Prostatitis-like symptoms are a common disease in adult men.The relationship between elevated serum Ig A levels and increased odds of moderate or severe symptoms indicates that immune response may participate in the etiology of chronic prostatitis. Key words: Serum of immunoglobulin; National Institutes of Health Chronic Prostatitis Symptom Index; Prostatitis-like symptoms

Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: results of a prospective pilot double-blind and randomized placebo-controlled study.

To evaluate the effect of botulinum neurotoxin type-A (BoNT-A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4-6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT-A or normal saline in a prospective pilot double-blind randomized study. The patients' NIH-CPSI total and subscale scores, American Urological Association (AUA)-symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups. A total of 60 consecutive patients were randomized to a BoNT-A (treatment) or normal saline (placebo) group. In the treatment group at the 1-, 3- and 6-month evaluation the NIH-CPSI total and subscale scores, and the AUA-SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA-SS and frequencies of nocturnal urination were not significant at 1-month follow-up, repeated-measure analysis showed significant improvement in each of these values over the entire follow-up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow-up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively. Transurethral intraprostatic BoNT-A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.

Tumor necrosis factor-α expression in patients with obstructive benign prostatic hyperplasia is associated with a higher incidence of asymptomatic inflammatory prostatitis NIH category IV and prostatic calcification

Objective. The aim of this study was to investigate the association of the expression of tumor necrosis factor-α (TNF-α) with asymptomatic inflammatory prostatitis National Institutes of Health (NIH) category IV and prostatic calculi, in patients with obstructive benign prostatic hyperplasia (BPH) treated by transurethral electroresection of the prostate (TURP). Materials and methods. Ninety-six patients with obstructive BPH and TURP were evaluated in a prospective study. Based on a preoperative transrectal ultrasound examination of the prostate gland, patients were divided into two groups, one with prostatic calculi (n = 31) and one without (n = 65). Prostatitis NIH category IV was classified according to Irani’s histological grading system (Irani et al. J Urol 1997;157:1301–3). Associations between the incidence of prostatic calculi, histological prostatitis, TNF-α expression, prostate-specific antigen, uric acid, cholesterol, triglycerides, C-reactive protein, International Prostate Symptom Score (IPSS), the International Index for Erectile Function (IIEF-5) and the NIH-Chronic Prostatitis Symptom Index Score (NIH-CPSI) were analyzed. Results. Prostatitis was confirmed by histological investigation in 71.9% of patients: 83.9% of those with prostatic calculi versus 66.1% of those without (p < 0.04). TNF-α expression was significantly higher in patients with prostatic calculi. Association calculations yielded significant values for the severity (histological grading) of inflammation (p < 0.029), TNF-α expression (p < 0.007), uric acid (p < 0.005), cholesterol (p < 0.028) and the NIH-CPS subdomain of urinary symptoms (p < 0.044) in patients with prostatic calculi. Conclusions. In patients with obstructive BPH, prostatic calculi were found on ultrasound in one-third of the cases, and histological NIH category IV prostatitis in two-thirds of cases. The incidence of both prostatitis NIH category IV and TNF-α expression was significantly higher in patients with prostatic calculi than in those without.

Greek Version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), its linguistic adaptation and the pilot test of its validity (ÍÇÉ)

Introduction To formulate the Greek version of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), its linguistic adaptation and the pilot test of its validity. Methods The classical method of linguistic vali-dation was adopted. Seven patients with chronic prostatitis (CP) histologically confirmed parti-cipated in cognitive debriefing. The sample of the pilot study consisted of 45 CP patients based on clinical diagnosis according to symptoms and 42 healthy individuals aged 21 to 68 years old. In retest 22 of the above CP patients were included. Statistical analysis was carried out with the Statistical Package PASW Statistics 18. The statistical analysis was based on the chi-square, t and ANOVA tests. Internal consistency was examined by Cronbach’s α and Pearson’s r while for test-retest reproducibility k statistic and Wilcoxon test were used. Results Cultural adaptation was not required since the sample consisted of Greek citizens with common socio-religious characteristics. Cognitive debriefing revealed that the Greek version of the NIH-CPSI was easily understood and answered. During the pilot validation it was assured that the patients and healthy individuals were comparable regarding age, education and marital status. Σκοπός: Η δημιουργία του Eλληνικού Διαγνωστικού Eρωτηματολογίου Χρόνιας Προστατίτιδος-Χρόνιου Πυeλικού Άλγους (EΔEΧΠΑ), η γλωσσική προσαρμογή του και η πιλοτική αξιολόγηση της eγκυρότητας του βασιζόμeνοι στο διαγνωστικό Eρωτηματολόγιο Χρόνιας Προστατίτιδος-Χρόνιου Πυeλικού Άλγους του Αμeρικάνικου Eθνικού Ινστιτούτου Υγeίας (ΝΗΙ). Μέθοδος: Χρησιμοποιήθηκe η κλασική μeθοδολογία γλωσσικής προσαρμογής στην Eλληνική γλώσσα. Eπτά ασθeνeίς μe χρόνια προστατίτιδα eπιβeβαιωμένη ιστολογικά πήραν μέρος στον γνωστικό έλeγχο. Το δeίγμα για την πιλοτική μeλέτη αποτέλeσαν 45 ασθeνeίς μe χρόνια προστατίτιδα που βάσeι της κλινικής διάγνωσης στηριζόμeνοι στην συμπτωματολογία και σαν ομάδα eλέγχου 42 υγιeίς άνδρeς ηλικίας από 21 έως 68 eτών. Στον eπανέλeγχο συμμeτeίχαν 22 από τους παραπάνω πάσχοντeς συμμeτέχοντeς. Η στατιστική eπeξeργασία έγινe μe χρήση του στατιστικού πακέτου PASW Statistics 18. Στην στατιστική ανάλυση χρησιμοποιήθηκαν οι έλeγχοι χι-τeτράγωνο, t και ANOVA. Η αξιο-πιστία eλέγχθηκe ως προς την eσωτeρική συνέπeια μe τους συντeλeστές Cronbach’s α και Pearson’s r eνώ ως προς την αναπαραγωγικό-τητα στον eπανέλeγχο μe το στατιστικό k και τον έλeγχο του Wilcoxon. Αποτeλέσματα: Πολιτιστική προσαρμογή του eρωτηματολογίου δeν απαιτήθηκe eπeιδή το δeίγμα ήταν Έλληνeς υπήκοοι μe κοινά κοινωνικό-θρησκeυτικά χαρακτηριστικά. Ο γνωστικός έλeγχος έδeιξe ότι το EΔEΧΠΑ έγινe eύκολα κατανοητό και οι απαντήσeις ήταν eύκολο να δοθούν. Στην πιλοτική μeλέτη eγκυρότητας διασφαλίστηκe ότι οι ασθeνeίς και οι υγιeίς ήταν συγκρίσιμοι όσον αφορά την ηλικία, την eκπαίδeυση και την οικογeνeιακή κατάσταση.

Correlation between chronic prostatitis and erectile dysfunction

Objective To discuss the clinical correlation between chronic prostatitis (CP) and erectile dysfunction (ED). Methods A retrospective analysis was made on the clinical data from patients who were diagnosed as CP in urology department of the First People′s Hospital of Yunnan Province and the First Affiliated Hospital of Sun Yat-sen University. Patients′ data were collected from July 2005 to July 2012. All the patients were diagnosed as CP based on their clinical manifestation, the NIH Chronic Prostatitis Symptom Index, prostatic fluid examination, routine urine examination and ultrasonography. The condition of erectile function was inquired on every patient and recorded. Results There were 4 315 patients diagnosed as CP in present study, while their age ranged from 17 to 64 years (average, 31 years). Sixty-one (1.41%) patients were identified as moderate and severe types of ED (International Index of Erectile Function 5 ≤11), while 42 (0.97%) patients were confirmed as ED after they got CP. 435/4 315 patients (10.08%) felt obviously sexuality descent after they got CP, and the sexuality was reported improved in 426/435 patients after prostatitis symptomatic relief. Conclusions The incidence rate of ED in CP patients is not obviously higher than that in common community. And sexuality descent in patients might be caused by local indisposition and anxiety after CP. Key words: Chronic prostatitis; Erectile dysfunction; Prevalence

MP25-01 RELATIONSHIP BETWEEN TESTOSTERONE AND PROSTATITIS-LIKE SYMPTOMS ASSESSED BY THE NATIONAL INSTITUTES OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2015MP25-01 RELATIONSHIP BETWEEN TESTOSTERONE AND PROSTATITIS-LIKE SYMPTOMS ASSESSED BY THE NATIONAL INSTITUTES OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX Gyeong Eun Min, Jun Ho Lee, Koo Han Yoo, Dong-Gi Lee, and Hyung-Lae Lee Gyeong Eun MinGyeong Eun Min More articles by this author , Jun Ho LeeJun Ho Lee More articles by this author , Koo Han YooKoo Han Yoo More articles by this author , Dong-Gi LeeDong-Gi Lee More articles by this author , and Hyung-Lae LeeHyung-Lae Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, it has been reported that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is related to decreased vascular endothelial dysfunction and cardiovascular disease. Testosterone has been suggested to play a role in vascular endothelial dysfunction and cardiovascular disease. Considering the relationship of testosterone and CP/CPPS with endothelial dysfunction and cardiovascular disease, there may also be a relationship between testosterone and CP/CPPS. Therefore, we evaluate their relationship. METHODS A total of 9180 middle aged men who had participated in a health examination were included. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was administered to evaluate prostatitis-like symptoms. Symptoms were regarded as mild pain if respondents reported perineal or ejaculatory pain and had an NIH-CPSI pain score ≥4 but <8 and the symptoms were considered moderate to severe pain if the pain score was ≥8. A full metabolic work-up and serum testosterone level checks by RIA. The Mantel-Haenszel Extension test, multiple linear regression tests, and logistic regression analyses were used. RESULTS The mean age was 52.3±9.4 years, and the mean serum testosterone level was 5.3±1.6 ng/mL. The number of man with late onset hypogonadism (LOH: testosterone <3.5 ng/mL) was 1037 (11.3%). In total, 1643 (17.9%) men had prostatitis-like symptoms, and 650 (7.1%) men had moderate to severe symptoms. The ages and components of the metabolic syndrome adjusted mean NIH-CPSI total score and NIH-CPSI pain score was significantly higher in the LOH group (mean (95%CI): total score: 9.26 (8.86-9.66) vs. 8.65 (8.50-8.80); P=.005; pain score: 3.90 (3.75-3.66) vs. 3.72 (3.70-3.75); P=.026). There was a significant increase in the incidence of LOH as the severity of prostatitis-like symptoms increased (positive ratio: no pain, 11.0%; mild pain, 11.4%; moderate to severe pain 14.5%; P trend=.019). Additionally, odds ratio for LOH was significantly associated with prostatitis-like symptoms and moderate to severe prostatitis-like symptoms after adjusting for potential confounding factors (mild prostatitis-like symptoms, OR for LOH: 1.074, 95% confidence interval:.904-1.275; moderate to severe symptoms, OR for LOH: 1.394: 95% confidence interval: 1.104-1.762). CONCLUSIONS LOH was significantly correlated with the presence and severity of prostatitis-like symptoms. Further researches would be needed to elucidate the role of testosterone in developing CP/CPPS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e285 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gyeong Eun Min More articles by this author Jun Ho Lee More articles by this author Koo Han Yoo More articles by this author Dong-Gi Lee More articles by this author Hyung-Lae Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP43-14 STUDY OF THE RISK FACTORS ASSOCIATED WITH PREMATURE EJACULATION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 2015MP43-14 STUDY OF THE RISK FACTORS ASSOCIATED WITH PREMATURE EJACULATION Seong Hyun Lee, See Min Choi, Sol Yoon, Jae Hwi Choi, Sung Chul Kam, Jeong Seok Hwa, Ky Hyun Chung, and Jae Seog Hyun Seong Hyun LeeSeong Hyun Lee More articles by this author , See Min ChoiSee Min Choi More articles by this author , Sol YoonSol Yoon More articles by this author , Jae Hwi ChoiJae Hwi Choi More articles by this author , Sung Chul KamSung Chul Kam More articles by this author , Jeong Seok HwaJeong Seok Hwa More articles by this author , Ky Hyun ChungKy Hyun Chung More articles by this author , and Jae Seog HyunJae Seog Hyun More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1621AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the risk factors associated with premature ejaculation (PE) in males who underwent a health checkup. METHODS Between January 2010 and July 2014, we retrospectively analyzed the medical records of males who had undergone medical checkups at Gyeongsang National University Hospital. Using electronic medical record data, we assessed intra-vaginal ejaculation latency time, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and Androgen Deficiency in the Aging Male (ADAM) scales. We also assessed BMI, body fat percentage, blood pressure, blood sugar, HbA1c, BUN, creatinine, lipid panel, CK, LDH, thyroid function, prostate-specific antigen, serum testosterone, urine flow (using uroflowmetry), and transrectal ultrasound results. Subjects were divided into two premature ejaculation (PE) groups: a latency time of < 1 min group, and a self-diagnosed PE group. Correlations with the other variables were then performed. RESULTS A total of 1029 subjects were enrolled in the study, between 27 and 70 years of age (mean age = 48.40 ¡¾ 7.57 years). Seventy-four patients (7.2%) were characterized by an ejaculation latency of < 1 min. Multivariate logistic regression analysis revealed a significant correlation between MSHQ-EjD scores, ejaculation anxiety, IIEF overall satisfaction scores, NIH-CPSI pain ratings, and prostate-specific antigen (PSA) levels (p < 0.05). The number of patients with self-diagnosed PE was 507 (49.3%); a statistically significant correlation between IPSS quality of life ratings, IIEF overall satisfaction scores, ADAM scores, and creatinine levels was observed in this group, using multivariate logistic regression analysis (p < 0.05). CONCLUSIONS IIEF overall satisfaction was significantly correlated with both PE with a latency of < 1min, and self-diagnosed PE. Therefore, it appears that PE has a major impact on the quality of sexual life. Furthermore, serum PSA and creatinine levels were also significantly correlated with PE, but age, BMI, body fat percentage, blood pressure, blood sugar, HbA1c, BUN, lipid panel, CK, LDH, thyroid function, serum testosterone levels, urine flow (assessed using uroflowmetry) and prostate size (assessed by transrectal ultrasound and digital rectal examination) were not. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e523 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seong Hyun Lee More articles by this author See Min Choi More articles by this author Sol Yoon More articles by this author Jae Hwi Choi More articles by this author Sung Chul Kam More articles by this author Jeong Seok Hwa More articles by this author Ky Hyun Chung More articles by this author Jae Seog Hyun More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common etiology of premature ejaculation (PE). However, the current data are insufficient to explain this relationship and to support routine screening of men with PE. This study aims to evaluate the relationship between PE and CP/CPPS. A cross-sectional study was conducted that included 8,261 men who had participated in a health examination. The Premature Ejaculation Diagnostic Tool (PEDT), the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and the International Index of Erectile Function-5 (IIEF) were used for assessment of symptoms. A full metabolic work-up and serum testosterone level checks were also performed. We then investigated the relationship using the Spearman correlation test, multiple linear regression, and logistic regression analyses. Associations of PEDT with NIH-CPSI. The mean age was 50.4 ± 5.5 years. In total, 2,205 (24.9%) men had prostatitis-like symptoms (NIH-CPSI pain score of ≥4 and perineal or ejaculatory pain), and 618 (7.0%) men had moderate to severe symptoms (NIH-CPSI pain score of ≥8). Additionally, 2,144 men (24.2%) were classified as demonstrating PE (PEDT > 10). The PEDT score was found to have a significant positive correlation with the NIH-CPSI pain domain score (correlation coefficient = 0.206; P < 0.001). After adjusting for age, metabolic syndrome status, testosterone level, and IIEF score, there was no change in the positive correlation between the NIH-CPSI pain domain score and PEDT score (Beta = 0.175; P < 0.001). After adjusting for age, testosterone level, metabolic syndrome, and IIEF score, the odds ratio (OR) for PE significantly increased with the severity of pelvic pain (mild prostatitis-like symptoms, OR for PE: 1.269, 95% confidence interval: 1.113-1.447; moderate to severe symptoms, OR for PE: 2.134: 95% confidence interval: 1.782-2.557). Our data showed a significant correlation between the PEDT score and the NIH-CPSI score. We suggest routine screening for CP/CPPS in men with PE and PE in men with CP/CPPS.

Clinical Significance of National Institutes of Health-Chronic Prostatitis Symptom Index Pain Score in Patients with Benign Prostatic Hyperplasia

Purpose: Many benign prostatic hyperplasia (BPH) patients were accompanied by pelvic pain apart from urinary symptoms. Therefore, we evaluate the treatment outcomes of alpha-blockers via a change of international prostate symptom score (IPSS) according to pain score of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Materials and Methods: A total of 356 male patients with BPH from March 2011 to May 2014 were analyzed retrospectively. Prostate specific antigen, prostate volume, IPSS, NIH-CPSI, international index of erectile function (IIEF-5), and uroflowmetry were collected. Patients were categorized according to 2 groups based on the presence and severity of pain and baseline characteristics and treatment outcomes were analyzed. Results: Two hundred twenty-nine patients (64.3%) reported pain/discomfort on NIH-CPSI. Mean IPSS, mean voiding symptoms, mean storage symptoms on IPSS, and mean IIEF-5 showed a significant difference in groups 1A and 1B. Logistic regression analysis showed that NIH-CPSI pain score was a significant predictive factor for severe IPSS (odds ratio, 2.830; 95% confidence interval, 1.307-6.129). After treatment for 3 months, improvement of IPSS, voiding symptoms, storage symptoms, and quality of life was observed in all groups (p=0.001, p 5) showed greater improvement of symptoms and statistically significant difference compared with group 2A (pain score ≤5) (p=0.029, p=0.026). Conclusions: We suggest that the presence and severity of pain score are helpful for therapeutic efficacy in patients with BPH.

Chronic Prostatitis: A Possible Cause of Hematospermia.

PurposeWhile hematospermia is mainly caused by genitourinary inflammatory disorders, very few studies have been published on prostatitis-associated hematospermia (PAH) diagnosed using robust prostatitis evaluation methods. Therefore, we have evaluated the incidence of PAH by using systematic methods for evaluating prostatitis.Materials and MethodsWe evaluated 37 hematospermia patients from a single hospital over the last five years. We classified the patients into PAH versus hematospermia without any evidence of prostatitis (HWP) by using a NIH-Chronic Prostatitis Symptom Index questionnaire and expressed prostatic secretion studies.ResultsThe mean age was 55.89±14.87 years, and the patients were grouped into two groups: one group had 12 HWP patients and the other 25 PAH patients. PAH patients were further sub-classified: chronic bacterial prostatitis (3 patients), chronic nonbacterial prostatitis (10 patients), prostadynia (7 patients), and asymptomatic prostatitis (5 patients). We found Enterococcus faecalis in the three chronic bacterial prostatitis patients. We could not find any statistically significant difference between the PAH and the HWP groups in terms of the age interval, serum prostate-specific antigen level, and prostate volume. Even though there was no statistically significant difference in the items about urination between the two groups, we found a statistically significant difference in the quality of life (QoL) impact for the patients in this study.ConclusionsTwo-thirds of the hematospermia patients were associated with some evidence of prostatitis. Further, the patients with PAH revealed poor QoL compared with the patients with HWP. Therefore, we must evaluate the presence of prostatitis in hematospermia patients and alleviate the prostatitis-associated symptoms to improve their QoL.

Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients.

The complex network of etiological factors, signals and tissue responses involved in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) cannot be successfully targeted by a single therapeutic agent. Multimodal approaches to the therapy of CP/CPPS have been and are currently being tested, as in the frame of complex diagnostic-therapeutic phenotypic approaches such as the urinary, psychosocial, organ-specific, infection, neurological and muscle tenderness (UPOINTS) system. In this study, the effect of combination therapy on 914 patients diagnosed, phenotyped and treated in a single specialized prostatitis clinic was analyzed. Patients received α-blockers, Serenoa repens (S. repens) extracts combined or not with supplements (lycopene and selenium) and, in the presence of documented or highly suspected infection, antibacterial agents. Combination treatment induced marked and significant improvements of National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) prostatitis symptom scores, International Index of Erectile Function (IIEF) sexual dysfunction scores, urinary peak flow rates and bladder voiding efficiency. These improvements, assessed after a 6-month course of therapy, were sustained throughout a follow-up period of 18 months. A clinically appreciable reduction of ≥6 points of the total NIH-CPSI score was achieved in 77.5% of patients subjected to combination therapy for a period of 6 months. When the patients were divided in two cohorts, depending on the diagnosis of CP/CPPS [inflammatory (IIIa) vs. non-inflammatory (IIIb) subtypes], significant improvements of all signs and symptoms of the syndrome were observed in both cohorts at the end of therapy. Intergroup comparison showed that patients affected by the IIIa sub-category of CP/CPPS showed more severe signs and symptoms (NIH-CPSI total, pain and quality of life impact scores, and Qmax) at baseline when compared with IIIb patients. However, the improvement of symptoms after therapy was significantly more pronounced in IIIa patients when compared with IIIb patients. In contrast to current opinion, the evidence emerging from the present investigation suggests that the inflammatory and non-inflammatory sub-categories of CP/CPPS may represent two distinct pathological conditions or, alternatively, two different stages of the same condition. In conclusion, a simple protocol based on α-blockers, S. repens extracts and supplements and antibacterial agents, targeting the urinary, organ specific and infection domains of UPOINTS, may induce a clinically appreciable improvement of the signs and symptoms of CP/CPPS in a considerable percentage of patients. In patients not responding sufficiently to such therapy, second-line agents (antidepressants, anxiolytics, muscle relaxants, 5-phosphodiesterase inhibitors and others) may be administered in order to achieve a satisfactory therapeutic response.

Prevalence of lower urinary tract symptoms and level of quality of life in men and women with chronic pelvic pain

Objectives. The aim of this study was to evaluate the prevalence of lower urinary tract symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS). Materials and methods. The McGill Pain Questionnaire, Dutch Leiden/Leuven Version (MPQ-DLV), Pain Disability Index (PDI), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Interstitial Cystitis Symptom Index (ICSI) and Pelvic Pain and Urinary/Frequency Symptom Scale (PUF) were used, based on their specific properties, to assess the symptoms and impact on the quality of life. Total scores and domains were compared for gender. Results. The studied group (N = 35; 18 male, 17 female) showed a good distribution in gender for age [Mann–Whitney U test (MW-U) p = 0.4] and body mass index (MW-U p = 0.2). The MPQ-DLV showed significantly higher scores for pain in women for Pain Rating Index – Affective (MW-U p = 0.030) and Total (MW-U p = 0.031), and Visual Analogue Scale for Pain – Most (MW-U p = 0.005). Women were less sexually active (PUF-SA) (chi-squared test p = 0.021) and had a significantly higher disability (PDI-T) (MW-U p = 0.005) and MPQ – Quality of Life (MW-U p = 0.003). The urinary symptoms showed similar results for gender (chi-squared test p > 0.05). Conclusions. A wide variety of symptoms and a negative impact on quality of life were shown. No differences in lower urinary tract symptoms were found between genders. Women were less sexually active than men. Chronic pelvic pain had a significantly higher negative impact on the level of quality of life in women than in men.

Relationships between intravaginal ejaculatory latency time and national institutes of health-chronic prostatitis symptom index in the four types of premature ejaculation syndromes: a large observational study in China.

Besides lifelong premature ejaculation (LPE) and acquired premature ejaculation (APE), Waldinger and Schweitzer proposed two addition PE syndromes (variable PE [VPE] and subjective PE [SPE]). We assessed the associations between intravaginal ejaculatory latency time (IELT) and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) in men with different PE syndromes. From September 2011 to September 2012, a total of 4,000 men were enrolled from the Anhui province of China. Subjects were required to complete a verbal questionnaire, including demographic information, medical and sexual history (e.g., IELT), and self-estimated scales (e.g., NIH-CPSI). IELT; NIH-CPSI; the new classification of PE syndromes. Of 3,016 of the men evaluated, 25.80% complained of PE. Distribution of the four PE syndromes among men with complaints of PE was as follows: LPE, 12.34%; APE, 18.77%; VPE, 44.09%; and SPE, 24.81%. Men with complaints of PE reported worse NIH-CPSI scores and lower IELT than men without complaints of PE (P < 0.001 for all). Moreover, total and subdomain scores of NIH-CPSI were higher in men with APE, and IELT was higher in men with SPE. IELT was negatively associated with NIH-CPSI scores in men with complaints of PE. Negative relationships between total and subdomain scores of NIH-CPSI and IELT were stronger in men with APE (total scores: adjusted r = -0.68, P < 0.001; pain symptoms: adjusted r = -0.70, P < 0.001; urinary symptoms: adjusted r = -0.67, P < 0.001; quality of life impact: adjusted r = -0.64, P < 0.001). Men with complaints of PE reported worse NIH-CPSI scores than men without complaints of PE. Relationships between IELT and NIH-CPSI scores were strongest in men with APE.

C hlamydia t rachomatis Infection Is Related to Premature Ejaculation in Chronic Prostatitis Patients: Results from a Cross-Sectional Study

Chronic bacterial prostatitis (CBP) is reported to be a common finding in men with acquired premature ejaculation (PE). The impact of different pathogens on PE development in chronic prostatitis patients is, however, unknown. To assess a possible link between CBP caused by Chlamydia trachomatis (Ct) and PE. A consecutive series of 317 patients with clinical and instrumental diagnosis of CBP due to Ct was enrolled (group A) and compared with data obtained from a control group of 639 patients with CBP caused by common uropathogen bacteria (group B). Prostatitis symptoms were investigated with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), while the ejaculatory status of patients was assessed using the PE Diagnostic Tool (PEDT). All participants were asked to complete the NIH-CPSI, the International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD), the PEDT, and the Short Form (SF)-36 questionnaires. Patient groups A and B had comparable scores of NIH-CPSI (P = 0.07), IPSS (P = 0.32), and IIEF-15-EFD (P = 0.33) tests. PE was assessed in 118 patients in group A (37.2%) and in 73 subjects in group B (11.5%). The two groups are different in terms of PE prevalence (P < 0.0002). Compared with group B, group A showed significantly higher scores of the PEDT test (11.3 [±2.6] vs. 4.5 [±2.9], P < 0.0001) and lower scores of the SF-36 tool (96.5 [±1.1] vs. 99.7 [±1.3], P < 0.0001). In our multivariate model assessment, being positive for a Ct infection marker was independently associated with the PEDT score even after adjusting for age, smoking habit, body mass index, and education level (adjusted odds ratio = 3.21; 95% confidence interval: 2.02-4.27; P < 0.003). Patients affected by CBP due to Ct infection reported higher prevalence of PE and lower quality of life when compared with patients affected by CBP caused by traditional uropathogenic bacteria.

P.8.b.007 The impact of depression and somatic symptoms on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome

Purpose of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) mainly presents with perineal or suprapubic pain, voiding difficulty and sexual dysfunction and is usually diagnosed in older male patients [1]. The exact pathophysiology underlying the development of CP/CPPS has yet to be elucidated. The symptoms of CP/CPPS are considered to be the result of an interplay between psychiatric factors and dysfunction in the immune, neurological and endocrine systems [2]. A number of recent studies have suggested that depression may be crucial clinical or pathophysiological component in the development and management of CP/CPPS [3]. The aim of this study was to evaluate the impact of depression and somatic symptoms on treatment outcomes in Korean male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) attending a routine clinical practice. Methods used: This was a 12-week prospective observational study (n = 80). The Korean version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) to measure the severity of CP/CPPS, the Korean version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression, the Korean version of the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatisation and the Korean version of the EuroQol Questionnaire-5 Dimensions (EQ-5D), specifically the EQ-5D utility index and the EQ-5D visual analogue scale (EQ-5D VAS), to assess quality of life, were utilised and given at baseline and week 12. The primary and secondary end-points in this study were changes in the NIHCPSI total score from baseline to week 12 according to depression and somatisation. For the analysis of improver and responder rates as defined a priori, a Fisher’s exact test was performed. Logistic regression analyses were used to assess predictors for secondary treatment response end-points. ORs with 95% confidence intervals (CIs) were also provided for the improver/responder analyses. A Spearman correlation analysis was performed to evaluate the associations among baseline individual total scores of the NIHCPSI, PHQ-9 and PHQ-15. Summary of results: The change in NIH-CPSI total score was significantly higher in those without depression than in those with depression (p = 0.003), with a magnitude of difference of 2.8. The responder rate (a 4 point decrease in NIH-CPSI total score from baseline) was significantly higher in those without depression (42.9%) than in those with depression (17.2%, p = 0.023). However, significant differences were not observed between the two groups in the other outcome measures or in all study outcomes between subjects with or without somatisation. A logistic regression analysis revealed that the presence or absence of depression may be a principal predictor of response to treatment. Conclusions: These preliminary results indicate that depression may have a negative impact on treatment outcome and is a likely predictor of response to treatment in patients with CP/CPPS. However, additional studies with adequate power and improved design are necessary to further support the present findings.

Sexual dysfunctions and psychological disorders associated with type IIIa chronic prostatitis: a clinical survey in China.

Chronic prostatitis (CP) is a frequent prostate-related complaint, impacts negatively on quality of life and is mostly of unclear etiology. Increasing attention has been paid to the prevalence of sexual dysfunctions in CP patients; however, the impact of specific types of CP and the correlation of sexual dysfunctions with psychological disorders associated with CP are not well understood. Type IIIa CP is characterized by chronic pelvic pain, urination symptoms and white blood cells in expressed prostatic secretion, but free of bacterial infection. A population of 600 type IIIa CP patients were randomly selected and 40 normal man were included as the control group. Queries were conducted by urologists. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function (IIEF-5) and the Symptom Checklist 90-R were used to evaluate the symptoms and severity of prostatitis, erectile dysfunctions and psychological problems, respectively. Scores of ejaculatory pain and premature ejaculation were also collected. Our study revealed that sexual dysfunctions are frequently associated with this specific type of CP. The prevalence of erectile dysfunction, premature ejaculation and ejaculatory pain was 19, 30 and 30 %, respectively. A variety of psychological problems exist among type IIIa CP patients, including depression, anxiety, somatization, obsessive-compulsive and interpersonal sensitivity. In particular, the severity of erectile dysfunctions, but not premature ejaculation and ejaculatory pain, correlated significantly with depression and anxiety. Our data indicate that a moderate level of sexual dysfunctions exists among the type IIIa CP patients, and highlight the association of depression and anxiety with erectile dysfunction in CP patients, suggestting that special attention should be paid to these psychological issues in clinical treatments of the prostatitis symptoms and the associated erectile dysfunctions.

Pollen extract in association with vitamins provides early pain relief in patients affected by chronic prostatitis/chronic pelvic pain syndrome.

The therapeutic efficacy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is currently unsatisfactory. The aim of the present study was to assess the safety and efficacy of pollen extract in association with vitamins (DEPROX 500®) in males with CP/CPPS. All patients with a diagnosis of CP/CPPS attending the same urologic centre between March and October 2012 were enrolled in this randomised controlled phase III study. Participants were randomised to receive oral capsules of DEPROX 500® (two capsules every 24 h) or ibuprofen (600 mg, one tablet three times a day) for four weeks. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score and Quality of Well-Being (QoL) questionnaires were used. In the intention-to-treat analysis, 87 males (25 class IIIa and 62 class IIIb) with a mean age of 33.6±5.9 years were randomly allocated to the DEPROX 500® (n=41) or ibuprofen (n=46) treatment groups. At the follow-up examination (following one month of treatment), in the DEPROX 500® group, 31/41 patients (75.6%) reported an improvement in quality of life, defined as a reduction of the NIH-CPSI total score by ≥25%, compared with 19/46 (41.3%) in the control group (P=0.002). The greater improvement in the DEPROX 500® group compared with the ibuprofen group was statistically significant (treatment difference in the NIH-CPSI pain domain, −2.14±0.51, P<0.001; QoL scores, P=0.002). All patients were negative at the Meares-Stamey test evaluation. Adverse events were less frequent in the DEPROX 500® group than in the ibuprofen group. The DEPROX 500® treatment significantly improved total symptoms, pain and quality of life compared with ibuprofen in patients with CP/CPPS, without severe side-effects.

Seasonal changes in symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome: a seasonal follow-up study

Objective. The aim of this study was to evaluate whether seasonal changes aggravate the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), by serial administration of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire for an extended period. Material and methods. Seventy-seven men with CP/CPPS were serially evaluated with the Korean version of the NIH-CPSI questionnaire every 2–3 months from October 2008 to October 2012. The mean duration of follow-up was 27.11 ± 10.00 months and the mean number of visits per patient was 14.68 ± 5.33 times during the study. Results. The number of patients complaining of breakthrough pain during the study was 31 in spring and autumn, nine in summer and 18 in winter. However, there were no significant differences in the mean NIH-CPSI scores across the seasons. In spring, summer and autumn, only urination symptoms correlated with quality of life (QoL) (r2 = 0.277, p < 0.001). In winter, both pain items and urination symptoms correlated with QoL (pain: r2 = 0.522, p < 0.001; urination symptoms: r2 = 0.250, p < 0.001). Conclusion. Although fewer severe pain attacks occurred in summer, the mean NIH-CPSI scores did not differ across seasons. The pain from CP/CPPS had a greater impact on QoL during winter than it did in the other seasons. In addition, pain was a more significant determinant of QoL than urination symptoms during winter.

The value of neutrophil elastase in diagnosis of type III prostatitis.

To explore the value and significance of neutrophil elastase (NE) in diagnosis of type III prostatitis. The prospective study recruited 123 patients diagnosed with type III prostatitis (IIIA, 36 cases; IIIB, 87 cases) and 84 healthy controls, between April 2008 and July 2012. NE concentrations in expressed prostatic secretions (EPS), EPS routine examination, bacterial culture and The National Institute of Health Chronic Prostatitis Symptom Index (NIHCPSI) score were detected in all the subjects. Difference of NE, CPSI score, and withe blood cell (WBC) count between 2 or more than 2 groups and relationships between NE concentrations and WBC count were all analyzed. There was significant difference in levels of NE (P < .05) between IIIA and IIIB groups, and obviously positive correlation between the level of NE and number of leukocyte in type IIIA prostatitis group was observed (P < .05). The values of CPSI score between IIIA and IIIB groups was statistically significant (P = .037). The levels of leukocyte mount, NE and CPSI were statistically significant between IIIA and the control group (P < .05). NE concentration and CPSI score were statistically significant between IIIB and control group (P < .05), while the numbers of leukocyte was not statistically significant (P = .360). The level of NE in EPS is a significant indicator in diagnosis of type IIIA and IIIB prostatitis.