NIH-CPSI Scores Research Articles

AB030. Premature ejaculation of clinical characteristic and risk factors in Korean men

Premature ejaculation (PE) is one of the most prevalent male sexual disorders and the global prevalence rates of PE estimated at approximately 20-30%. From nationwide survey in Korea, the prevalence of PE is 17 to 27% according to different definitions. In PE patients, the frequency of sexual intercourse was decreased (less than 1 time; 36.4% in PE group vs. 20.6% in non-PE group) and the stress in life was increased (serious stress; 44.9% in PE group vs. 29.6% in non-PE group). The satisfaction level of sexual intercourse (in the category of very unsatisfactory or unsatisfactory) in PE males and non-PE males was 41.1% and 9.8%. PE had a negative impact on the subjects’ overall relationships with their partners. Over half of the non-PE males thought that the frequency of their partner’s organism during sexual intercourse was more than 50%, whereas most of the PE males thought that their partner did not achieve orgasm. In a cross-sectional study conducted that included 8,261 men, 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 (NIHCPSI 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). These data showed a significant correlation between the PEDT score and the NIH-CPSI score. I suggest routine screening for CP/CPPS in men with PE and PE in men with CP/CPPS.

MP25-04 TRANSUTRICULAR SEMINAL-VESICULOSCOPY IN THE MANAGEMENT OF SYMPTOMATIC MIDLINE CYSTS OF THE PROSTATE

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2015MP25-04 TRANSUTRICULAR SEMINAL-VESICULOSCOPY IN THE MANAGEMENT OF SYMPTOMATIC MIDLINE CYSTS OF THE PROSTATE Pil Moon Kang, Won Ik Seo, Wan Suk Kim, Jang Ho Yoon, Dong Il Kang, Kweon Sik Min, and Jae Il Chung Pil Moon KangPil Moon Kang More articles by this author , Won Ik SeoWon Ik Seo More articles by this author , Wan Suk KimWan Suk Kim More articles by this author , Jang Ho YoonJang Ho Yoon More articles by this author , Dong Il KangDong Il Kang More articles by this author , Kweon Sik MinKweon Sik Min More articles by this author , and Jae Il ChungJae Il Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the utility of transutricular seminal vesiculoscopy as a diagnostic and therapeutic option for symptomatic midline cysts of the prostate in patients with hematospermia and symptoms associated with prostatitis. METHODS From January 2005 to July 2013, 61 patients with symptomatic (hematospermia, pain on ejaculation, scrotal discomfort) midline cysts of the prostate, who did not improve with medication within a 4-week period, were included. Diagnosis of a midline cyst of the prostate was based on an anechoic round or spheroid-shaped lesion in the median, above the level of the verumontanum, extending into the prostatic base on transrectal ultrasonography (TRUS). All patients underwent transutricular seminal-vesiculoscopy using a 9.0 Fr rigid ureteroscope and Bugbee electrode. Medical records, the Chronic Prostatitis Symptom Index (NIH-CPSI), and TRUS were used for assessment for more than 3 months after the procedure. RESULTS Of the 61 patients, 32 (52.4%) had hematospermia, 20 (32.7%) had symptoms associated with chronic pelvic pain syndrome, such as perineal pain, scrotal discomfort, and testicular pain, and 9 (14.7%) patients had ejaculatory disturbances, such as painful or uncomfortable ejaculation and anejaculation as major complaints/symptoms. Hematospermia resolved in 29 of 32 (90.6%) patients after transutricular semino-vesiculoscopy. Hematospermia recurred in one patient after 2 years. In 29 patients with chronic pelvic pain syndrome and ejaculatory disturbances, NIH-CPSI scores improved, from 19.0¡¾3.8 to 11.8¡¾3.6, after treatment. The pain domain and quality of life domain scores of the NIH-CPSI were better postsurgery than presurgery (p < 0.05). Acute epididymitis, as a postoperative complication, was observed in two patients. CONCLUSIONS The transutricular seminal vesiculoscopy procedure can be readily performed using conventional endoscopic equipment. This technique enables useful diagnostic and therapeutic approaches for symptomatic midline cysts of the prostate. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e286 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pil Moon Kang More articles by this author Won Ik Seo More articles by this author Wan Suk Kim More articles by this author Jang Ho Yoon More articles by this author Dong Il Kang More articles by this author Kweon Sik Min More articles by this author Jae Il Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP16-04 IMMUNOSTIMULATION IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS). A ONE-YEAR PROSPECTIVE, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2014MP16-04 IMMUNOSTIMULATION IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS). A ONE-YEAR PROSPECTIVE, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY Florian Wagenlehner, Stefania Ballarini, and Kurt Naber Florian WagenlehnerFlorian Wagenlehner More articles by this author , Stefania BallariniStefania Ballarini More articles by this author , and Kurt NaberKurt Naber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.577AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inflammation/ immunological dysfunction are discussed etiological causes of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS). OM-89 is an orally immunostimulating agent. We performed a phase 3 multicentre, randomized, double-blind, placebo controlled long term (12 months) study with OM-89 produced with a different lysis process in patients with moderate to severe CP/CPPS type II and III. METHODS Patients were randomised to placebo or OM-89. Primary efficacy variable was difference of responders at end of treatment (month 9) in patients receiving placebo versus OM-89. RESULTS 203 patients were screened, 185 (90% of CP/CPPS type IIIb) enrolled in 30 centres. 94 were randomized to OM-89, 91 to placebo. All 185 patients (47.8±8.4 years) were included in Safety Set (SS), 181 in Full Analysis (FAS), 155 in Per Protocol Set (PPS). Baseline NIH-CPSI score was 23.0±3.8 (OM-89) and 21.8±3.8 (placebo). At primary efficacy endpoint (month 9), 67.0% (PPS 72.7%) of OM-89 and 64.0% (PPS 64.1%) of placebo group were responders in the FAS [FAS: OR 1.20, p=0.563; PPS: p=0.154]. The mean relative decrease in NIH-CPSI was 40.5% and 43.4% in the FAS. Treatment related adverse events were low: 8.5% with OM-89 and 5.5% with placebo. Because of small numbers no conclusion could be drawn regarding the potential benefit of OM-89 in CP/CPPS type II and IIIa. CONCLUSIONS This placebo-controlled study evaluating OM-89 in patients with CP/CPPS showed a significant and long-lasting (12 months) favourable response with OM-89, but also with placebo. OM-89 was safe and well tolerated. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e154 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Florian Wagenlehner More articles by this author Stefania Ballarini More articles by this author Kurt Naber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Immunostimulation in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a one-year prospective, double-blind, placebo-controlled study

Inflammation/immunological dysfunction are discussed etiological causes of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). OM-89 is an orally immunostimulating agent. We performed a phase three multicentre, randomized, double-blind, placebo-controlled, long-term (12 months) study with OM-89 produced with a different lysis process in patients with moderate-to-severe CP/CPPS type III. Patients were randomized to OM-89 or placebo. Primary efficacy variable was difference of responders at the end of treatment (month 9) in patients receiving OM-89 versus placebo. Two hundred and three patients were screened, 185 patients (47.8 ± 8.4 years) (90 % of CP/CPPS type IIIb) were enrolled in 30 centers and included in the safety set. Ninety-four were randomized to OM-89, 91 to placebo. One hundred and seventy-six patients were subjected to the full analysis (FAS), 150 to the per protocol set (PPS). Baseline NIH-CPSI score in FAS was 21.8 ± 3.8 (OM-89) and 23.0 ± 5.6 (placebo). At primary efficacy endpoint (month 9), in the OM-89 group, 67.0 % in FAS (PPS 72.7 %) and in the placebo group, 64.3 % in FAS (PPS 64.4 %) were responders [FAS: OR 1.19, p = 0.59; PPS: p = 0.19]. Mean relative decrease in NIH-CPSI was 40.5 and 44.0 % in the FAS. Treatment-related adverse events were low: 8.5 % with OM-89 and 5.5 % with placebo. Because of small numbers, no conclusion could be drawn regarding the potential benefit of OM-89 in CP/CPPS IIIa. This placebo-controlled study evaluating OM-89 in patients with CP/CPPS showed a significant and long-lasting (12 months) favorable response with OM-89, but also with placebo. OM-89 was safe and well tolerated. 2007-004609-85.

Maintenance Of The Response To Sacral Pulsed Radiofrequency In Chronic Prostatitis/Pelvic Pain Syndrome Using Hyperbaric Oxygen

Introduction: None of treatments reported for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has shown considerable improvement in patient´s daily life. Our objective is to determine the efficacy of hyperbaric oxygen therapy (HBOT) in the maintenance of response after sacral pulsed radiofrequency (PRF) in patients with CP/CPPS. Material and methods: Prospective, comparative study including men with CP/CPPS divided in group A: S2-S4 PRF; and group B: S2-S4 PRF+HBO. The evaluated variables were pain (through the visual analog scale, VAS), and quality of life using the The NIH Chronic Prostatitis Symptom Index (CPSI) at 0, 1, 3, 6 and 12 months-follow up. Responders were predefined as patients who had experienced a more than 50% of decrease in the total NIH- CPSI score and more than 50% improvement in different areas of KHQ. Results: 24 patients met the inclusion/exclusion criteria (17 Group A; 7 Group B) . A significant manteinance of improvement (p<0.05) for pain subscore, urinary subscore, quality of life subscore, total NIH-CPSI score and all the areas of KHQ was noticed in Group B after 18 months follow-up. No adverse effects were reported. Conclusions: In this study, HBO improved the maintenance of the beneficial effects of sacral PRF among men with CP/CPPS.

Comparison of results after fluoroquinolones and combination therapies in type iiiA chronic prostatitis

PurposeWe investigated retrospectively the clinical outcomes of the patients with type iii inflammatory chronic prostatitis, who were treated with fluoroquinolones with and without an α-blocker between 2009 and 2011. Material and methodsDiagnosis was established with medical history (symptoms presented longer than 3 months within previous 6 months), physical examination, Meares-Stamey test and the questionnaire of the NIH-CPSI. The responses to the treatment were assessed with uroflowmetry test and the questionnaire of NIH-CPSI at initial and after 4 weeks of the treatment. The patients with incomplete data and treatment and who treated with α-blockers and/or antibiotics in the period 4 weeks prior to the therapy started in our clinic and had any surgery of lower urinary tract previously were excluded. The patients were classified under 6 groups: group1=ciprofloxacin, group2=ofloxacin, group3=levofloxacin, group4=ciprofloxacin+tamsulosin, group5=ofloxacin+tamsulosin, group 6=levofloxacin+tamsulosin. Wilcoxon Signed Ranks and Kruskal Wallis test were used for comparison of results. Mann Whitney U test with Bonferroni correction made was used as post hoc (p<.05). ResultsThe median scores of NIH-CPSI decreased significantly in all groups (p<.05). Levofloxacin reduced the median total scores of NIH-CPSI more than ciprofloxacin and ofloxacin monotherapies. The combination therapies were better than antibiotic therapies alone and best result was obtained in levofloxacin+tamsulosin combination. ConclusionTamsulosin+fluoroquinolone (especially tamsulosin+levofloxacin) combinations yielded better results in both NIH-CPSI scores and peak flow rates.

Comparison of tamsulosin vs tamsulosin/sildenafil effectiveness in the treatment of erectile dysfunction in patients affected by type III chronic prostatitis

We evaluated the effectiveness of tamsulosin monotherapy versus tamsulosin plus sildenafil combination therapy on erectile dysfunction (ED) in young patients with type III chronic prostatitis and ED by using symptom score scales. 44 male patients were divided into 2 groups: the first group (20 patients) was treated with tamsulosin 0,4 mg monotherapy and the second one 24 patients) was treated with tamsulosin 0,4 mg plus sildenafil 50 mg combination therapy. “International Prostate Symptom Score, “National Institute of Health Chronic Prostatitis Symptom Index" (NIH-CPSI) and “International Index of Erectile Function" (IIEF-5) were investigated in each group of patients, and scores calculated during the first medical examination. Both groups were treated with tamsulosin once daily for 60 days, while sildenafil 50 mg was given on demand (at least 2 times per week) for 60 days. During the second medical examination IPSS, NIH-CPSI and IIEF-5 scores were analyzed once more. Afterwards, the alterations of scores among medical examinations in each group and between both groups were statistically compared. The age average of the 44 cases included was 32.04 3.15 years. Both groups present a statistically significant decrease, between the first and the second medical examination, in IPSS, NIH-CPSI scores and statistically significant increase in IIEF-5 score. In addition, there is no statistically significant difference, in all scores, between mono and combination therapy. tamsulosin monotherapy, as well as a combination therapy (tamsulosin plus sildenafil) has an improving effect on symptoms and on ED in patients with type III prostatitis. In the near future alpha-blockers monotherapy could be used in the treatment of chronic prostatitis and ED cases instead of phosphodiesterase type 5 (PDE-5) inhibitors combination therapy.

The impact of biofilm-producing bacteria on chronic bacterial prostatitis treatment: results from a longitudinal cohort study

We aim to evaluate the role of biofilm-producing bacteria in the clinical response to antibiotic therapy among patients affected by chronic bacterial prostatitis (CBP). All patients attending our centre from January to December 2008 due to prostatitis-like symptoms with a positive Meares-Stamey test were enroled. The clinical symptoms were assessed according to the NIH-CPSI, and the bacterial strains isolated from the patients enroled were identified and tested for antibiotic sensitivity using cards of the Vitek II semi-automated System for Microbiology (BioMerieux). Quantitative bacterial slime production was assessed by the Christensen microwell assay. All patients were treated with fluoroquinolones for 4 weeks and reevaluated clinically and microbiologically after 3 months. One hundred and sixteen patients were enroled, and 150 bacterial strains were isolated from all patients. About 85 % of these strains were strong or moderate biofilm producers. Patients with strong or moderate biofilm-producing bacteria had a higher NIH-CPSI symptom score than those without biofilm-producing bacteria (mean 17.6 ± 5.6 vs. 14.1 ± 3.3; p = 0.0009). At the follow-up, 68 patients (58.6 %) had negative microbiological tests, but only 11 (9.48 %) reported a reduction in NIH-CPSI score. Improvement of symptoms was found statistically significantly less frequent in patients with biofilm-producing bacteria than in those without (p = 0.03). Ultrastructural analysis showed cellular forms in active replication with aberrant morphology of unknown cause and confirmed strong slime production with consistent bacterial stratification. In our CBP population, biofilm-producing bacteria were commonly found and had a significant negative impact on the clinical response to antibiotic therapy.

Comparación de los resultados después de flouroquinolonas y terapias de combinación en prostatitis crónica tipo iiiA

PurposeWe investigated retrospectively the clinical outcomes of the patients with type iii inflammatory chronic prostatitis, who were treated with fluoroquinolones with and without an α-blocker between 2009-2011. Material and methodsDiagnosis was established with medical history (symptoms presented longer than 3 months within previous 6 months), physical examination, Meares-Stamey test and the questionnaire of the NIH-CPSI. The responses to the treatment were assessed with uroflowmetry test and the questionnaire of NIH-CPSI at initial and after 4 weeks of the treatment. The patients with incomplete data and treatment and who treated with α-blockers and/or antibiotics in the period 4 weeks prior to the therapy started in our clinic and had any surgery of lower urinary tract previously were excluded. The patients were classified under 6 groups; group1=ciprofloxacin, group2=ofloxacin, group3=levofloxacin, group4=ciprofloxacin+tamsulosin, group5=ofloxacin+tamsulosin, group 6=levofloxacin+tamsulosin. Wilcoxon Signed Ranks and Kruskal Wallis test were used for comparison of results. Mann Whitney U test with Bonferroni correction made was used as posthoc (P<.05). ResultsThe median scores of NIH-CPSI decreased significantly in all groups (P<.05). Levofloxacin reduced the median total scores of NIH-CPSI more than ciprofloxacin and ofloxacin monotherapies. The combination therapies were better than antibiotic therapies alone and best result was obtained in levofloxacin+tamsulosin combination. ConclusionTamsulosin+fluoroquinolone (especially tamsulosin+levofloxacin) combinations yielded better results in both NIH-CPSI scores and peak flow rates.

Defining the aetiology of erectile dysfunction in men with chronic pelvic pain syndrome

Men presenting with chronic pelvic pain syndrome (CPPS) frequently report concomitant erectile dysfunction (ED), but the underlying cause of ED in this patient population has not been previously studied. This study prospectively investigated the aetiology of ED in men with CPPS. The study population comprised 46 men with penile pain or dysorgasmia, and concomitant ED. All participants completed the NIH-CPSI and international index of erectile function- erectile function domain (IIEF-EFD) questionnaires, and underwent penile duplex Doppler ultrasonography (DUS), following intracavernosal trimix injection, to evaluate erectile hemodynamic parameters. Pearson's correlation between NIH-CPSI and IIEF-EFD scores, and between NIH-CPSI score and the erectile response to trimix injections was investigated. The prevalence of mild, moderate and severe CPPS symptoms was 26, 48 and 26% respectively. The severity of ED was mild, moderate or severe in 15, 61 and 24% of men respectively. NIH-CPSI and IIEF-EFD scores were negatively correlated (r=-0.32, p=0.002). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were normal in 96 and 100% of men respectively. The majority of men (78%) required ≥2 trimix injections to attain an adequate erection for DUS. NIH-CPSI scores and the number of trimix injections needed were positively correlated (r=0.22, p=0.035). The aetiology of erectile dysfunction in men who present with CPPS and concomitant ED is almost always psychogenic. Penile DUS in this population of men is fraught with the potential for error, and frequently necessitates more than one dose of a vasoactive agent.

Clinical Utility of the UPOINT Phenotype System in Chinese Males with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): A Prospective Study

BackgroundRecent data showed that a six-domain UPOINT is a flexible and responsive new classification system that has the clinical applicability in CP/CPPS. However, the utility of UPOINT algorithm in men in China with CP/CPPS has not been comprehensively studied. For international validation and adoption, we evaluated this clinical phenotype system for a large cohort of Chinese CP/CPPS patients and correlated it with patient symptoms and erectile dysfunction (ED). We also investigated the addition of an ED domain in regard to symptom correlation.MethodsA total of 389 Chinese males with CP/CPPS were prospectively collected and classified in each domain of the UPOINT system. Symptom severity was measured using the NIH-CPSI and IPSS. The erectile function was evaluated using the IIEF-5. Clinically relevant associations were calculated.ResultsThe percentage of patients positive for each domain was 54.0%, 42.1%, 41.9%, 20.8%, 26.7%, and 40.4% for the Urinary, Psychosocial, Organ-specific, Infection, Neurological/systemic, and Tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI (r = 0.706, p<0.001), IPSS (r = 0.682, p<0.001) and IIEF-5 scores (r = 0.631, P = 0.007) in Chinese cohort. Except for patients age, symptom duration was associated with a significantly greater number of positive domains (r = 0.638, P = 0.005). After adding an ED domain to create a modified UPOINT system, the correlation between the number of phenotypic domains and symptom severity was improved (0.706 to 0.844, p<0.001).ConclusionsThe clinical applicability of using UPOINT phenotyping system has been validated in the Chinese patients with CP/CPPS. In our cohort, the number of positive domains was also correlated with ED symptoms and the significant association between the number of UPOINT domains and NIH-CPSI scores was further refined by adding a domain for ED. Our findings presented here support the utility of using ED as a stand-alone item in the UPOINT domain.

Effects of Pollen Extract in Association with Vitamins (Deprox 500®) for Pain Relief in Patients Affected by Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results from a Pilot Study

The therapeutic efficacy of CP/CPPS is not very satisfactory and the impact on young male's quality of life is considerable. The aim of the present study is to evaluate the efficacy of pollen extract associated with vitamins (DEPROX 500®) in order to improve the quality of life of young patients affected by chronic prostatitis type IIIb (CP/CPPS) by pain relieving. All patients with clinical and instrumental diagnosis of CP/CPPS (class b) underwent DEPROX 500® 2 tablets in a single dose daily for 30 days. Clinical and microbiological analyses were carried out at the enrolment and after 1 month. NIH-CPSI and IPSS questionnaires have been used. The main outcome measure was the improvement of quality of life at the end of the whole study period, evaluated by questionnaires results. 20 men (mean age 32.8 ± 6.78) were enrolled in this pilot study. The baseline questionnaire mean scores were 25.90 ± 2.1 and 8.01 ± 3.64 for NIH-CPSI and IPSS, respectively. At the follow-up examination (1 month after treatment), 18 out of 20 patients (90.0%) reported an improvement of quality of life, in terms of pain reduction. The questionnaire results after 1 month from treatment were as follows: NIH-CPSI 12.8 ± 2.20, IPSS 7.6 ± 1.58. Statistically significant differences were then reported between the two visits, in terms of NIH-CPSI scores (p<0.001). No statistically significant differences have been reported in terms of IPSS between the two groups. All patients were negative at the Meares-Stamey test evaluation. The compliance to the study protocol was 100%. The pollen extract associated with vitamins (DEPROX 500®) significantly improved total symptoms, pain, and QoL in patients with non-inflammatory CP/CPPS without severe side effects.

Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values?

IntroductionWe investigated if antibiotherapy has any role on total prostate specific antigen (tPSA), free prostate specific antigen (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 of 108 patients older than 50 years of age with lower urinary system symptoms 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) questionnaires are performed and serum tPSA, fPSA and fPSA/tPSA values are 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, a statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. ConclusionsAntibiotherapy given to patients with prostate specific antigen (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.

¿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.

1430 THE EFFICACY OF ELECTROMAGNETIC STIMULATION FOR TREATMENT OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME PATIENTS WHO DO NOT RESPOND TO PHARMACOTHERAPY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111430 THE EFFICACY OF ELECTROMAGNETIC STIMULATION FOR TREATMENT OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME PATIENTS WHO DO NOT RESPOND TO PHARMACOTHERAPY Woojoong Kim, Jae Seung Lee, Geonseok Lee, Wonjin Cho, Ha Na Lee, Young Suk Lee, DeokHyun Han, and Kyu-Sung Lee Woojoong KimWoojoong Kim Seoul, Korea, Republic of More articles by this author , Jae Seung LeeJae Seung Lee Seoul, Korea, Republic of More articles by this author , Geonseok LeeGeonseok Lee Seoul, Korea, Republic of More articles by this author , Wonjin ChoWonjin Cho Seoul, Korea, Republic of More articles by this author , Ha Na LeeHa Na Lee Seoul, Korea, Republic of More articles by this author , Young Suk LeeYoung Suk Lee Seoul, Korea, Republic of More articles by this author , DeokHyun HanDeokHyun Han Seoul, Korea, Republic of More articles by this author , and Kyu-Sung LeeKyu-Sung Lee Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1342AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated the effect of electromagnetic stimulation (EMS) as primary treatment for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) who did not respond to pharmacotherapy, evaluating the changes in their pain and lower urinary tract symptoms. METHODS The patients with CP/CPPS symptoms for at least 3 months in spite of medication were included. Inclusion criteria were > 18 years, total score of NIH-CPSI > 15, score of item 1 and item 2 in NIH-CPSI > 1. All patients underwent EMS for 6 weeks (total 12 sessions). The primary end-point was the change of total and pain scores of NIH-CPSI 24 weeks after treatment. Patients were evaluated by NIH-CPSI, International Prostate Symptom Score(IPSS), Benefit Satisfaction and Willingness (BSW) questionnaire, patient perception of symptom improvement (PPSI), voiding diary and complications. RESULTS A total of 46 men were included. 37 patients who completed this study were analyzed. Nine of 46 patients dropped out −7 in withdrawal of consent, 1 in unsatisfactory therapeutic effect, 1 in adverse effect of EMS. Figure 1 shows the changes of total and pain scores of NIH-CPSI. Total and pain scores of NIH-CPSI were significantly decreased immediately after treatment and maintained till 24 weeks after treatment. At 24 weeks, 22 patients (59.5%) shows 6 or greater improve of total NIH-CPSI score. Total and and sub-domain sum of IPSS, 24-hr micturition number were improved significantly after treatments. In BSW, 75.7%, 70.3% and 78.4% patients reported positive answer to the benefit, satisfaction and willingness domain respectively 24 weeks after treatment. PPSI measured by visual analog scale was maintained from immediately after treatment (45.0) till 24 wks (45.9). There were 4 adverse events, including 1 increased postvoid residual, 1 hip joint pain, 1 urethral discharge, and 1 reflux esophagitis. CONCLUSIONS In this study, EMS significantly improved pain and lower urinary tract symptoms in CP/CPPS patients who did not respond medical treatments and more than 70% patients were satisfied with EMS. These data suggest that EMS could be considered as a safe and effective treatment option for CP/CPPS patients who do not respond to pharmacotherapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e572-e573 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Woojoong Kim Seoul, Korea, Republic of More articles by this author Jae Seung Lee Seoul, Korea, Republic of More articles by this author Geonseok Lee Seoul, Korea, Republic of More articles by this author Wonjin Cho Seoul, Korea, Republic of More articles by this author Ha Na Lee Seoul, Korea, Republic of More articles by this author Young Suk Lee Seoul, Korea, Republic of More articles by this author DeokHyun Han Seoul, Korea, Republic of More articles by this author Kyu-Sung Lee Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Identification, Pharmacologic Considerations, and Management of Prostatitis

Background Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland. There are many different causes for prostatitis, including infection; occasionally no clear etiology for the inflammation is found. Effective treatment often depends on identification of the cause, but a microbiologic organism is not always detectable, especially in cases of chronic prostatitis. Objective The aim of this article was to review identification and treatment options for prostatitis, including pharmacologic and nonpharmacologic interventions. Methods Relevant information was identified through a search of MEDLINE (1966–June 2010), International Pharmaceutical Abstracts (1970–June 2010), and EMBASE (1947–June 2010). Randomized, controlled trials that examined prostate cancer, benign prostatic hypertrophy, or procedures related to the prostate (ie, biopsies) were excluded. Results A working classification system for prostatitis was developed in 1999, but there are few randomized controlled trials that distinguish between the various treatment options. Bacterial prostatitis can be acute or chronic but always requires some degree of antimicrobial therapy. Pharmacologic features of fluoroquinolones make them the preferred agents for most patients. These antibiotics can become trapped in a chronically inflamed prostate due to pH differences between prostatic tissue and serum. Many fluoroquinolones have penetration ratios (prostate level:serum level) of up to 4:1. A study in European men (N = 117) who received levofloxacin 500 mg/d with a diagnosis of chronic bacterial prostatitis demonstrated clinical success rates of 92% (95% CI 84.8%–96.5%), 77.4% (95% CI, 68.2–84.9%), 66.0% (95% CI, 56.2%–75.0%), and 61.9% (95% CI, 51.9%–71.2%) at 5–12 days, 1 month, 3 months, and 6 months after treatment. Additionally, there have been numerous randomized, placebo-controlled trials in patients with chronic prostatitis that have studied α-blockers, steroid inhibitors, anti-inflammatory agents, and bioflavonoids. Treatment responses to α-blockers appear to be greater with longer durations of therapy in α-blocker–naïve patients (National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI] score reduction of at least 3.6 points after 6 weeks of tamsulosin therapy [ P = 0.04] and up to 14.3 and 9.9 point NIH-CPSI score reductions with 14 weeks of terazosin and 24 weeks of alfuzosin therapy, respectively [ P = 0.01 for both]). Combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy (12.7 vs 12.4 point reduction in NIH-CPSI scores) and a stepwise approach to therapy involving antibiotics followed by bioflavonoids and then α-blockers appears to effectively reduce symptoms for up to 1 year in patients with chronic prostatitis (mean NIH-CPSI point reduction of 9.5 points compared with baseline, P < 0.0001). Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy. Conclusions Prostatitis can resemble various other medical conditions but proper classification and an understanding of the pharmacologic features and expectations of the medications used to treat it can help identify effective treatment strategies. Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified. However, the use of agents with anti-inflammatory or antiadrenergic properties may be necessary in combination with or after trying antimicrobial agents.

Effectiveness of doxazosin on erectile dysfunction in patients with lower urinary tract symptoms

We evaluated the effectiveness of doxazosin on ED in patients with LUTS/BPH and ED by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, "International Prostate Symptom Score" (IPSS), "National Health Institute Chronic Prostatitis Symptom Index" (NIH-CPSI) and "International Index of Erectile Function" (IIEF-5) were investigated, and the scores were calculated in the first visit. Doxazosin was given for 30 days, and at the second visit IPSS, NIH-CPSI and IIEF-5 scores, Qmax and PMR were once more analysed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03 ± 1.35. The alterations in parameters between 1st and 2nd visit were compared in the cases who used doxazosin and a statistically significant decrease in IPSS, NIH-CPSI scores and statistically significant increase in Qmax were observed. Besides, there was a statistically significant increase in IIEF-5 score. In addition, when the cases were divided into two groups patients with asymptomatic inflammatory prostatitis and without asymptomatic inflammatory prostatitis, there was not any difference in all scores. Doxazocin use in cases with LUTS/BPH and ED has an improving effect on ED as well as LUTS. Therefore, we believe that in the future, single agents or combined therapies might have a place in cases with LUTS/BPH and ED.

The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis

We evaluated the effectiveness of sildenafil citrate on lower urinary system symptoms (LUTS) by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, 'International Prostate Symptom Score' (IPSS), 'National Health Institute Chronic Prostatitis Symptom Index' (NIH-CPSI) and 'International Index of Erectile Function' (IIEF-5) were investigated and the scores were calculated in the first visit. Sildenafil citrate was given for 30 days and at the second visit IPSS, NIH-CPSI and IIEF-5 scores were once more analyzed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03±1.35. When the alterations in parameters of first visit and second visit were evaluated, we found a statistically significant increase in IIEF-5 and a statistically significant decrease in IPSS, IPSS-QOL (Quality of Life). In addition, when the cases were divided into two groups with and without asymptomatic inflammatory prostatitis, in the cases with asymptomatic inflammatory prostatitis, sildenafil citrate caused improvement only in ED, but had no effect on LUTS. Sildenafil citrate use in cases with LUTS and ED has an improving effect on LUTS as well as ED. However, in cases with asymptomatic inflammatory prostatitis, sildenafil citrate did not lead to an improvement in LUTS.

Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients

Chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is a common disabling condition that is primarily associated with pain in the urogenital region and disturbances in urinary and sexual function. Chronic pelvic pain symptoms are the most common presentation, especially perineal, lower abdominal, testicular, penile as well as ejaculatory pain. Other genitourinary tract complaints include voiding disorders and sexual dysfunction. We aimed in the study at examining the prevalence rates of premature ejaculation and erectile dysfunction in patients with chronic pelvic pain syndrome and comparing these rates with those of healthy control subjects. Between November 2006 and January 2008, 85 patients with the diagnosis of CP/CPPS were chosen for the study; 30 patients without regular sexual activity and 12 patients without inclusion criteria were excluded from the study. A total of 43 patients were included in the study. Twenty healthy volunteers without prostatitis-like syndromes were used as a control group. The sexual function of the patients and the healthy volunteers were evaluated using Arizona Sexual Function Questionary Form and International Index of Erectile Function (IIEF). Erectile dysfunction (ED), ejaculatio precox (EP) and pain on ejaculation (PEP) were investigated as sexual dysfunction. The mean age of the patients was 33.7 (22-48) years; the mean symptom period was 37.7 (6-120) months, while the mean age of the control group was 32.4 (24-48) years. The mean NIH-CPSI score of the patient group was 26.1 (16-34). Patient group was classified as CPPS type IIIa and CPPS type IIIb. Mild and moderate erectile dysfunction (ED) was found in [9] 23.2% patients at the patient group and [2] 10% at the control group (P: 0.185). Severe erectile dysfunction was not found in both groups. Ejaculatio Precox (EP) was found at (29) 67.4% of the patient group and [7] 40% of the control group. Pain on ejaculation (PEP) was detected in [15] 37.2% of the patient group, while none of the control group had pain on ejaculation. More than one sexual dysfunction was found in [17] 41.8% of the patient group and none of the control group. Comparing patient group versus control group, ejaculation disorders (EP and PEP) and more than one sexual dysfunction disorder were statistically significant. According to ED, there is no statistical difference between the groups (P > 0.05). Sexual function disorders, especially ejaculation disorders (EP and PEP), are frequently seen in CP/CPPS patients versus normal population. Age, symptoms period, symptom score and CP/CPPS subgroups are not risk factors for sexual function disorders. Patients with the diagnosis of CP/CPPS should be evaluated for sexual function disorders.

Effects of a 6-month course of tamsulosin for chronic prostatitis/chronic pelvic pain syndrome: a multicenter, randomized trial

To evaluate the efficacy and long-term benefits of tamsulosin in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A total of 100 men diagnosed with CP/CPPS were randomly allocated to receive either 0.2 mg of tamsulosin daily or placebo for 6 months. Patients were followed up at 3, 6, 12, 18 and 30 months after initiation of treatment. The primary outcome variable was the change from baseline in the total and domain scores of the NIH-CPSI. Secondary variables used to evaluate efficacy of treatment included the following: peak urinary flow rate, post-voiding residual (PVR) volume and the International Index of Erectile Function (IIEF). The tamsulosin patients had modest satisfactory improvements compared to the placebo group during treatment. Six months after initiation of treatment, the mean decrement of total NIH-CPSI score in tamsulosin and placebo group were 7.5 ± 1.9 and 4.0 ± 2.3, respectively, P < 0.01. After cessation of therapy, the significant difference waned gradually. Two years after cessation of therapy, the mean decrement of total NIH-CPSI score in two groups were 3.0 ± 1.3 and 1.9 ± 0.9, respectively, P > 0.05. No differences were observed for data of patients classified as class III A or III B and data of peak urinary flow rate, PVR and the IIEF during the study period. Our study shows that a 6-month course of tamsulosin ameliorated symptoms of CP/CPPS during treatment. However, these effects decreased gradually 6 months after cessation of treatment. This suggests that long-term tamsulosin may be indicated, particularly in the responders.