[Urogenital infections in the male and the desire to father a child]

Urogenital infections may often have a major effect on fertility. For the most part, however, the pathogenetic aspects of such cases have not yet been clarified. In the future, the integration of functional and molecular parameters will be decisive for defining an interaction between urogenital infection and male fertility. As a rule, infection-related alterations to the ejaculate require antimicrobial treatment, although the effect of the latter on fertility remains uncertain.

[Experience in wilaprafen treatment of chlamydial prostatitis, complicated by infertility]

The antichlamydial action of wilprafen was studied in patients suffering from urogenital chlamydial prostatitis complicated by infertility. An individual approach to etiotropic and pathogenetic therapy with wilprafen alone and in combination with vobenzim introduced by the authors in men with chlamydial prostatitis complicated by infertility produced a high curative effect.

[Chronic prostatitis with chronic pelvic pain syndrome]

Almost 10% of the adult male population suffer from prostatitis. The International Prostatitis Collaborative Network has devised and validated a clinically useful classification of prostatitis that urologists and primary care clinicians will find helpful. According to this schema, chronic bacterial prostatitis is clearly an infectious disease, and patients with chronic prostatitis associated with chronic pelvic pain syndrome can have either inflammatory or noninflammatory disease. Chronic bacterial prostatitis is uncommon, chronic nonbacterial prostatitis (CPPS) is extremely common. Antibiotic therapy is indicated in management of chronic bacterial prostatitis and inflammatory chronic pelvic pain syndrome. Fluoroquinolones are safe and effective in managing chronic bacterial prostatitis. Based on literature, noninflammatory chronic pelvic pain syndrome can be treated using adrenergic blockade, analgesic, tricyclic antidepressants, benzodiazepie, physical therapy.

[Varicocele and coincidental abacterial prostato-vesiculitis: negative role about the sperm output]

OBJECTIVE

To evaluate the frequency and the role of a coincidentally expressed abacterial prostato-vesiculitis (PV) on sperm output in patients with left varicocele (Vr).

MATERIALS AND METHODS

We evaluated 143 selected infertile patients (mean age 27 years, range 21-43), with oligo- and/or astheno- and/or teratozoospermia (OAT) subdivided in two groups. Group A included 76 patients with previous varicocelectomy and persistent OAT. Group B included 67 infertile patients (mean age 26 years, range 21-37) with OAT and not varicocelectomized. Patients with Vr and coincidental didymo-epididymal ultrasound (US) abnormalities were excluded from the study. Following rectal prostato-vesicular ultrasonography, each group was subdivided in two subsets on the basis of the absence (group A: subset Vr-/PV-; and group B: subset Vr+/PV-) or the presence of an abacterial PV (group A: subset Vr-/PV+; group B: subset Vr+/PV+). Particularly, PV was present in 47.4% and 41.8% patients of groups A and B, respectively. This coincidental pathology was ipsilateral with Vr in the 61% of the cases. Semen analysis was performed in all patients.

RESULTS

Patients of group A showed a total sperm number significantly higher than those found in group B. In presence of PV, sperm parameters were not significantly different between matched--subsets (Vr-/PV+ vs. Vr+/PV+). In absence of PV, the sperm density, the total sperm number and the percentage of forward motility from subset with previous varicocelectomy (Vr-/PV) exhibited values significantly higher than those found in the matched--subset (Vr+/PV-).

CONCLUSION

Sperm analysis alone performed in patients with left Vr is not a useful prognostic post-varicocelectomy marker. Since following varicocelectomy a lack of sperm response could mask another coincidental pathology, the identification through US scans of a possible PV may be mandatory. On the other hand, an integrated uro-andrological approach, including US scans, allows to enucleate subsets of patients with Vr alone, who will have an expected better sperm response following Vr repair.

Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls

PURPOSE

Previous reports have identified bacteria in the prostate of men with chronic pelvic pain syndrome. To examine whether prostatic bacteria are more prevalent among patients with chronic pelvic pain syndrome than among those without pelvic pain, we compared 4-glass urine test and prostate biopsy results.

MATERIALS AND METHODS

A total of 120 patients with types IIIa and IIIb chronic pelvic pain syndrome and 60 asymptomatic controls underwent a standard 4-glass urine test, examination of expressed prostatic secretion leukocytes by hemocytometer and transperineal, digitally guided prostate biopsies. Tissue was cultured for aerobes, anaerobes, Trichomonas vaginalis, Chlamydia trachomatis and herpes simplex virus. Skin cultures were performed on a subset of patients and controls.

RESULTS

Positive prostate biopsy cultures were obtained from patients and controls. Bacteria were found in 45 of 118 pain patients (38%) and in 21 of 59 controls (36%) (p = 0.74). Older men were more likely to have positive cultures. Men with type IIIa chronic pelvic pain syndrome were more likely than those with type IIIb to have positive prostate biopsy cultures.

CONCLUSIONS

Bacteria cultured from transperineal prostatic biopsies do not differ between men with and without chronic pelvic pain syndrome. Prostatic bacteria obtained by biopsy are probably not etiologically related to the symptoms in the majority of men with chronic pelvic pain syndrome.

Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial

PURPOSE

We evaluate terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS

The study included 100, 20 to-50-year-old subjects who met the consensus criteria for chronic prostatitis/chronic pelvic pain syndrome and had not received previous alpha-blockers. Subjects were randomized to receive terazosin with dose escalation from 1 to 5 mg. daily or placebo for 14 weeks. The primary criterion for response was scoring 2 or less ("delighted-to-mostly satisfied") on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) quality of life item. The secondary criterion for response was greater than 50% reduction in NIH-CPSI pain score at 14 weeks. Other outcomes included total and NIH-CPSI domain scores, International Prostate Symptom Score, peak urinary flow rate, post-void residual urine and adverse effects.

RESULTS

Using the primary criterion 24 of 43 evaluable subjects (56%) responded in the terazosin group compared to 14 of 43 (36%) in the placebo group (p = 0.03). Using the secondary criterion 26 of 43 subjects (60%) responded in the terazosin group compared to 16 of 43 (37%) in the placebo group (p = 0.03). The terazosin group had greater reductions (p <0.05) in NIH-CPSI total score, individual domain scores and International Prostate Symptom Score than the placebo group. There was no difference in peak urinary flow rate or post-void residual. In the terazosin group 18 patients (42%) had side effects compared to 9 (21%) in the placebo group (p = 0.04).

CONCLUSIONS

Terazosin proved superior to placebo for patients with chronic prostatitis/chronic pelvic pain syndrome who had not received alpha-blockers previously.

[Changes in the subjective state of patients with chronic prostatitis after treatment at a health resort]

In 102 patients with chronic prostatitis, a scoring system was employed to obtain a numerical score for those symptoms characteristic of the illness in question. This permitted the determination of such items as severity of the condition, degree of the depressive syndrome, efficacy of the treatment adopted without conducting paraclinical investigations and with taking into account of attitude of patients toward both the illness and modes of its treatment.

[Tamsulosin for the treatment of chronic abacterial prostatitis]

OBJECTIVES

To evaluate the efficacy of selective alpha 1A-adrenergic receptor antagonists for the treatment chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS).

METHODS

From October 2000 to September 2001, a selective alpha 1A-adrenergic receptor antagonists, tamsulosin, had been used in 43 patients with CPPS for four weeks. 0.2 mg dosage was given daily, and uroflowmetry was followed. Symptom scores were evaluated by the NIH-chronic prostatitis symptom index (NIH-CPSI) before and after the treatment.

RESULTS

These patients had a clinically significant response to the treatment of tamsulosin. Of these, thirty two patients (74.5%) responded to one month therapy and had a decrease in NIH-CPSI scores, while maximal urinary flow rate (MFR) and average urinary flow rate (AFR) in patients with poor MFR improved 30.4% and 65.4%, respectively. No severe side effects were observed.

CONCLUSIONS

It is suggested that Tamsulosin, a selective alpha 1A-adrenergic receptor antagonist, is effective in the treatment of CPPS.

[Treatment of external RF hyperthermia combining with alpha 1-adrenergic receptor blocker for patients with prostatodynia and chronic non-bacterial prostatitis]

OBJECTIVES

To evaluate a new effective treatment for prostatodynia (PD) and chronic non-bacterial prostatitis (CNP).

METHODS

One hundred and thirty-six patients suffered from PD or CNP were divided randomly into experiment group (n = 76), which were treated with external RF hyperthermia (ERFH) combining with alpha 1-adrenergic receptor blocker Terazosin for 12 weeks, and control group (n = 60), which were only treated with ERFH. Symptoms scores, urodynamic indexes and expressed prostate secretion were recorded pre- and post-treatments.

RESULTS

MFR and AFR were significantly improved and symptoms scores significantly decreased in both groups (P < 0.05). The efficacy was better in experiment group than that in control group. The combination treatment also led to a significantly decrease in MUP and MUCP (P < 0.05). Additionally, the leucocytes in expressed prostate secretion were also reduced in experiment group (P < 0.05).

CONCLUSIONS

Treatment of ERFH combining with alpha 1-adrenergic receptor blocker for patients with PD or CNP was effective and had little side-effect, while the future curative effect should be observed furtherly.

Symptoms and inflammation in chronic prostatitis/chronic pelvic pain syndrome

OBJECTIVES

To evaluate the possibility that patients with inflammatory and noninflammatory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) might present with different symptoms. Patients with CP/CPPS present with characteristic symptoms without bacteriuria. The new National Institutes of Health consensus suggests that CP/CPPS can be divided into inflammatory and noninflammatory categories.

METHODS

Standardized symptom surveys were completed by 130 subjects who met the criteria for CP/CPPS after clinical examination and urethral, urine, expressed prostatic secretion (EPS), and seminal fluid analysis evaluations.

RESULTS

When classified by either EPS or postprostatic massage urine (VB3) findings, subjects with and without inflammation had similar symptoms. However, when classified using the combination of EPS, VB3, and seminal fluid analysis, subjects with inflammatory CP/CPPS had more severe (P <0.02) and more frequent symptoms, in particular, difficulty reaching erection (P <0.01), weak urinary stream (P <0.01), urinary frequency (P = 0.03), and penile pain (P = 0.04).

CONCLUSIONS

The increased severity and frequency of symptoms among patients with inflammatory CP/CPPS provide empirical support for the new consensus classification on the basis of the combination of EPS, VB3, and seminal fluid analysis findings.

Antioxidant treatment with carnitines is effective in infertile patients with prostatovesiculoepididymitis and elevated seminal leukocyte concentrations after treatment with nonsteroidal anti-inflammatory compounds

OBJECTIVE

To evaluate whether the association of antioxidants and anti-inflammatory compounds may be beneficial in treatment of patients with abacterial prostatovesiculoepididymitis (PVE) and elevated seminal leukocyte concentrations.

DESIGN

Open, prospective, random study.

SETTING

Academic research environment.

PATIENT(S)

Ninety-eight patients with PVE who had increased seminal leukocyte concentrations (>1 x 10(6) cells/mL). Carnitines (group A; n = 30) or nonsteroidal anti-inflammatory drugs (group B; n = 16) for 4 months; nonsteroidal anti-inflammatory drugs for 2 months, followed by treatment with carnitines for 2 months (group C; n = 26); or nonsteroidal anti-inflammatory treatment given concomitantly with carnitines (group D; n = 26) for 4 months.

MAIN OUTCOME MEASURE(S)

Semen variables, production of reactive oxygen species, and pregnancy outcome were evaluated before and after treatment and following a 3-month washout period.

RESULT(S)

Patients in group C had the highest reduction in production of reactive oxygen species associated with increased sperm motility and viability. Groups B and D experienced intermediate effects, and group A experienced the least effect.

CONCLUSION(S)

Antioxidant treatment with carnitines is effective in patients with abacterial PVE and increased seminal leukocyte concentrations if these patients have been pretreated with nonsteroidal anti-inflammatory drugs.

Prevalence of prostatitis-like symptoms in a community based cohort of older men

PURPOSE

We describe a community based study to estimate the prevalence of prostatitis-like symptoms using questions similar to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

MATERIALS AND METHODS

Study subjects were a randomly selected sample of Olmsted County, Minnesota white men 40 to 79 years old in January 1990 who participated in a longitudinal study of lower urinary tract symptoms. Subjects were evaluated biennially using self-administered questionnaires. In 2000 questions similar to the NIH-CPSI were incorporated into the questionnaire and questionnaire responses were used to categorize men as having prostatitis-like symptoms.

RESULTS

Of 1,541 men 182 (12%) had at least 1 urogenital pain symptom. Pubic (76 men, 4.9%) and testicular (73, 4.7%) pain were the most frequent pain symptoms. A total of 34 men with prostatitis-like symptoms (2.2%) had higher mean pain (6.7 versus 0.5), urinary symptom (3.5 versus 2.1) and quality of life impact (3.7 versus 1.9) scores compared to men who did not (all p <0.001). Pain frequency (OR 39.2, 95% CI 18.8, 81.9) and pain intensity (OR 21.5, 95% CI 8.7, 52.9) were more strongly associated with prostatitis-like symptoms than urinary symptom score (OR 2.8, 95% CI 1.4, 5.6) or quality of life impact score (OR 4.5, 95% CI 1.9, 10.7).

CONCLUSIONS

Although urogenital pain is common among community dwelling men, prostatitis-like symptoms based on the modified questions from the NIH-CPSI are less common. While pain measures may be useful in distinguishing between men with and without prostatitis-like symptoms, the urinary symptom and quality of life impact scores could partly reflect benign prostatic hyperplasia.

Prevalence of prostatitis-like symptoms in a community based cohort of older men

PURPOSE

We describe a community based study to estimate the prevalence of prostatitis-like symptoms using questions similar to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

MATERIALS AND METHODS

Study subjects were a randomly selected sample of Olmsted County, Minnesota white men 40 to 79 years old in January 1990 who participated in a longitudinal study of lower urinary tract symptoms. Subjects were evaluated biennially using self-administered questionnaires. In 2000 questions similar to the NIH-CPSI were incorporated into the questionnaire and questionnaire responses were used to categorize men as having prostatitis-like symptoms.

RESULTS

Of 1,541 men 182 (12%) had at least 1 urogenital pain symptom. Pubic (76 men, 4.9%) and testicular (73, 4.7%) pain were the most frequent pain symptoms. A total of 34 men with prostatitis-like symptoms (2.2%) had higher mean pain (6.7 versus 0.5), urinary symptom (3.5 versus 2.1) and quality of life impact (3.7 versus 1.9) scores compared to men who did not (all p <0.001). Pain frequency (OR 39.2, 95% CI 18.8, 81.9) and pain intensity (OR 21.5, 95% CI 8.7, 52.9) were more strongly associated with prostatitis-like symptoms than urinary symptom score (OR 2.8, 95% CI 1.4, 5.6) or quality of life impact score (OR 4.5, 95% CI 1.9, 10.7).

CONCLUSIONS

Although urogenital pain is common among community dwelling men, prostatitis-like symptoms based on the modified questions from the NIH-CPSI are less common. While pain measures may be useful in distinguishing between men with and without prostatitis-like symptoms, the urinary symptom and quality of life impact scores could partly reflect benign prostatic hyperplasia.

Psychological problems in young men with chronic prostatitis-like symptoms

OBJECTIVE

To take a different perspective in assessing young men with chronic prostatitis-like symptoms, this study was designed since few prospective studies are available to survey a population of young men.

MATERIAL AND METHODS

One hundred and fifty men aged 20 years dwelling in the community were randomly selected. Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index and the selfreported scores for pain and urinary symptoms were used to identify chronic prostatitis-like symptoms. The psychological methods used were the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Bem Sex Role Inventory. A total of 87 men (a response rate 58%) completed self-administered questionnaires.

RESULTS

As the scores for pain and urinary symptoms increased, those for depression increased (p < 0.001 and p = 0.01, respectively). However, the mean scores for state and trait anxiety were not different according to the scores for pain and urinary symptoms. The mean masculinity scores were not different according to the scores for pain but those were significantly different according to the scores of urinary symptoms (p = 0.042). The mean femininity scores were not different according to the scores of pain and urinary symptoms.

CONCLUSIONS

Our findings suggest that psychological factors, especially depression and weak masculine identity may be associated with an early stage of chronic prostatitis-like symptoms. Young men with chronic prostatitis-like symptoms also have psychological problems.

Effects of pollen extract EA-10, P5 on chronic prostatitis or infertility with chronic prostatitis

AIM

To determine the drug action mechanism of pollen extract EA-10, P5 on the treatment of chronic prostatitis (CP) or infertility with CP.

METHODS

Malondiadehyde (MDA), superoxide dismutase (SOD), and nitrogen monoxide (NO) were measured by biochemical assay, and zinc content was assayed by atomical spectrophotography in the pre-treatment and post-treatment of CP or infertility with CP.

RESULTS

Compared with control group, leukocytes in expressed protatic secretion (LEPS), MDA, and NO were increased, and zinc content and SOD were decreased significantly in the pre-treatment of CP. After the treatment, LEPS was improved, and MDA and NO were reduced, while zinc content were increased apparently and the alteration of SOD was not evident (P>0.05). In the pre-treatment of infertility with CP, LEPS, MDA, NO, sperm viability, and seminal leukocytes were obviously higher and seminal plasma SOD, zinc content, and sperm motility were obviously lower than those in control group. After the treatment, LEPS, sperm motility, and sperm viability were improved, MDA, NO, and seminal leukocytes were decreased, SOD and zinc content were increased markedly.

CONCLUSION

There was inter-correlation between oxygen free radicals (OFR) and occurrence, development, and recovery of CP; Change of OFR may be involved in the drug action mechanism of EA-10, P5 in the treatment of CP or infertility with CP.

Prostatitis-like symptoms: one year later

OBJECTIVES

To re-survey (after 1 year) men identified in 1999 as having perineal and/or ejaculatory pain/discomfort severe enough to suggest a clinical diagnosis of chronic prostatitis (using the National Institutes of Health-Chronic Prostatitis Symptom Index, NIH-CPSI), and to compare them with an age-matched population of men who had no prostatitis-like symptoms in the initial survey, to determine the effect of time on specific symptoms associated with the diagnosis of chronic prostatitis.

SUBJECTS AND METHODS

A comprehensive questionnaire incorporating the pain and voiding domains of the NIH-CPSI, and data on demographics, medical history, socio-economic status, health-seeking behaviour and a quality of life assessment, was sent to 67 men who had reported prostatitis-like symptoms in the 1999 survey, and to 202 age-matched controls (1 : 3) who reported no prostatitis-like symptoms in the same survey.

RESULTS

Forty men (60%) with previous prostatitis-like symptoms, i.e. a mean (sd) 1999 NIH-CPSI pain score of 8.8 (0.4), and 119 (59%) of the control population completed and returned the survey. There was no difference in the 1999 demographics (P = 0.82) or NIH-CPSI pain score (P = 0.49) between patients who returned the recent questionnaire and those who could not be located or declined to complete the survey. Fifteen men (38%) identified with prostatitis in 1999 did not report similar symptoms in 2000. The initial mean NIH-CPSI pain score (0-21) for the men who had resolution of their prostatitis-like symptoms was 7.5 (0.6); 1 year later it was 0.73 (0.3). Their mean age was 51.1 (3.9) years and mean duration of symptoms 1.1 (0.3) years. Those with persistent symptoms had an initial NIH-CPSI pain score of 9.6 (0.5); 1 year later it was 8.68 (0.4), at mean age of 51.4 (2.5) years and duration of symptoms 2.2 (0.3) years. Four men (3%) in the control group who had no symptoms in 1999 reported prostatitis-like symptoms in 2000; these men had a mean age of 52.5 (5.9) and NIH-CPSI pain score of 7.0 (0.9).

CONCLUSION

About a third of men reporting prostatitis-like symptoms in the general population had resolution of their symptoms (usually those with a shorter duration and less severe symptoms) 1 year later. The severity of symptoms of men with persistent chronic prostatitis remained relatively unchanged over the year.

Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment

Chronic pelvic pain syndrome is a conundrum that may be explained partly by pudendal nerve entrapment (PNE), which causes neuropathic pain. In men with PNE, aberrant development and subsequent malpositioning of the ischial spine appear to be associated with athletic activities during their youth. The changes occur during the period of development and ossification of the spinous process of the ischium.

Emphysematous prostatitis and carcinoma in a dog

A 10-year-old, male beagle was presented for lethargy, anorexia, and straining to urinate. A mass was palpated in the caudal abdomen in the area of the bladder. Abdominal radiography revealed a gas-filled mass in the caudoventral abdominal quadrant. Subsequent positive-contrast cystography revealed that the mass was caudal to the bladder. Abdominal exploratory celiotomy resulted in the drainage of a prostatic abscess containing gas. The histopathological diagnosis of the prostate was a poorly differentiated tubular carcinoma with necrosis. To the authors' knowledge, this article is the first report of an emphysematous prostatitis in a dog.

Intravesical potassium sensitivity in patients with prostatitis

PURPOSE

Prostatitis and interstitial cystitis encompass similar symptoms and may be manifestations of a single pathophysiological process in the lower urinary tract. Most patients with interstitial cystitis have urinary epithelial dysfunction, as indicated by a positive intravesical potassium sensitivity test. We used the potassium sensitivity test for the presence of epithelial dysfunction in men with diagnosed prostatitis.

MATERIALS AND METHODS

We administered the potassium sensitivity test in men who presented with the signs and symptoms of prostatitis (urgency/frequency and/or pelvic pain) after being diagnosed with prostatitis and receiving at least 1 course of antibiotic treatment administered by a urologist other than one of us. We also surveyed the patients for urinary symptoms and pain locations using 2 self-evaluation questionnaires.

RESULTS

A total of 44 patients with prostatitis completed the questionnaires and underwent the potassium sensitivity test. Of the 44 men 37 (84%) had positive potassium sensitivity test results, 89% reported urinary urgency/frequency and 82% reported pain. Pain locations included the perineum, lower abdomen, lower back, penis, testes, scrotum and rectum as well as dysuria and post-void pain. Pain with sexual intercourse was reported by 75% of the patients with prostatitis.

CONCLUSIONS

The rate of positive potassium sensitivity test results in patients with prostatitis is almost identical to that reported in those with interstitial cystitis (84% and 79%, respectively), suggesting that prostatitis and interstitial cystitis may be a continuum of lower urinary epithelial dysfunction. Similar to patients with interstitial cystitis, most patients with prostatitis experience pain during sexual intercourse and perceive pain at locations throughout the pelvis. We suggest reclassifying the prostatitis-interstitial cystitis disease process as lower urinary dysfunctional epithelium.

Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study

OBJECTIVES

To investigate the effectiveness and durability of transurethral needle ablation (TUNA) in the treatment of symptoms of chronic pelvic pain syndrome (CPPS) in a randomized, single-blind, sham-controlled study.

METHODS

Thirty-three patients with moderate-to-severe symptoms of CPPS were randomized to either TUNA (n = 25) or urethrocystoscopy as a sham treatment (n = 8). The response to therapy was evaluated 3, 6, and 12 months after treatment using the Prostatitis Symptom Severity Index (PSSI), the International Prostate Symptom Score (IPSS), a visual analogue scale, and prostate volume, prostate-specific antigen, urinary flow, and residual urine volume measurements.

RESULTS

The PSSI decreased in both groups (TUNA group, P <0.001; sham group, P not significant), but no statistically significant difference was detected between them. Similarly, the IPSS decreased in the two groups (TUNA group, P = 0.002; sham group, P = 0.05), but no difference was found between those treated with TUNA and those who underwent sham treatment. Also the quality of life (IPSS-8) was significantly better at 12 months in both groups, but no difference was detected between them. Changes in pain score (visual analogue scale) were not statistically significant. Peak urinary flow rate, residual urine volume, prostate-specific antigen, and prostate volume were not altered in either group.

CONCLUSIONS

The efficacy of TUNA in CPPS is comparable to sham treatment, and so cannot be recommended as routine treatment of CPPS.

Prostatitis and male infertility: evidence and links

Prostatitis and infertility are common disorders in men and many researchers have investigated a possible link between the two disorders. After almost 3 decades of research the answer to this question remains unknown, although ample evidence exists to support a relationship between male infertility and prostatitis. This paper discusses this evidence and then derives a rational treatment approach to the man with infertility and prostatitis.

Voiding dysfunction associated with "chronic bacterial prostatitis"

OBJECTIVE

The study was done to evaluate flowmetry parameters, bladder capacity and postvoiding residual volume (PVR) in patients with chronic bacterial prostatitis/category II according to the National Institute of Health (NIH) categorization of prostatitis syndromes (CBP/Cat.II).

SUBJECTS AND METHODS

A prospective study of 42 patients with chronic CBP/Cat. II was undertaken. Clinical evaluation and the standard four-glass test with direct microscopy and culture were done for all patients. Flowmetry parameters and PVR were measured. Two groups were compared to the CBP/Cat.II group; a control age matched 42 males without lower urinary tract symptoms and 279 patients with prostatodynia/non-inflammatory chronic pelvic pain (CPP/Cat.IIIB).

RESULTS

All the three groups had similar age. The CBP/Cat.II and CPP/Cat.IIIB patients had similar duration of symptoms. In CBP/Cat.II maximum flow rate (Q(max)), average flow rate (Q(ave)), and voided volume (V(ura)) were 12.8+/-5.9 ml/s, 7.4+/-3.4 ml/s, and 238.9+/-110.8 ml. These were significantly less than those for normal controls (21.3+/-4.2 ml/s, 12.2+/-3.4 ml/s, and 381.3+/-144.4 ml). The flowmetry findings in CBP/Cat.II group did not show statistically significant differences from those for CPP/Cat.IIIB group (Q(max), Q(ave), and V(ura) were 11.3+/-5.3 ml/s, 6.6+/-2.0 ml/s, and 230.5+/-88.8 ml). In CBP/Cat.II group, patients with Q(max) < 15 ml/s (25/42) had statistically significant longer duration of symptoms (33.6+/-19.3 compared to 13.1+/-6.3 months).

CONCLUSION

In this study, CBP/Cat.II patients had significantly lower flowmetry parameters compared to matched age normals. The flowmetry parameters in this group were found similar to those in a group of CPP/Cat.IIIB patients. Voiding dysfunction in CBP/Cat.II may contribute to the longer duration of symptoms.

Preexisting histologic evidence of prostatitis is unrelated to postimplant urinary morbidity

The presence and extent of prostatitis on the patients' preimplant biopsy slides was correlated with their postimplant course to determine if any relationship exists between histological prostatitis and postimplant morbidity. Biopsy slides from 56 patients treated with I-125 (144 Gy, TG-43), Pd-103 (125 Gy, NIST-1999), or Pd-103 plus supplemental external beam radiation (20-44 Gy) were studied. As part of ongoing prospective protocols, treatment-related morbidity is monitored by mailed questionnaires at 1, 3, 6, 12, and 24 months postimplant, using standard American Urologic Association (I-PSS) and Radiation Therapy Oncology Group criteria. Patient's preimplant biopsies, stained with standard hematoxylin and eosin, were retrieved for review by one uropathologist (LT). Separate evaluations of the degree and extent of inflammation in biopsy cores free of cancer and in cancerous biopsy cores were undertaken. Infiltrates were classified as periglandular if they were within 50 microns of a glandular structure. They were otherwise classified as stromal. Distribution of the inflammation was reported as focal, multifocal, or diffuse. The intensity of inflammation was separately graded as mild if there were fewer than 10 inflammatory cells per high-power field, moderate if there were 10-200 cells per high-power microscopic field, or severe if there were more than 200 cells per field. In all cases the great majority of inflammatory cells were mononuclear, predominantly lymphocytes. Periglandular inflammation was most common, with 18% of patients having focal periglandular and 20% having multifocal periglandular inflammation on their preimplant biopsies. Cancer-related infiltrates were the second most common, with 23% of patients having focal, 13% multifocal, and 13% diffuse cancer-related inflammation on their preimplant biopsies. Eight of the 55 patients developed postimplant urinary retention, requiring catheterization for 2 to 8 days. The overall incidence of postimplant urinary retention was low and there was no obvious relationship between the presence of inflammation on preimplant biopsy and the likelihood of postimplant urinary retention. AUA score changes at 1 and 6 months postimplant were highly variable and unrelated to the presence or severity of periglandular or cancer-related inflammation. Considering the apparent lack of relationship between histological findings and clinical outcomes in the patients reported here, the authors conclude that histologic evidence of prostatitis is not a contraindication to brachytherapy.

Chronic pelvic pain in men

Chronic pelvic pain is a condition which receives less attention in men than in women. It is often difficult to diagnose and more difficult to treat. The new classification of prostatis and its variants has introduced the term 'chronic pelvic pain syndrome' which underlines the difficulties in dealing with this disorder which may represent a variety of chronically painful conditions with a large functional component.