Association between asymptomatic inflammatory prostatitis NIH category IV and prostatic calcification in patients with obstructive benign prostatic hyperplasia

BACKGROUND

The aim of this study was to evaluate the incidence of prostatic calcification and prostatitis NIH category IV in patients with obstructive BPH.

METHODS

Ninety-six patients with obstructive BPH who had undergone transurethral electroresection of the prostate gland were evaluated. In accordance with a preoperative transrectal ultrasound examination, patients were divided into one group with prostatic calcification (N.=31) and one without (N.=65). Prostatitis NIH category IV was classified according to the grading system by Irani. Correlations between the incidence of prostatic calcification, histological prostatitis, PSA, uric acid, cholesterol, triglycerides, CRP, IPSS, IIEF-25, and NIC-CPSI were analyzed. A stone analysis of prostatic calcification was performed using X-ray powder diffraction.

RESULTS

Sixty-nine (71.9%) patients had NIH category IV prostatitis, accounting for 83.9% of those with prostatic calcification versus 66.1% of those without (P<0.04). Significant correlations were found between prostatic calcification and the severity of inflammation (P<0.02) as well as the NIH-CPSI subdomain of urinary symptoms (P<0.02). The only predictor for prostatic calcifications were elevated levels of uric acid. Such patients were 1.4times more likely of having calcifications in the prostate gland (OR=1.4, P<0.047). Stone analysis revealed the following: apatite in 41.7%, whewellite in 29.2%, weddellite and brushite in 8.7% each, whitlockite, apatite/whewellite and organic substances in 4.2%.

CONCLUSIONS

On ultrasound examination, one third of patients who were treated with TURP for obstructive BPH had prostatic calcification. These were significantly more common in patients with NIH category IV prostatitis.

The effect of asymptomatic histological prostatitis on sexual function and lower urinary tract symptoms

OBJECTIVE

Prostatitis affects 10-14% of men of all ages and ethnicities. More than 50% of the men experience episodes of prostatitis at one time of their lives. Patients with CP typically have longlasting genitourinary/pelvic pain and obstructive and/or irritative voiding symptoms. Sexual dysfunction and psychological symptoms are frequently added to these symptoms. We also investigated the relationship between sexual functions, and lower urinary system symptoms, and asymptomatic histological prostatitis detected on transrectal ultrasound-guided (TRUS) biopsy performed with the indication of high PSA levels.

METHODS

Sixty cases compliant with the study criteria among patients who underwent prostate biopsies between September 2014 and June 2015 with the indication of higher PSA levels were included in the study. All patients were requested to complete IIEF-5 and IPSS forms one day previously. Based on histological analysis of biopsy materials, the patients were allocated into groups of BPH (simple BPH without histological prostatitis) (n:30) and histological chronic prostatitis (combination of BPH and histological prostatitis) (n:30).

RESULTS

Mean age of the cases was 65.73±5.01 (range, 56-75 yrs) years. PSA levels ranged between 4-15 ng/ml. A statistically significant intergroup difference was not found regarding mean age, BMIs, PSA levels, incidence rates of hypertension and coronary artery disease (p>0.05). Prostate volumes of the HCP group were higher than those of the BPH group , with statistically significant differences (p:0.001; p<0.01). Questionnaire forms of the patients included in the study were statistically evaluated, and mean IPSS score of the HCP group was found to be higher when compared with that of the BPH group, with statistically significant differences. (p:0.016; p<0.05). However mean IIEF score of the BPH group was higher than that of the HCP group, with statistically significant differences (p:0.039; p<0.05).

DISCUSSION

These findings suggested the presence of a correlation between chronic inflammation and lower urinary tract symptoms (LUTS). In addition, statistically significant lower IIEF values in patients with histological chronic prostatitis relative to those without suggested negative effects of even asymptomatic inflammation on sexual functions and mechanism of erection.

Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Outcomes from a Multi-Center Study and Risk Factor Analysis in a Single Center

The aim of this study was to investigate the prevalence of erectile dysfunction (ED) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and explore the influence of UPOINT domains, National Institutes of Health-CP symptom index (NIH-CPSI) and other factors on ED prevalence. This was a prospective study of consecutive patients with CP/CPPS seen at 11 tertiary hospitals during January–July 2014. ED was diagnosed as a score of<21 on the International Index of Erectile Function (IIEF-5). Patients from one center were evaluated by the UPOINT system and NIH-CPSI. Each patient was assessed using clinical examination, asocio-demographic questionnaire, the Patient Health Questionnaire (PHQ), the Pain Catastrophizing Scale (PCS), NIH-CPSI and IIEF-5.1406 patients from 11 centers (mean age, 32.18 years; range 18–60 years) were enrolled. ED was found in 638/1406 patients (45.4%), and was categorized as mild in 291(45.6%), moderate in 297(46.6%) and severe in50(7.7%). 192 patients from one center(mean age,31.3 years; range 18–57 years) were further studied.IIEF-5 score correlated negatively with NIH-CPSI(r = 0.251), PHQ (r = 0.355) and PCS (r = 0.322)scores (P<0.001).PHQ score correlated positively with NIH-CPSI (r = 0.586) and PCS(r = 0.662) scores (P<0.001).NIH-CPSI, PHQ, PCS and IIEF-5 scores did not differ significantly between class IIIA and IIIB CP/CPPS. Multivariate logistic regression showed that UPOINT psychological (P) domain and NIH-CPSI symptom severity were independent risk factors for ED in CP/CPPS. It is concluded that psychological factors and symptom severity are independent risk factors for ED in CP/CPPS.

[Combined transurethral procedure for bladder outlet obstruction induced by small-volume prostatic hyperplasia]

OBJECTIVE

To investigate the clinical effect of transurethral resection of the prostate(TURP) combined with transurethral incision of the bladder neck( TUIBN) in the treatment of bladder outlet obstruction( BOO) caused by small-volume benign prostatic hyperplasia( BPH).

METHODS

We retrospectively analyzed the clinical data about 56 cases of small-volume BPH. The patients,aged 45- 71( mean 59. 6) years,all showed varied degrees of dysuria and 20 of them had a history of chronic prostatitis. Preoperative examinations included the obtainment of International Prostate Symptom Score( IPSS),evaluation of the quality of life(QOL),ultrasonography, urodynamic examination, and cystoscopy. All the patients received alpha-blockers for 3- 6 months without obvious response and therefore underwent TURP + TUIBN.

RESULTS

Postoperative follow-up lasted 12- 24 months. Urinary tract stricture was found in 2 cases(3. 57%) at 1 month after surgery, which was improved after urethral dilation,and bladder neck contracture occurred in 1 case(1. 79%) at 3 months, which was relieved by repeated TUIBN. Compared with the baseline, the IPSS was dramatically decreased at 12 months postoperatively(25. 54 ± 2. 33 vs 12. 76 ± 2. 37,P < 0. 01),and so was the postvoid residual([68. 07 ± 17. 09]vs [31. 02 ± 9. 75] ml. P < 0. 01),while the maximum urinary flow rate(Qmax) was significantly increased([8. 47 ± 0. 96]vs [15. 83 ± 1. 47]ml/s, P < 0. 01).

CONCLUSION

TURP + TUIBN is superior to either TURP or TUIBN alone in the treatment of BOO induced by small-volume BPH for its higher effectiveness and safety.

Common Questions About Chronic Prostatitis

Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the urethra and prostate (which also predispose the patient to urinary tract infections) and conditions that can lead to chronic neuropathic pain. Chronic prostatitis must be differentiated from other causes of chronic pelvic pain, such as interstitial cystitis/bladder pain syndrome and pelvic floor dysfunction; prostate and bladder cancers; benign prostatic hyperplasia; urolithiasis; and other causes of dysuria, urinary frequency, and nocturia. The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis. CBP and CNP/CPPS both lead to pelvic pain and lower urinary tract symptoms. CBP presents as recurrent urinary tract infections with the same organism identified on repeated cultures; it responds to a prolonged course of an antibiotic that adequately penetrates the prostate, if the urine culture suggests sensitivity. If four to six weeks of antibiotic therapy is effective but symptoms recur, another course may be prescribed, perhaps in combination with alpha blockers or nonopioid analgesics. CNP/CPPS, accounting for more than 90% of chronic prostatitis cases, presents as prostatic pain lasting at least three months without consistent culture results. Weak evidence supports the use of alpha blockers, pain medications, and a four- to six-week course of antibiotics for the treatment of CNP/CPPS. Patients may also be referred to a psychologist experienced in managing chronic pain. Experts on this condition recommend a combination of treatments tailored to the patient's phenotypic presentation. Urology referral should be considered when appropriate treatment is ineffective. Additional treatments include pelvic floor physical therapy, phytotherapy, and pain management techniques. The UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, tenderness) approach summarizes the various factors that may contribute to presentation and can guide treatment.

[Correlation of IL-8 and IL-6 in prostatic fluid with serum prostate-specific antigen level in patients with benign prostatic hyperplasia complicated by prostatitis]

OBJECTIVE

To investigate the correlation of the levels of interleukin-8 (IL-8) and IL-6 in the prostatic fluid with serum levels of serum prostate-specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH) complicated by prostatitis.

METHODS

A series of 211 patients undergoing surgery of BPH were divided into BPH group (n=75) and BPH with prostatitis group (n=136) according to the white blood cell count in the prostatic fluid. The clinical and laboratory findings were compared between the two groups, and stepwise regression analysis was used to assess the association of IL-8 and IL-6 with serum PSA level.

RESULTS

No significant differences were found in age, BMI, blood pressure, blood glucose, blood lipids, IPSS score, PSA-Ratio, or prostate volume between the two groups (P<0.05). The patients with prostatitis had significantly increased serum PSA and prostate fluid IL-8 and IL-6 levels compared with those without prostatitis (P<0.001). Multiple linear regression analysis showed that IL-8 and IL-6 levels and white blood cell count in the prostatic fluid were all positively correlated with serum PSA level.

CONCLUSION

Prostatitis is an important risk factor for elevated serum PSA level in patients with BPH, and both IL-8 and IL-6 levels in the prostatic fluid are correlated with serum PSA level.

Couple-related factors of ART outcome

PURPOSE OF INVESTIGATION

Although assisted reproductive technologies (ART) are the current mainstay of infertility treatment, several mechanisms leading to ART failure are still unclear. The aim of the present study was to determine possible health-related risk factors in both counterparts of the couple affecting the ART outcome.

MATERIAL AND METHODS

The authors recruited 100 consecutive couples who were undergoing ART procedure. All subjects filled out a health questionnaire, and the presence of bacterial vaginosis in females and/or prostatitis in males was evaluated.

RESULTS

Success of the ART procedure was 30.2%, failure being most significantly related to woman's age (OR = 0.24, 95% CI 0.09-0.66, p = 0.003) and excess body weight (OR = 0.08, 95% CI 0.01-0.63, p = 0.002). Male factors, previous conceptions, and presence of children increased the likelihood of ART success. Bacterial vaginosis and prostatitis did not significantly compromise the effectiveness of the ART procedure in this study.

CONCLUSION

In 100 consecutive infertile couples scheduled for ART procedure, pregnancy was achieved in 30.2%, with female age and overweight and previous children from male side being the most significant factors affecting the ART outcome.

[Seminal vesicle abscess after acute prostatitis]

A 45 year old male was referred to our clinic after an episode of acute prostatitis six weeks before, treated with ciprofloxacin for one month. Genital examination was normal with prostate slightly painful on DRE.

Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals

PURPOSE

Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals.

MATERIALS AND METHODS

The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases.

RESULTS

No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34).

CONCLUSIONS

In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic prostatitis/chronic pelvic pain syndrome remains unknown, additional prospective studies are needed to elucidate modifiable risk factors for this common condition.

The Effect of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) on Erectile Function: A Systematic Review and Meta-Analysis

Background

High prevalence of erectile dysfunction (ED) has been observed in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, whether or not CP/CPPS is a risk factor of ED remains unknown and controversial. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between CP/CPPS and ED.

Methods

PubMed, Embase, Web of Science, and The Cochrane Library were searched up to November 11, 2014 to identify studies reporting the association between CP/CPPS and ED. Case–control, cohort and cross-sectional studies were included. Quality of the included studies was assessed. The odds ratio of ED and the mean difference of five-item International Index of Erectile Function (IIEF-5) score were pooled using a random effects model. Subgroup analysis and sensitivity analyses were performed.

Results

Three cross-sectional studies, two case–control studies, and four retrospective studies with 31,956 participants were included to calculate the pooled odds ratio of ED, and two studies with 1499 participants were included to calculate the pooled mean difference of IIEF-5 scores. A strong correlation was found between CP/CPPS and ED (pooled odds ratio: 3.02, 95% CI: 2.18–4.17, P < 0.01), with heterogeneity across studies (I² = 65%; P < 0.01). A significant decrease in the IIFE-5 score was observed in the CP/CPPS group (pooled mean difference: −4.54, 95% CI: −5.11–−3.98; P < 0.01).

Conclusion

Our study indicates that patients with CP/CPPS have an increased risk of suffering from ED. Assessment of erectile function is necessary for the therapy of patients with CP/CPPS. Further evidence is necessary to confirm the relationship between CP/CPPS and ED.

Electrophysiological Identification of Central Sensitization in Patients with Chronic Prostatitis

PURPOSE

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain condition and a com­mon problem in urology clinics. Although many different etiologies and mechanisms exist, the exact cause of the disease has been unknown. Central sensitization (CS) is defined as an augmentation of responsiveness of central cortical neurons to input from peripheral nociceptive structures. Somato-sensory evoked potentials (SEPs) is an electroneurophysiological method to assess cortical activity in somatosensory area of brain related to sensorial stimuli. We aimed to determine the presence of CS using the SEPs of dorsal penile nerve stimulation in patients with CP/CPPS.

MATERIALS AND METHODS

Seventeen male patients diagnosed CP/CPPS and 17 male healthy controls were pro­spectively included in the study. For SEP study, electrical stimulus was applied with penile ring electrodes. Re­cording electrodes were placed as active to Cz' and reference electrode on Fz' according to the 10-20 Interna­tional System. Latency of N50 was defined as the second negative (up-ward) deflection of the W-shaped averaged cortical waveform.

RESULTS

N50 latencies were significantly shortened in the patient group compared to the healthy controls (P < .001).

CONCLUSION

These results support the presence of central sensitization because of exaggerated trans-mission of pain sensation to the somatosensory cortex. Therefore, normalization of transmission might be an important step in treatment of pain in patients with CP/CPPS. This study can be counted as an important guiding on pathogenesis and treatment of disease.

[Prostatic inflammation-induced chronic pelvic pain: Roles of substance P and c-fos in the spinal cord]

OBJECTIVE

To explore the possible pain mechanism of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

METHODS

The models of CP/CPPS were established in male Wistar rats by the autoimmune method. The paw withdrawal threshold (PWT) was detected using Von Frey filament. The expressions of the substance P and c-fos in the prostate and spinal L5-S2 segments were determined by immunohistochemistry followed by analysis of their correlation with CP/CPPS.

RESULTS

Compared with the control rats, the CP/CPPS models showed significantly decreased PWT (P < 0.05), remarkable prostatic inflammation, enlarged scope of lesions, and obvious interstitial lymphocytic infiltration (P < 0.05). Both the expressions of substance P and c-fos were markedly elevated in the prostate and spinal dorsal horn (L5-S2) of the rat models (P < 0.05), but the expression of substance P in the prostate exhibited no correlation with that in the spinal cord (r = 0.099, P = 0.338), nor did that of c-fos (r = 0.027, P = 0.454).

CONCLUSION

The upregulated expressions of substance P and c-fos in the spinal cord L5-S2 sections may be associated with the pain mechanism of CP/CPPS.

[PATHOGENETIC TREATMENT OF CHRONIC NONBACTERIAL PROSTATITIS COMPLICATED BY SPERM DISORDERS]

This study examines the efficacy and safety of the natural complex of multi-component biologically active dietary supplement Prostatinol in the pathogenetic treatment of 45 patients with chronic nonbacterial Prostatitis complicated by sperm disorders. Within 4 weeks 25 patients of the treatment group and 20 patients of the control group received Prostatinol or traditional anti-inflammatory therapy correspondingly. The results were evaluated at weeks 4 and 12 after treatment cessation. Prostatinol was found to significantly increase the treatment effectiveness. More pronounced positive clinical effect was noted in 92% of treatment group patients receiving Prostatinol (disappearance of perineal pain, reduction of the IPSS score to an average of 2.1 points, absence of residual urine, normal Prostate echotexture, improvement of Prostate circulation, increase of sperm concentration and motility, higher pregnancy incidence among the wives of the treated patients). In the control group similar treatment effect was achieved in twice less number of patients. These results confirm that the components of the Prostatinol complex are effective, safe, have no side effects and can be used in the treatment of chronic Prostatitis, as well as for prevention of Prostatic diseases and improvement of sexual function.

[Shugan Jieyu Capsules combined with conventional therapy for type III B prostatitis complicated by sexual dysfunction]

OBJECTIVE

To explore the clinical effect of Shugan Jieyu Capsules (SJC) on type III B prostatitis complicated by sexual dysfunction.

METHODS

A total of 98 patients with type III B prostatitis complicated by sexual dysfunction were equally randomized to a control and a trial group, the former treated with the combination of biofeedback/electrical stimulation and the α-blocker Tamsulosin Hydrochloride, and the latter with oral SJC in addition, both for 8 weeks. Before and after treatment, the severity of the symptoms was determined with NIH-CPSI, the patients'sexual function evaluated with CIPE-5 and IIEF-5, and their anxiety, depression and other psychological problems assessed with Hamilton Anxiety Scale (HAMA) and Hamilton Depression Rating Scale ( HAMD). The results were subjected to statistical analysis and compared between the two groups.

RESULTS

Statistically significant differences were found between the control and trial groups in the NIH-CPSI score (26.31 ± 7.91 vs 18.84 ± 6.63, P < 0.01), CIPE-5 premature ejaculation score (10. 41 ± 3.03 vs 14.37 ± 2.35, P < 0.05), IIEF-5 score (10.29 ± 3.97 vs 14.69 ± 4.19, P < 0.05), HAMA score (24.31 ± 1.78 vs 13.41 ± 4.21, P < 0.01), and HAMD score (25.24 ± 2.83 vs 14.49 ± 4.44, P < 0.01).

CONCLUSION

SJC can effectively relieve anxiety, depression and other psychological problems in type III B prostatitis patients with sexual dysfunction and improve their clinical symptoms as well.

Comparison of baseline urological symptoms in men and women in the MAPP research cohort

PURPOSE

The clinical features of the interstitial cystitis/bladder pain syndrome are similar to those of the chronic prostatitis/chronic pelvic pain syndrome. However, to our knowledge no studies have directly compared the characteristics of these syndromes in men and women.

MATERIALS AND METHODS

The MAPP Research Network recruited 191 men and 233 women with IC/BPS or CP/CPPS. Baseline data included demographics, Interstitial Cystitis Symptom Index and Problem Index scores; Genitourinary Pain Index score; American Urological Association Symptom Index score; Likert scales to assess urinary urgency, frequency, pain and overall symptom severity; and a single question about the most bothersome pelvic symptom.

RESULTS

After adjustment for age, income and symptom duration, measures of pain severity were similar across genders. Mean scores for the ICSI, ICPI and AUASI were significantly higher in women than in men, reflecting more bladder focused symptoms in women. The most bothersome single symptom in men as well as in women was pain in the pubic/bladder area (men 34%, women 58%). The characteristics of the men and women in the MAPP cohort were similar to those reported in other research cohorts for IC/BPS and CP/CPPS.

CONCLUSIONS

Our findings indicate that pain severity is similar for both genders and that bladder focused symptoms (urgency, suprapubic pain, frequency) are more common in women. However, a substantial proportion of men also reported these types of bladder symptoms.

Escherichia coli isolates from patients with bacteremic urinary tract infection are genetically distinct from those derived from sepsis following prostate transrectal biopsy

BACKGROUND

Transrectal ultrasound-guided (TRUS) prostate biopsy is a very common procedure that is generally considered relatively safe. However, severe sepsis can occur after TRUS prostate biopsies, with Escherichia coli being the predominant causative agent. A common perception is that the bacteria that cause post-TRUS prostate biopsy infections originate in the urinary tract, but this view has not been adequately tested. Yet other authors believe on the basis of indirect evidence that the pathogens are introduced into the bloodstream by the biopsy needle after passage through the rectal mucosa.

METHODS

We compared E. coli isolates from male patients with bacteremic urinary tract infection (B-UTI) to isolates of patients with post prostate biopsy sepsis (PPBS), in terms of their sequence types, determined by multi-locus sequence typing (MLST) and their virulence markers.

RESULTS

B-UTI isolates were much richer in virulence genes than were PPBS isolates, supporting the hypothesis that E. coli causing PPBS derive directly from the rectum. Sequence type 131 (ST131) strains and related strain from the ST131 were common (>30%) among the E. coli isolates from PPBS patients as well as from B-UTI patients and all these strains expressed extended spectrum beta-lactamases.

CONCLUSIONS

Our finding supports the hypothesis that E. coli causing PPBS derive directly from the rectum, bypassing the urinary tract, and therefore do not require many of the virulence capabilities necessary for an E. coli strain that must persist in the urinary tract. In light of the increasing prevalence of highly resistant E. coli strains, a new approach for prevention of PPBS is urgently required.

[Extracorporeal shock wave: An effective and safe therapy for the pain symptom of type IIIB prostatitis]

OBJECTIVE

To investigate the effect and safety of extracorporeal shock wave (ESW) in the treatment of pain symptom of type III B prostatitis.

METHODS

We treated 50 cases of type III B prostatitis by ESW once a week for 4 weeks. Then we evaluated the clinical effect and safety of the therapy based on the NIH-CPSI scores, visual analogue scale (VAS) scores, IIEF-5 scores, prostate volume and morphous, state of urination, color of urine, results of routine semen analysis, and changes of cytokines (IL-6, TNF-α and IL-1β) in expressed prostatic secretion (EPS).

RESULTS

All the patients successfully accomplished the treatment. Compared with the baseline, decreases were observed after 4 weeks of cytokine treatment in the pain scores (14. 61 ± 1. 82 vs 9. 36 ± 1. 47, P <0. 01), urination symptom scores (4. 59 ± 1. 01 vs.4. 66 ± 0. 89, P >0. 05) , quality of life scores (6. 51 ± 1. 03 vs 4. 56 ± 1. 02, P <0. 01), NIH-CPSI (25. 43 ± 1. 72 vs 18. 28 ± 2. 32, P <0. 01 ), and VAS (6. 59 ± 1. 10 vs 3. 02 ± 1. 07, P < 0. 01). The concentration of IL-6 in the EPS was significantly increased ([55.82 ± 6. 28] vs [86.59 ± 4. 55] ng/ml, P <0. 01) , while the level of TNF-α ([3.89 ± 0. 12] vs [3. 19 ± 0.22] ng/ml, P<0.01) and that of IL-1β ([3.21 ± 1.01] vs [1.48 ± 0.95] ng/ml, P< 0. 01) remarkably reduced after treatment. However, there were no statistically significant differences in IIEF-5 scores (18. 58 ± 2. 03 vs 18. 51 1. 89, P >0. 05) or various sperm parameters before and after treatment (P >0. 05). And no significant changes were observed in the prostate volume, morphous or internal echoes.

CONCLUSION

The ESW therapy is effective and safe for the pain symptom of type III B prostatitis.

CD-163 correlated with symptoms (pain or discomfort) of prostatic inflammation

The purpose of this study is to identify significant immune-system related for symptom of patients with prostatic inflammation in order to investigate the etiology of prostatic inflammation which may relate to potentially chronic prostatitis (CP). We investigated the expression of immune system-related biomarkers such as Interleukin (IL) -6 (humoral immunity), CD-3 (T-lymphocyte), and CD-163 (macrophage) in prostate biopsy (PBx) specimens from patients with prostatic inflammation (without cancer) which had been neither clinically diagnosed benign prostatic hyperplasia nor chronic prostatitis. We examined the correlation between these markers' expressions and the symptom scores using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS)/quality of life (QOL) which are the index for lower urinary tract symptoms (LUTS). Our results showed CD-163 (macrophage) reflected pain or discomfort on NIH-CPSI scores (P=0.0389 and r=0.3307) in the patients with prostatic inflammation; however, the control patients had no significant correlation between symptom scores and those immune-related markers' expression. These results suggest that pain or discomfort related to macrophages in the relationship between immune-system and the symptom of prostatic inflammation. In conclusion, CD-163, related to immune-system (macrophage), correlated with symptoms (pain or discomfort) of prostatic inflammation and might represent a significant immune-system related biomarker for pain or LUTS score in potentially CP.

[CORRECTION OF BLOOD CIRCULATION IN THE PROSTATE IN PATIENTS WITH CHRONIC PROSTATITIS ASSOCIATED WITH UROGENITAL INFECTIONS]

The aim of the study was to assess the effect of a combined preparation of Vitaprost on blood supply and microcirculation in the prostate gland in 35 patients with chronic infectious urethral prostatitis. The effectiveness of treatment was estimated by a combination of clinical, bacteriological and instrumental diagnostic methods. Transrectal ultrasonography with color Doppler and laser Doppler flowmetry were used to estimate all components of blood circulation in the prostate. Examination results obtained before and after treatment showed better clinical outcomes and improved parameters of blood flow and microcirculation in the prostate in patients receiving Vitapost. These results indicate that combination therapy including Vitaprost is effective in correcting blood flow and microcirculatory disorders of the prostate and can be utilized in the treatment of chronic infectious urethral prostatitis.

Phenotype, symptom severity and treatment in a 'cured' cohort of chronic pelvic pain syndrome patients

INTRODUCTION

To identify a cohort of chronic pelvic pain syndrome (CPPS) patients who considered their symptoms completely resolved and analyze their demographics, clinical phenotype, treatments and NIH-Chronic Prostatitis Symptom Index (CPSI) scores.

MATERIALS AND METHODS

We identified 35 CPPS patients who at the follow up, reported their symptoms completely resolved ('cured'). Demographics, UPOINT phenotypes, treatments, and CPSI scores were examined. We also compared these variables to a database of 220 previously evaluated CPPS patients.

RESULTS

Patients ranged in age from 19 to 72 years. Median follow up was 12 months. Mean change in CPSI sub scores before and after therapy were pain 9.7 ± 3.8 to 2.7 ± 2.9, urinary 4.0 ± 2.8 to 1.1 ± 1.2, QoL 8.1 ± 2.7 to 2.3 ± 2.5, and total 21.8 ± 6.6 to 6.2 ± 1.0 (all p < 0.0001). Only 9 (26%) patients reported a total score of 0. Comparing this 'cured' group to a previously published cohort of phenotyped CPPS patients, the 'cured' group had lower starting total and pain CPSI scores (21.8 versus 25.0 p = 0.007; 9.7 versus 11.5 p = 0.006 respectively).

CONCLUSIONS

Many men with CPPS can reach a subjective cure, however, the majority do not reach a CPSI score of 0. This group of "cured" patients is similar to our typical tertiary referral cohort in terms of age and phenotype but differs in having slightly lower pre-treatment CPSI scores.

[REPRODUCTIVE FUNCTION IN MEN WITH CHRONIC PROSTATITIS: CLINICAL, DISEASE HISTORY AND MICROBIOLOGICAL RISK ASPECTS]

Association between chronic prostatitis (HP) and fertility disorders remains a controversial issue. The aim of this retrospective multicenter cross-sectional study was to examine clinical, disease history and microbiological risk factors for fertility deterioration in men with HP. Case records of 3174 men aged 20-45 years living in a heterosexual marriage and having a regular sexual life were analyzed. Examination of couples and sperm analysis was conducted in accordance with the requirements of the WHO. Leukocytospermia was present in 19% of infertile cases. In 54% of those cases chronic prostatitis was associated with aerobic bacterial infection, in 9% - with chlamydial and in 12% with urea- and mycoplasma. It was found that concentrations ofleukocytes in semen and clinical symptoms (pain and dysuria) were not independent risk factors for infertility. Infertile patients had higher incident rates of E. coli (OR=4,1) and bacterial associations (OR=6,9) with reduced antimicrobial resistance of seminal plasma(for E. coli OR=9,9; for Ps. aeruginosa OR=6,0). Other risk factors for fertility reduction in patients with HP are the duration of the disease (OR=2,7), frequency of exacerbations (OR=2,6), presence of fibrosis and prostatolites (OR=1,8) and functional prostate-vesicular obstruction (OR=1,4). Further studies are needed to understand HP pathogenesis and explain the negative impact of HP on male fertility.

[Influence of combined phytotherapy on sexual function in patients with chronic abacterial prostatitis]

An open, prospective, comparative, randomized, placebo-controlled study on the evaluation of the efficacy and safety of combined drug prolit super in patients with chronic abacterial prostatitis without signs of inflammation (NIH 3B category), complicated by sexual dysfunction, was performed. The study included 57 men aged 28 to 50 years. Patients in group 1 (n=29) have received daily 4 capsules of prolit super for 2 months, patients in group 2 (n=28) - placebo for the same period. Excellent results were noted in 58.6% of patients in Group 1 and in 17.9% - in group 2; good results - in 20.7 and 21.4%, satisfactory results - in 20.7 and 17.9%, respectively. Weak effect and its absence were registered only in patients in group 2 - 28.6 and 14.3% of cases, respectively. Significant adverse events or complications against the background of therapy were not observed. The results of the study allows to recommend the appointment of prolit super.in routine clinical practice for patients with chronic abacterial prostatitis without signs of inflammation, complicated by sexual dysfunction.

[Combination therapy of prostatitis-associated copulative dysfunction]

Chronic prostatitis is characterized by clinical polymorphism, that may include pain, dysuria, asthenovegetative syndrome, and others. Symptoms associated with impaired copulatory cycle in chronic prostatitis have a significant impact on the quality of life of patient. Sexual dysfunction and sexuality cessation can exacerbate the inflammation of the prostate gland and worsen the underlying disease. The study included 60 patients diagnosed with chronic bacterial prostatitis, complicated by sexual disorders. Patients were divided into two comparable groups of 30 persons. Control group ofpatients received standard antibacterial therapy; study group ofpatients in addition received phytodrug prostanorm. At the end of treatment, higher IIEF-5 scores, increasing number of lecithin granules in the prostate secretion, as well as reducing the severity of irritative symptoms were registered in the study group.

Effects of Difaprost® on voiding dysfunction, histology and inflammation markers in patients with benign prostatic hyperplasia who are candidates for surgical treatment

AIM

Although previous studies assessed the effects of Serenoa repens, quercetin and β-sitosterol on inflammatory parameters, no randomized studies have tested the combination of these agents neither on BPH symptoms nor on the inflammatory pattern. The aim of this trial was to evaluate the effects of Difaprost® on voiding dysfunction, histological inflammatory alterations and apoptotic molecular mechanisms in BPH patients.

METHODS

We included 36 patients affected by BPH with obstructive symptoms eligible for surgery. Patients were randomly assigned to two groups: 18 patients received Difaprost® for three months before surgery, and 18 patients did not receive any additional therapy and were scheduled for surgery. All patients receiving Difaprost® were evaluated with uroflowmetry with post-void residual volume (PVR) evaluation, serum PSA, and IPSS questionnaire before and after treatment. Moreover, we evaluated inflammatory patterns in prostatic specimens at final pathology.

RESULTS

Even without statistically significant differences on inflammatory pattern between patients receiving Difaprost® and controls, patients receiving Difaprost® had lower presence of edema and angiectasia at histological evaluation of prostate specimens. Moreover, patients included in the treatment group had a clinically significant reduction of PVR (46.1 vs. 25.2 mL; P=0.1) and a slight increase in Qmed (5.6 vs. 6.5 mL/s; P=0.9) after three months of chronic treatment with Difaprost®. No statistically significant differences were recorded in other clinical parameters between patients receiving Difaprost® and controls.

CONCLUSION

Although not statistically significant, patients treated with Difaprost® showed an improvement in voiding function compared to controls (namely, an increase in Qmed and a reduction of PVR). Future trials with a larger number of patients and a longer treatment period could be necessary to evaluate the clinical efficacy of Difaprost®.

Development and validation of an animal model of prostate inflammation-induced chronic pelvic pain: evaluating from inflammation of the prostate to pain behavioral modifications

BACKGROUND

Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is the most common type of prostatitis. Due to the lack of a suitable animal model partly, the pathogenesis for this condition is obscure. In the current study we developed and validated an animal model for nonbacterial prostatitis and prostate inflammation-induced chronic pelvic pain in rats with the use of intraprostatic injection of λ-carrageenan.

METHODS

Male Sprague-Dawley rats weighing 250-350 g were used for the experiments. After intraprostatic injection of 3% λ-carrageenan, at different time points(after 24 h, 7 d, 14 d and 30 d of injection), radiant heat and von Frey filaments were applied to the scrotum of rats to measure the heat and mechanical thresholds respectively. Then the prostate was removed for histology, and cyclooxygenase (COX) 2 protein expression was determined by Western-blot. Evans blue(50 mg/kg) was also injected intravenously to assess for plasma protein extravasation at different time points after injection of λ-carrageenan.

RESULTS

Compared to control group, inflamed animals showed a significant reduction in mechanical threshold (mechanical allodynia) at 24 h and 7d(p = 0.022,0.046, respectively), and a significant reduction in heat threshold (thermal hyperalgesia) at 24 h, 7d and 14 d(p = 0.014, 0.018, 0.002, respectively) in the scrotal skin. Significant increase of inflammatory cell accumulation, COX2 expression and Evans blue extravasation were observed at 24 h, 7d and 14 d after injection.

CONCLUSIONS

Intraprostatic λ-carrageenan injection induced neurogenic prostatitis and prostate inflammation pain, which lasted at least 2 weeks. The current model is expected to be a valuable preclinical tool to study the neurobiological mechanisms of male chronic pelvic pain.