[Four-glass or two glass test for chronic prostatitis]

Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients (case group) and 341 nonCP/CPPS patients (control group). Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.04–2.66). In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 (95% CI, 1.2–2.88). The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

Value of semen culture in the diagnosis of chronic bacterial prostatitis: A simplified method

OBJECTIVE

To investigate the role of semen cultures versus segmented urine cultures for the diagnosis of bacterial chronic prostatitis.

MATERIAL AND METHODS

We retrospectively examined 895 patients (age range 17-67 years) who met the consensus criteria for clinical chronic prostatitis/chronic pelvic pain syndrome, 50.1% of whom had dysuria and/or perineal discomfort, 37.4% infertility of unknown etiology and 12.5% erectile dysfunction. Segmented urine cultures, including expressed prostatic secretions (EPSs) and semen culture, were performed in all patients.

RESULTS

Of the 895 patients, 182 had significant positive cultures for Gram-negative microorganisms (Escherichia coli was the commonest specimen isolated: 70.4% of cases) and 283 had significant positive cultures for Gram-positive microorganisms. We compared the culture yield in EPS and/or the urine voided after prostatic massage (VB3) sample (four-glass method) with that of the semen sample. In the Gram-negative group, 32 patients were diagnosed by means of semen culture (negative EPS and/or VB3 sample) and in only five cases was a positive diagnosis made despite a negative semen culture (positive EPS and/or VB3 sample). In the remaining subjects, diagnosis was performed with the aid of both EPS/VB3 sample and semen (both of which were positive). In the Gram-positive group, there was significant growth of such microorganisms in semen in every case considered positive, but in only 46 cases was diagnosis achieved via EPS and/or VB3 sample. A diagnosis of chronic prostatitis by Gram-positive microorganisms in these patients was only considered when the same microorganism was retrieved in repeated cultures without previous treatment. Only three cases met such criteria (all of whom had negative EPSs). To evaluate the diagnostic efficiency of the semen and EPS samples, we analyzed their sensitivity and specificity, obtaining higher sensitivity in semen than EPS samples for significant Gram-negative cultures: 97% vs 82.4%. In significant Gram-positive cultures, the sensitivity of semen samples was 100%, compared to only 16.1% for EPS.

CONCLUSIONS

A semen sample has higher sensitivity than an EPS for the diagnosis of bacterial chronic prostatitis. In our clinical work-up, first-void urine and a semen culture are considered the only tests necessary to diagnose chronic prostatitis.

How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?

PURPOSE

The Meares-Stamey 4-glass test is the standard method of assessing inflammation and the presence of bacteria in the lower urinary tract in men presenting with the chronic prostatitis syndrome. However, most urologists do not use it in daily practice because of the time and difficulty in performing it, as well as the additional expense. We evaluated a simpler test, the 2-glass pre-massage and post-massage test, and compared it with the Meares-Stamey 4-glass test to detect inflammation and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS

The study population included 353 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study with baseline leukocyte counts and 2-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, expressed prostatic secretions, VB3). The chi-square test was performed to assess associations of white blood cell counts in expressed prostatic secretions and VB3. A receiver operating characteristic curve was constructed to determine the optimal cut point of white blood cells in VB3 in predicting white blood cells in expressed prostatic secretions. Sensitivity and specificity of VB3 cultures predicting expressed prostatic secretions and positive Meares-Stamey results were calculated from 2 x 2 contingency tables.

RESULTS

Analysis of binary leukocyte outcomes (no white blood cells vs any white blood cells) suggests that white blood cells tend to be present in expressed prostatic secretions when there are any white blood cells in VB3, p <0.0001, the optimal cut point being white blood cell counts of 3 in VB3 (best predictive ability with area under ROC 0.771) to predict 5+ in expressed prostatic secretions with a sensitivity of 76% and specificity of 70%. The optimal cut point of white blood cells in VB3 to predict 10 white blood cells in expressed prostatic secretions was 4 (62% sensitivity and 75% specificity). Uropathogens localizing to expressed prostatic secretions or VB3 confirms a positive 4-glass Meares-Stamey localization test. The sensitivity and specificity of a VB3 localizing culture only in predicting a positive Meares-Stamey 4-glass test result for any uropathogen were 44% to 54% (depending on definition) and 100%, respectively. The pre-massage and post-massage test predicted a correct diagnosis in more than 96% of subjects.

CONCLUSIONS

The value of localizing leukocytes and uropathogens to prostate specific specimens remains controversial in chronic heavily pretreated patients, but these data may help direct therapy (anti-inflammatory or antimicrobial) when obtained at first presentation. The pre-massage and post-massage test has strong concordance with the 4-glass test and is a reasonable alternative when expressed prostatic secretions are not obtained.

Impact of Prostatitis NIH IIIB (Prostatodynia) on Ejaculate Parameters

OBJECTIVES

Prostatitis NIH IIIB is defined by chronic pelvic pain without evidence of inflammation in prostate secretions or ejaculate. The relations between chronic prostatitis and fertility are discussed controversially. In this context, we analysed fertility data of a well defined collective of patients with prostatitis NIH IIIB.

METHODS

We analysed prospective fertility data of a group of 30 patients with chronic prostatitis NIH IIIB and compared these data with the duration of symptoms as well as with an age-matched control group.

RESULTS

The prostatitis group and the control group differed significantly in terms of ejaculate volume, motility and fructose concentration. The remaining parameters did not differ significantly. An azoospermia was present in 3 patients of the prostatitis group versus none of the control group. The duration of symptoms did not correlate with the sperm parameters (sperm density, motility and morphology).

CONCLUSIONS

Patients with prostatitis NIH IIIB have changes in their ejaculate with a reduction of motility and a reduced fructose concentration. This supports a somatic aetiology of the chronic pelvic pain syndrome.