The prevalence of chronic prostatitis-like symptoms in young men: a community-based survey

Male pelvic pain: the role of psychological factors and sexual dysfunction in a young sample

OBJECTIVES

Male pelvic pain is a common yet poorly understood condition, strongly influencing quality of life of those affected. Research on psychological and sexual factors is lacking, specifically on younger men in family-forming ages. This study aims to explore psychological and sexual factors related to pelvic pain in younger men (<40 years) through a cross-sectional design.

METHODS

Participants were recruited via social media, and completed a digital survey regarding sexual health and psychological distress (n=2,647). Men with varying levels of pelvic pain were compared on levels of psychological distress and self-reported sexual health.

RESULTS

Men with pelvic pain (n=369) reported significantly higher levels of catastrophizing, anxiety and premature ejaculation compared to men without pelvic pain. Furthermore, men with higher pain intensity reported significantly higher levels of catastrophizing, anxiety and depressive symptoms compared to men experiencing lower pain intensity. Hierarchical regression analysis revealed catastrophizing and depressive symptoms as significantly predictors of pain intensity.

CONCLUSIONS

These findings underscore the role of psychological factors in male pelvic pain, and points to the need for integrating a psychological understanding for further treatment development.

Clinical efficacy of roxithromycin in men with chronic prostatitis/chronic pelvic pain syndrome in comparison with ciprofloxacin and aceclofenac: a prospective, randomized, multicenter pilot trial

Roxithromycin is effective in the treatment of intracellular organisms, including chlamydia and mycoplasma, and exhibits anti-inflammatory and immunomodulatory effects on respiratory diseases. To explore the potential therapeutic benefit of roxithromycin in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), this study compared the effect of roxithromycin with ciprofloxacin and aceclofenac. A total of 75 patients with CP/CPPS were randomized to three groups in open-label: group 1, ciprofloxacin; group 2, aceclofenac; and group 3, roxithromycin. The patients were treated for 4 weeks and were subsequently followed for 12 weeks. Changes from baseline in the total and domain scores of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) were evaluated. The NIH-CPSI score decreased in the roxithromycin, ciprofloxacin, and aceclofenac groups to a similar degree. The NIH-CPSI initial and 12-week total scores were 20.3 and 10.0, respectively, in group 1; 23.6 and 14.3, respectively, in group 2; and 21.1 and 9.8, respectively, in group 3. The three treatment arms did not differ significantly with respect to the efficiency of treatment (p > 0.05). Compared to patients in groups 1 and 2, group 3 patients with Category IIIb disease exhibited favorable results upon follow-up 12 weeks after treatment. The International Prostate Symptom Score (IPSS), uroflowmetry, and post-void residual volume were equivalent between the groups. Roxithromycin exhibits similar or favorable effects on the improvement of CP/CPPS compared to ciprofloxacin and aceclofenac. Roxithromycin could be used as a new therapeutic agent for CP/CPPS. Further study of the immunomodulatory action of roxithromycin in CP/CPPS is required.

National prevalence of urogenital pain and prostatitis-like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index

STUDY TYPE

Prognosis (cohort).

LEVEL OF EVIDENCE

2a.

OBJECTIVE

To provide a summary, using the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), of the prevalence of prostatitis-like symptoms in a population-based sample of Australian men.

SUBJECTS AND METHODS

Participants were Australian men aged 16-64 years recruited as part of the Australian Longitudinal Study of Health and Relationships: a nationally representative study. In all, 1346 men completed an extensive questionnaire which included the NIH-CPSI. The index identifies six types of urogenital pain, the presence of urinary problems, and effects on quality of life. Men who reported perineal and/or ejaculatory pain or discomfort and a total NIH-CPSI pain score of > or =4 were considered as having prostatitis-like symptoms.

RESULTS

Based on a weighted population of 1373 men, some form of urogenital pain was reported by 105 (7.6%) men; with 2.8% of men reporting more than one type of urogenital pain. The mean (range) NIH-CPSI pain score for men reporting pain was 6.2 (5.6-6.8); for all men the mean score was 0.5 (0.4-0.6). About 20% of men (284) were considered to have urinary problems. The mean urinary symptom score for all men was 0.9 (0.9-1.0). The mean total NIH-CPSI score for men reporting pain was 13.3 (12.0-14.7) and for all men it was 2.6 (2.3-2.8). The estimated prevalence of prostatitis-like symptoms was approximately 2%.

CONCLUSIONS

Using the NIH-CPSI the estimated prevalence for urogenital pain in Australian men is 8%; an estimated 3% of men experience pain from more than one urogenital location. The estimated prevalence of prostatitis-like symptoms in Australian men is 2%. Almost a third of Australian men experiencing urogenital pain or prostatitis-like symptoms would be less than satisfied if this was to be ongoing for the rest of their life.

Prevalence, symptom impact and predictors of chronic prostatitis-like symptoms in Canadian males aged 16-19 years

OBJECTIVE

To estimate the prevalence and examine the extent that pain, urinary symptoms, depression and pain catastrophizing predict the quality of life (QoL) in Canadian male adolescents, as the prevalence and impact of chronic prostatitis (CP)-like symptoms in adolescents is unknown.

SUBJECTS AND METHODS

Participants completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the Patient Health Questionnaire-depression screen (PHQ-D), and the Pain Catastrophizing Scale (PCS). CP-like case identification was based on NIH-CPSI report of pain/discomfort in perineum and/or with ejaculation and NIH-CPSI total pain score (0-20) of >or=4 (mild) and >or=8 (moderate-severe). The point prevalence was estimated and regressions used to examine predictors of diminished QoL gathered from the NIH-CPSI.

RESULTS

The prevalence of at least mild CP-like symptoms in 264 Canadian adolescents aged 16-19 years (mean age 17.5, sd 1.1) was 8.3%, with 3% reporting moderate-severe CP-like symptoms. Pain, urinary symptoms, depression and catastrophizing were correlated with diminished QoL. Additionally, catastrophizing predicted diminished QoL when the variance of pain, urinary symptoms and depression were simultaneously considered in the analysis.

CONCLUSIONS

Similar to that reported by older cohorts, these data provide the first point-prevalence estimate of CP-like symptoms in adolescents. These findings suggest increased vigilance to a potential diagnosis of adolescent CP syndrome and indicate that psychological features (i.e. catastrophizing) are significant in diminished QoL. Adolescent male chronic pelvic pain is an important and understudied area for future investigations.

Prevalence of chronic prostatitis symptoms in a randomly surveyed adult population of urban-community-dwelling Nigerian males

OBJECTIVES

Chronic prostatitis is a debilitating disease of the prostate gland that is characterized by chronic pelvic pain. Unlike the developed world, the prevalence of chronic prostatitis and its impact on the quality of life (QOL) of the sufferer is not known in Nigeria. This work was carried out to fill this vacuum.

METHODS

A random cross-sectional survey of apparently normal men of ages 20-70 years, living in Nsukka, a university town in South-eastern Nigeria, using the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was carried out. The self reported pain and QOL scores were used to identify subjects with chronic prostatitis symptoms and the subjects' QOL status, respectively.

RESULTS

Of the 1507 men studied, 12.21% had symptoms suggestive of chronic prostatitis. Subjects with chronic prostatitis symptoms (CPS) (mean relative age 40.98 +/- 12.51 years) had higher mean pain and voiding scores (5.65 +/- 1.99 and 2.61 +/- 2.23, respectively) compared with subjects without CPS (0.44 +/- 0.73 and 1.29 +/- 1.70 for pain and voiding scores, respectively; mean relative age 41.99 +/- 12.99 years). A total of 39.62% of the population had pain in at least one location, while 22.69% of the population had impaired QOL.

CONCLUSION

Chronic prostatitis symptoms are as common in Nigeria as they are in the developed world, and so are their effects on the QOL of the sufferer.

Increased inflammatory factors activity in model rats with experimental autoimmune prostatitis

Male rats were immunized with prostate tissue homogenate supernate (PTHS) of male rats with complete Freund's adjuvant (CFA) intra dermal in the multiple points and simultaneously immunized with 0.5 ml Pertussis-Diphtheria-Tetanus (PDT) vaccine intra peritonea on 0 and 30th day. At the 45th day after first immunization, animals were sacrificed and a series of examinations such as HE stain, assay of TNF-alpha by ELISA and assay of inducible nitric oxide synthase (iNOS) mRNA by in-situ hybridization (ISH) were taken. We observed that there was a remarkable up-regulation of TNF-alpha expression in the high dosage model group. The results of macropathology, histopathology and iNOS ISH also revealed the same tendency. This experimental procedure is effective to induce chronic abacterial prostatitis (CAP).

Prostatite chronique et syndrome douloureux pelvien chronique de l’homme. Enquête auprès des urologues français

OBJECTIVE OF THE SURVEY: To determine the usual practice of French urologists in relation to the diagnostic and therapeutic management of chronic prostatitis.

MATERIAL AND METHODS

A questionnaire on the diagnostic and therapeutic management of chronic prostatitis was sent by mail in June 2003 to 810 urologists, members of the Association Française d'Urologie and working in France.

RESULTS

124 (15%) urologists returned the questionnaire. 61% of these urologists diagnosed less than 11 new cases of chronic prostatitis per year and 65% were not familiar with the new classification proposed in 1995 in the USA by the NIH (National Institutes of Heath) designed to remove this disease from the strict context of the prostate, placing greater emphasis on the concept of pain and introducing the concept of male chronic pelvic pain syndrome. 83% of urologists performed microbiological investigations often or always, but only 10% often or always performed a Meares and Stamey test comprising analysis of prostatic secretions after massage and 68% never performed this test. On the other hand, 76% of urologists ordered a first-stream urine culture, 61% ordered a second-stream urine culture and 76% ordered semen culture. 73% often or always prescribed antibiotics (82% used fluoroquinolones and 43% used the trimethoprim-sulfmethoxazole combination). Even in the absence of microbiological proof of infection, 41% of urologists often or always prescribed antibiotics, 89% sometimes or often prescribed an alpha-blocking agent, 89% sometimes, often or always prescribed a non-steroidal anti-inflammatory drug, 81% sometimes, often or always prescribed analgesics, 52% sometimes or often prescribed anxiolytics, and 66% sometimes or often referred the patient to another specialist.

CONCLUSION

This survey shows that chronic prostatitis, now generally referred to as "chronic pelvic pain syndrome", continues to raise diagnostic and therapeutic problems for French urologists.

Prevalence of prostatitis-like symptoms in Japanese men: Population-based study in a town in Hokkaido

AIM

To determine the prevalence of prostatitis-like symptoms in Japanese men living in one town.

METHODS

A cross-sectional and population-based study was performed in a town that had 6385 men aged from 20 to 79 years. We sent two questionnaires, the validated Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score (I-PSS) with questions about individual medical information, to 1424 randomly selected community-indwelling men. Subjects were defined as having prostatitis-like symptoms if they complained of perineal and/or ejaculatory pain or discomfort and their total pain score was four or greater.

RESULTS

A total of 512 men (36%) responded completely to the questionnaires. Of the 512 responders, 25 men (4.9%) were identified as having prostatitis-like symptoms. Prevalence of symptoms was the same in men aged younger than 50 years (5.0%) as those 50 years and older (4.8%). The I-PSS score was 10.8 in men with prostatitis-like symptoms, which was higher than in those without symptoms.

CONCLUSIONS

Prevalence of prostatitis-like symptoms was 4.9% in randomly selected men. International comparison of prevalence of the symptoms may contribute to further understanding of chronic prostatitis.

Sexual dysfunction in the patient with prostatitis

Prostatitis (chronic prostatitis/chronic pelvic pain syndrome ) is a common condition in men that accounts for a significant number of visits to a medical doctor or urologist. It is one of the most widely diagnosed conditions in men who attend urologic clinics. Erectile dysfunction, defined as the consistent inability to obtain and/or maintain a penile erection sufficient for adequate sexual relations, also is a common problem. This review explores the links between sexual dysfunction and prostatitis. Most of the data linking lower urinary tract symptoms and erectile dysfunction suggest that lower urinary tract symptoms impair the overall quality of life and that a low quality of life contributes to or causes erectile dysfunction. Prostatitis-like symptoms such as perineal, penile, and suprapubic discomfort or pain during or after ejaculation and voiding complaints such as irritative and obstructive voiding symptoms (urinary frequency, urgency, and dysuria) may affect the global emotional well-being of a man. Erectile dysfunction also is strongly associated with a negative impact on the quality of life. The available literature demonstrating the influence of CP/CPPS on the incidence of erectile dysfunction is scant. From the literature, it is known that lower urinary tract symptoms and benign prostatic hyperplasia are definitely related to erectile dysfunction. Any kind of pain is likely to be the most significant symptom in men with CP/CPPS as it relates to sexual dysfunction. Sexual dysfunction such as ejaculation discomfort is described as a symptom of CP/CPPS. Most of the data linking the two suggest that CP/CPPS impairs the overall quality of life and it is this that contributes to or causes erectile dysfunction.

Sexual dysfunction in the patient with prostatitis

PURPOSE OF REVIEW

Prostatitis [chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)] is a common condition in men that accounts for a significant number of visits to a medical doctor or urologist. It is one of the most widely diagnosed conditions in men attending urologic clinics. Erectile dysfunction, defined as the consistent inability to obtain and/or maintain a penile erection sufficient for adequate sexual relations, is also a common problem. This review explores the links between sexual dysfunction and prostatitis.

RECENT FINDINGS

Most of the data linking lower urinary tract symptoms and erectile dysfunction suggest that lower urinary tract symptoms impair the overall quality of life and that a low quality of life contributes to or causes erectile dysfunction. Prostatitis-like symptoms such as perineal, penile, and suprapubic discomfort or pain during or after ejaculation and voiding complaints such as irritative and obstructive voiding symptoms: urinary frequency, urgency, and dysuria may affect the global emotional well-being of a man. Erectile dysfunction is also strongly associated with a negative impact on the quality of life.

SUMMARY

The available literature demonstrating the influence of CP/CPPS on the incidence of erectile dysfunction is scant. From the literature, it is known that lower urinary tract symptoms and benign prostatic hyperplasia are definitely related to erectile dysfunction. Any kind of pain is likely to be the most significant symptom in men with CP/CPPS as it relates to sexual dysfunction. Sexual dysfunction like ejaculation discomfort is described as a symptom of CP/CPPS. Indeed, most of the data linking the two suggest that CP/CPPS impairs the overall quality of life and it is this that contributes to or causes erectile dysfunction.

The Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index

OBJECTIVES

To perform the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index (NHI-CPSI), and to study its linguistic validity and its correlations with the Visual Analogue Scale for pain (VAS) and the Italian version of International Prostatic Symptom Score (I-PSS) in men with chronic pelvic pain syndrome (CPPS) and healthy controls.

METHODS

A rigorous double-back translation of the original English NHI-CPSI was performed by a staff composed of 3 professional bilingual experts and 3 urologists. The study population consisted of 160 male CPPS patients and 125 healthy controls, who were asked to self complete the Italian version of the NHI-CPSI together with the VAS and the Italian I-PSS. The discriminatory power, psychometric properties, internal correlations and convergent validity of the questionnaire were tested.

RESULTS

Of the 285 enrolled patients, 223 patients (142 with CPPS and 81 healthy patients) were definitively considered for the study. The overall Italian NIH-CPSI scores and each subscale differed significantly (p<0.001) between the two groups, and so that the index proved a good discriminant validity. High correlations were found between the VAS and the pain domain (0.88) and between I-PSS and void domain (0.94), suggesting a good convergent validity of the Italian version of the NIH-CPSI. The questionnaire proved to have a high internal consistency.

CONCLUSIONS

The Italian NIH-CPSI is a reliable symptom index that can be self-administrated in about 5 minutes in daily clinical practice for the follow-up of the Italian patients with chronic prostatitis.

Low Agreement Between Previous Physician Diagnosed Prostatitis and National Institutes of Health Chronic Prostatitis Symptom Index Pain Measures

PURPOSE

We evaluate the agreement between self-reported physician diagnosed prostatitis and pain questions from the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI).

MATERIALS AND METHODS

A randomly selected cohort of white men 47 to 90 years old from Olmsted County, Minnesota completed a study questionnaire on a history of physician diagnosed prostatitis in the preceding 2 years, including the CPSI questions. The medical records were also reviewed for physician diagnosis of chronic prostatitis during the preceding 10 years.

RESULTS

Of 1,543 men 27 (1.7%) reported a physician diagnosis of prostatitis in the preceding 2 years. There were strong associations between self-reported prostatitis and pain at the tip of the penis (OR 6.3, 95% CI 1.4, 28.5), ejaculatory (5.9, CI 1.3, 26.6) and testicular (3.6, 1.2, 10.8) pain. The chance corrected agreement between self-reported prostatitis and pain symptoms was low at 0.01 (pubic pain) to 0.07 (pain at the tip of the penis, ejaculatory pain and testicular pain). Agreement in positive responses was also low at 3.7% (perineal pain) to 8% (pain at the tip of the penis, ejaculatory pain and testicular pain). The predictive value of the modified total CPSI score for prostatitis was 0.67, which was better than chance (0.5). Associations based on medical record ascertainment of prostatitis during followup were weak, and the area under the curve was 0.57, which was no better than chance.

CONCLUSIONS

These findings demonstrate low agreement between CPSI-like pain measures and self-reported physician diagnosed prostatitis. The stronger associations between pain symptoms and self-reported diagnosed prostatitis, and the moderate predictive ability of the modified total CPSI score measures for self-reported prostatitis compared to medical record ascertainment demonstrate the sensitivity of the CPSI to prevalent symptoms. Thus, the tool may be best used to evaluate the severity of current symptoms rather than to assess the presence or absence of prostatitis.

The Finnish version of The National Institutes Of Health Chronic Prostatitis Symptom Index correlates well with the visual pain scale: translation and results of a modified linguistic validation study

Authors from Finland have assessed a version in their language of the National Institutes of Health-Chronic Prostatitis Symptom Index; they found that their translated version was valid and easily understandable in the management of the symptoms of chronic pelvic pain syndrome. They felt it should be used as a primary outcome measure in studies with these patients. There are three papers in this issue relating to the effect of drugs on LUTS; the first of these is a pooled analysis of three double-blind placebo-controlled studies into the safety and efficacy of the 10 mg dose of alfuzosin. The second evaluates the effect on quality-of-life issues of treatment with dutasteride. Finally, authors from Australia compare the effect of a Serenoa repens extract with placebo for LUTS.

OBJECTIVES

To provide a fluent and easily comprehensible Finnish version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and to study its linguistic validity and correlation with a visual pain scale (VAS).

PATIENTS AND METHODS

The double-back translation method with two interim modifications was used to produce the Finnish version of the NIH-CPSI. The validity was tested by presenting the questionnaire to 155 men with clinically confirmed chronic pelvic pain syndrome (CPPS) and 12 controls with no previous urological symptoms. Convergent validity of the NIH-CPSI was tested by determining the correlation between the Finnish NIH-CPSI and VAS. Patients' and urologists' opinions about the utility of the Finnish NIH-CPSI were also reviewed.

RESULTS

The total Finnish NIH-CPSI scores and the pain domain and voiding symptom domain scores differed significantly (P < 0.001) between the groups, suggesting good discriminant validity of the symptom index. The NIH-CPSI scores correlated well with the VAS (Pearson's correlation 0.76). The preciseness and comprehensibility of the questionnaire were consistently evaluated to be 'good' or 'excellent' both by patients and urologists.

CONCLUSIONS

The Finnish version of the NIH-CPSI is valid and easily comprehensible for measuring CPPS symptoms. In addition, it provides good discriminant and convergent validity in distinguishing CPPS symptoms and should be used as primary outcome measure in CPPS studies.