Experience with different questionnaires in the management of patients with CP/CPPS: GPSS, IPSS and NIH-CPSI

Correlation of resistive index of prostatic capsular artery to clinical symptoms in men with chronic prostatitis/chronic pelvic pain syndrome

OBJECTIVES

To evaluate the relation between resistive index (RI) of prostatic capsular arteries by transrectal Doppler ultrasonography in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its correlation with lower urinary tract symptoms, erectile dysfunction and premature ejaculation parameters of CP/CPPS.

METHODS

In total, we included 68 patients presenting with chronic prostatitis/chronic pelvic pain syndrome. We formed two groups, as Group 1 of 35 patients with a RI ≥ 0.7 and Group 2 of 33 patients with RI < 0.7. All patients were assessed with International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), premature ejaculation diagnostic tool (PEDT) and National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). In addition, the RI of the prostate capsular artery was measured in all patients using Doppler ultrasound. Statistical analyses were performed with SPSS version 18. A p value < .05 was considered significant.

RESULTS

Demographic characteristics were similar in the two groups. IPSS was 11.3 ± 6 in Group 1 and 9.7 ± 5.3 in Group 2. IIEF-5 was 18.6 ± 2 in Group 1 and 20.4 ± 2.3 in Group 2. PEDT was 12.4 ± 5.6 in Group 1 and 11.2 ± 4 in Group 2. CPSI (total) was 19.3 ± 12.3 in Group 1 and 10.6 ± 7.7 in Group 2. There was significant statistical difference in IPSS, IIEF-5, and CPSI between the two groups (p < .001, p < .001, p < .001 respectively). However, we found no significant difference in PEDT between the two groups (p = .19).

CONCLUSIONS

There is a significant correlation between the lower urinary tract symptoms and erectile dysfunction parameters and the RI of the prostatic capsular artery in CP/CPPS and RI is an effective and noninvasive method to assess the severity of the disease.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome Leads to Impaired Semen Parameters, Increased Sperm DNA Fragmentation and Unfavorable Changes of Sperm Protamine mRNA Ratio

BACKGROUND

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a frequent disease affecting men of every age and accounting for a great number of consultations at urology departments. Previous studies suggested a negative impact of CP/CPPS on fertility. As increasing attention has been attributed to additional aspects, such as sperm DNA integrity and sperm protein alterations, besides the WHO standard semen analysis when assessing male fertility, in this prospective study, we aimed to further characterize the fertility status in CP/CPPS patients with a focus on these parameters.

METHODS

Sperm DNA fragmentation measured by sperm chromatin structure assay (SCSA) and protamine 1 to protamine 2 mRNA ratio assessed by RT-qPCR were analyzed along with conventional ejaculate parameters and inflammatory markers in 41 CP/CPPS patients and 22 healthy volunteers.

RESULTS

We found significant differences between the groups concerning multiple conventional ejaculate parameters. A significant increase in sperm DNA fragmentation was shown in CP/CPPS patients with association to other sperm parameters. The majority of CP/CPPS patients exhibited protamine mRNA ratios out of the range of regular fertility.

CONCLUSIONS

This is a pioneering study with a strong practical orientation revealing that CP/CPPS leads to increased sperm DNA damage and changes in sperm protamine levels, emphasizing an unfavorable impact of CP/CPPS on fertility.

A systematic review of cross-cultural adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index

Background

The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was developed to accurately assess the pain, urinary symptoms, and quality of life related to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This study aimed to evaluate the cross-cultural adaptations of the NIH-CPSI.

Method

PubMed, Embase, CINAHL, and SciELO databases were searched from their established year to September 2020. Cross-cultural adaptations and the quality control of measurement properties of adaptations were conducted by two reviewers independently according to the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Quality Criteria for Psychometric Properties of Health Status Questionnaire.

Results

Area total of 21 papers with 16 adaptations, and six studies of the original version of the NIH-CPSI were enrolled in the systematic review. Back translation was the weakest process for the quality assessment of the cross-cultural adaptations of the NIH-CPSI. Internal consistency was analyzed for most of the adaptations, but none of them met the standard. Only 11 adaptations reported test reliability, then only the Arabic-Egyptian, Chinese-Mainland, Danish, Italian, Persian, and Turkish adaptations met the criterion. Most adaptations reported the interpretability, but only the Danish adaptation reported the agreement. The other measurement properties, including responsiveness, and floor as well as ceiling effects were not reported in any of the adaptations.

Conclusions

The overall quality of the NIH-CPSI cross-cultural adaptations was not organized as expected. Only the Portuguese-Brazilian, Italian, and Spanish adaptations reached over half the process for the cross-cultural adaptation. Only the Turkish adaptations finished half of the measurement properties of cross-cultural adaptations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01796-8.

Interventions to chronic prostatitis/Chronic pelvic pain syndrome treatment. Where are we standing and what's next?

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a frustrating syndrome. The pathogenesis and state of the art treatment of CP/CPPS are not known. A wide variety of therapies including anti-inflammatories, antibiotics, alpha-blockers, neuropathic pain modulators, and 5α-reductase inhibitors are in practice. These treatment strategies focus on alleviating symptoms in specific domains without treating root-cause and therapeutic outcome is far from satisfactory. We review the literature on current pharmacological treatments for CP/CPPS in detail and suggest future perspectives to modify the treatment strategies. We suggest that introducing novel treatment strategies such as gene editing, and T_regs expressing chimeric receptors may improve the treatment outcomes by inducing immune tolerance and controlling expression of pro-inflammatory cytokines.

Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases

Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study

Background

Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes.

Methods

We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges).

Results

A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16–39] and decreased to 22.2 [7–37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the process of completing 10 sessions. Duration of therapy appears to predict treatment response. Longer duration has better response.

Conclusions

Male CPPS is difficult to treat and often requires a multimodal approach. Based on the results of our pilot study, pelvic floor rehabilitation may be an effective treatment option for select patients. A larger study with a control group is needed to validate the routine use of pelvic floor rehabilitation in men with CPPS and predict characteristics of men who would respond to therapy.

Urogenital infections and male sexuality: effects on ejaculation and erection

The relation of urogenital infections and sexual dysfunction in men was largely neglected in the past but has attracted increasing interest recently. Despite direct anatomical and physiological interactions of the pelvic structures, an adverse effect of chronic prostatitis on quality of life and well-being should be considered to be another crucial point for any sexual disorder. Erectile dysfunction, premature ejaculation and painful ejaculation are the leading sexual symptoms in urogenital infections. On the other hand, chronic prostatitis has been found with a high frequency especially in men presenting with secondary premature ejaculation and the importance of a careful physical and microbiological examination of the prostate before any pharmacologic or psychosexual therapy for sexual disorder should be considered.

Is "shy bladder syndrome" (paruresis) correctly classified as social phobia?

Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia.

The Estonian version of the National Institutes of Health chronic prostatitis symptom index

Our aim was to establish the Estonian version of the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and to examine its validity and applicability in chronic prostatitis patients as well as in community-based study. The questionnaire was tested in 54 category III prostatitis patients. In addition, 452 men were enrolled into a community-based study that resulted in 83 completed questionnaires. The discriminatory power, psychometric properties and internal correlations of the questionnaire were tested. The questionnaire demonstrated good internal consistency, with Cronbach's alpha coefficient 0.82. The pain and quality of life domains demonstrated high correlations with each other and with the entire questionnaire. The total score and the scores of pain and quality of life domains of the Estonian NIH-CPSI differed significantly between the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients and the men without CP/CPPS, and so the index proved a good discriminant validity. We can conclude that the Estonian NIH-CPSI is easily understood and reflects accurately the clinical symptoms and the quality of life in patients with chronic prostatitis. The similarity of the psychometric properties of the English and Estonian versions of the NIH-CPSI supports their measurement equivalence.

Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study

OBJECTIVES

To assess the efficacy and safety of the pollen extract preparation Prostat/Poltit in the treatment of patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome.

METHODS

In a double-blind study, 60 patients between 20 and 55 years old with chronic nonbacterial prostatitis/chronic pelvic pain syndrome were randomized to receive Prostat/Poltit or placebo for 6 months. The patients had been symptomatic for more than 6 months without response to any given therapy. The patients were evaluated at the start of the treatment and after 6 months of treatment with the help of a symptom questionnaire covering the symptoms in seven pain locations, five voiding symptoms, three storage symptoms, and four sex-related symptoms.

RESULTS

The overall clinical evaluation of the treatment result showed that after treatment for 6 months more patients taking Prostat/Poltit were cured or improved than patients taking placebo. No adverse reactions to the treatment were found.

CONCLUSIONS

Prostat/Poltit is superior to placebo in providing symptomatic relief in men with chronic nonbacterial prostatitis/chronic pelvic pain syndrome.

Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome

To discuss challenges concerning treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and review complementary and alternative medical (CAM) therapies being evaluated for this condition, we performed a comprehensive search of articles published from 1990-2005 using the PubMed, Medline databases. Data from the articles were abstracted and pooled by subject. Keywords cross-searched with CP/CPPS included: complementary, alternative, integrative, therapies, interventions, nutrition, antioxidants, herbs, supplements, biofeedback and acupuncture. Listed articles with no abstracts were not included. Various CAM therapies for CP/CPPS exist including biofeedback, acupuncture, hyperthermia and electrostimulation. Additionally, a variety of in vitro and in vivo studies testing herbal and nutritional supplements were found. Saw palmetto, cernilton and quercetin were the most frequently tested supplements for CP/CPPS. Although many CAM therapies demonstrate positive preliminary observations as prospective treatments for CP/CPPS, further exploratory studies including more randomized, controlled trials are necessary for significant validation as treatment options for this complex disorder.

Entwicklung und Überprüfung der Paruresis-Skala (PARS)

Zusammenfassung. Theoretischer Hintergrund: Die Störung der Paruresis besteht in dem Unvermögen, auf öffentlichen Toiletten zu urinieren. Sie ist bislang in der Sozialen Phobie-Forschung nur wenig beachtet worden, was nicht zuletzt an dem Mangel an Messinstrumenten liegen könnte. Fragestellung: Entwicklung und Überprüfung der Paruresis-Skala (PARS). Methode: An einer Stichprobe von N = 180 über das Internet rekrutierten Probanden, die vier Gruppen zugeordnet wurden (Paruresis, Nichtgeneralisierte Soziale Phobie, Generalisierte Soziale Phobie, Kontrollgruppe), wurde eine Item- und Faktorenanalyse durchgeführt sowie konvergente und diskriminante Validität bestimmt. Ergebnisse: Die PARS weist sehr gute Kennwerte der Reliabilität auf, korreliert mit urologisch bedingten Miktionsbeschwerden nur schwach und kann zwischen den an Paruresis und den an reiner sozialer Phobie leidenden Probanden trennen. Schlussfolgerung: Die PARS ist als Messinstrument im Forschungskontext geeignet.

[Symptoms or complaints in the aging male--which questionnaires are available?]

Age associated hypoandrogenism and related changes in sexual function, as well as multiple physical complaints, and affective and cognitive changes have all been described in the aging male. In addition to decreased testosterone levels, clinical symptoms are required in order to perform substitution therapy. The assessment of symptoms and complaints in the aging male is discussed based on scientific test criteria. Commonly used questionnaires have the advantages of economy and independence from the investigator. In order to cover the broad range of age associated changes, numerous standardized and reliable procedures are available. However, these have usually not been developed specifically in order to assess androgen dependent changes. Preliminary, specific "aging male" questionnaires do not correlate reliably with the levels of testosterone. Thus there is a need for research and development in order to identify and assess androgen dependent complaints.

Two-year experience with the german-translated version of the NIH-CPSI in patients with CP/CPPS

OBJECTIVES

To examine, after psychometric evaluation and validation of the translated National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the practical value of this questionnaire in a routine diagnostic prostatitis setup for patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The NIH-CPSI is a well-accepted tool for the symptomatic evaluation of patients with CP/CPPS. The recently translated German version has not yet been validated in detail.

METHODS

A total of 137 consecutive patients attending a prostatitis outpatient department were classified according to the internationally accepted NIH consensus classification into CP/CPPS NIH type IIIA (n = 53; mean age 43.2 years) and IIIB (n = 84; mean age 43.4 years). For psychometric analysis, the overall type III group was evaluated for reliability and validity of the German NIH-CPSI. The psychometric properties of the translated NIH-CPSI were compared with those of the original English version. In addition, the total scores of all men and separately for CP/CPPS NIH types IIIA and IIIB were evaluated.

RESULTS

The German NIH-CPSI was reliable, with an alpha coefficient for the overall index and its subscales of between 0.60 and 0.74. However, the internal consistency of the pain subdomain was lower in our translated version (alpha 0.60) compared with the original English version (alpha 0.86). In this cohort, men with NIH type IIIB CP/CPPS were significantly (P = 0.03) more symptomatic in the total index compared with men with NIH type IIIA CP/CPPS.

CONCLUSIONS

The German version of the NIH-CPSI has a relatively high reliability and face and construct validity overall. A validated translated NIH-CPSI is suggested as a standardized tool to quantify chronic pelvic pain symptoms for different countries and languages.