[Correlation between TCM syndrome types and clinical symptoms of benign prostatic hyperplasia with chronic prostatitis]

OBJECTIVE

To investigate the correlation between the syndrome types of traditional Chinese medicine (TCM) and clinical symptoms of benign prostatic hyperplasia (BPH) with chronic prostatitis (BPH-CP).

METHODS

We selected 150 cases of BPH-CP in this study and divided them into 7 TCM syndrome types. Using univariate and multivariate logistic regression analyses, we studied the correlation of each TCM syndrome type with the age, disease course, prostate volume, postvoid residual urine volume (PVR), prostate-specific antigen (PSA) level, maximum urinary flow rate (Qmax), and International Prostate Symptoms Score (IPSS).

RESULTS

Kidney-yin deficiency was correlated positively with the prostate volume but negatively with Qmax and IPSS; kidney-yang deficiency positively with the age and prostate volume but negatively with IPSS; the damp heat syndrome positively with the PSA level but negatively with the disease course, prostate volume and Qmax; the spleen-qi deficiency syndrome positively with the prostate volume but negatively with the disease course; liver-qi stagnation positively with the disease course but negatively with the age, prostate volume and PVR; the syndrome of qi stagnation and blood stasis positively with the disease course and IPSS but negatively with PVR; the syndrome of lung-heat and qi blockage positively with the age, Qmax and IPSS but negatively with the disease course.

CONCLUSIONS

The TCM syndrome types of BPH-CP are closely correlated to their clinical symptoms. The analysis of the clinical objective indexes of BPH-CP can provide some reliable evidence for accurate identification of the TCM syndrome type of the disease.

[Longjintonglin Capsules for type IIIA prostatitis accompanied by abnormal semen liquefaction: A clinical observation]

OBJECTIVE

To evaluate the therapeutic effect of Longjintonglin Capsules on type IIIA prostatitis accompanied by abnormal semen liquefaction.

METHODS

We selected 140 patients with type IIIA prostatitis accompanied by abnormal semen liquefaction according to the diagnostic standards of the American Institutes of Health (NIH) and treated them with Longjintonglin Capsules orally 3 capsules once tid for 12 weeks. We obtained the NIH Chronic Prostatitis Symptom Indexes (NIH-CPSI), traditional Chinese medicine (TCM) syndrome scores, leukocyte count in the expressed prostatic secretion (EPS), semen liquefaction time, and the results of semen analysis and compared these indicators before and after the treatment.

RESULTS

Of the 140 cases, 132 were included in this study, excluding 8 due to their incomplete case histories. Before and after 4, 8 and 12 weeks of medication, the total NIH-CPSI scores were 24.52 ± 5.43, 21.28 ± 4.85, 18.01 ± 4.28, and 14.49 ± 3.65 (P < 0.01), the TCM syndrome scores were 35.63 ± 6.07, 26.66 ± 5.03, 17.37 ± 4.18, and 11.11 ± 3.96 (P < 0.01), and the leukocyte counts (/HP) were 27.50 ± 7.01, 22.38 ± 5.22, 16:76 ± 4.10, and 11.40 ± 4.74 (P < 0.01), respectively. After 12 weeks of treatment, 31 of the patients with type IIIA prostatitis were cured and another 72 well responded, with an overall response rate of 78.0%. Of those with abnormal semen liquefaction, 61 were cured, 39 well responded, and 32 failed to respond, with an overall effectiveness rate of 75.8%. Semen analysis showed significantly increased percentage of progressively motile sperm after 4, 8 and 12 weeks of medication as compared with the baseline (P < 0.01). No abnormal liver or renal function or other adverse reactions were observed during the treatment.

CONCLUSION

Longjintonglin Capsules, with its advantages of safety, effectiveness and no obvious adverse effects, deserve to be recommended for the treatment of type IIIA prostatitis accompanied by abnormal semen liquefaction.

Painful Bladder Filling and Painful Urgency are Distinct Characteristics in Men and Women with Urological Chronic Pelvic Pain Syndromes: A MAPP Research Network Study

PURPOSE

We describe bladder associated symptoms in patients with urological chronic pelvic pain syndromes. We correlated these symptoms with urological, nonurological, psychosocial and quality of life measures.

MATERIALS AND METHODS

Study participants included 233 women and 191 men with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome in a multicenter study. They completed a battery of measures, including items asking whether pain worsened with bladder filling (painful filling) or whether the urge to urinate was due to pain, pressure or discomfort (painful urgency). Participants were categorized into 3 groups, including group 1-painful filling and painful urgency (both), 2-painful filling or painful urgency (either) and 3-no painful filling or painful urgency (neither).

RESULTS

Of the men 75% and of the women 88% were categorized as both or either. These bladder characteristics were associated with more severe urological symptoms (increased pain, frequency and urgency), a higher somatic symptom burden, depression and worse quality of life (3-group trend test each p<0.01). A gradient effect was observed across the groups (both>either>neither). Compared to those in the neither group men categorized as both or either reported more frequent urological chronic pelvic pain syndrome symptom flares, catastrophizing and irritable bowel syndrome, and women categorized as both or either were more likely to have a negative affect and chronic fatigue syndrome.

CONCLUSIONS

Men and women with bladder symptoms characterized as painful filling or painful urgency had more severe urological symptoms, more generalized symptoms and worse quality of life than participants who reported neither characteristic, suggesting that these symptom characteristics might represent important subsets of patients with urological chronic pelvic pain syndromes.

Intraepithelial lymphocytes in relation to NIH category IV prostatitis in autopsy prostate

BACKGROUND

Quantitative analysis of the number, normal and pathologic ratios between lymphocytes and epithelial cells (ECs), and the significance of intraepithelial lymphocytes (IELs) in normal prostatic epithelium, benign prostatic hyperplasia (BPH), and high grade prostatic intraepithelial neoplasia (PIN) in relation to NIH category IV prostatitis (histologic prostatitis: HP) was studied in autopsy prostate.

METHODS

IELs were analysed in 59 autopsy prostates, which was routinely embedded in paraffin and immunohistochemically stained for CD3. An average of 300-500 ECs were counted per case. The number of IELs was calculated as the mean/100 ECs. Category IV prostatitis was evaluated using NIH consensus grading system in terms of anatomical localization and grade.

RESULTS

In healthy individuals the mean number of IELs/100 ECs was 0.61 ± 0.34% or ≤1 lymphocyte/100 ECs, which is considered as the normal basal level of prostate IELs. In category IV prostatitis, the mean number of IELs/100 ECs was 8.53 ± 3.25% or 5-11 lymphocytes/100 ECs. The number of IELs in both around and inside inflammation areas correlated to the grade and location of HP (P < 0.0001 and P < 0.0003), the presence of acute glandular inflammation (P < 0.0001), the scattered stromal lymphocytes (P = 0.029), and BPH and PIN associated prostatic inflammation (P < 0.0001).

CONCLUSION

The study presents the first attempt to examine and score the basic quantitative values of prostatic IELs in normal prostate and in relation to category IV prostatitis. The detected normal upper limit of CD3+ IELs is 1 lymphocyte/100 ECs in the normal prostate epithelium. This is considered as an organ specific characteristic of the prostate-associated lymphoid tissue (PALT). Values >5 IELs/100 ECs indicate the presence of category IV prostatitis. The severity of inflammation correlates to the number of IELs. There is an intimate link between the quantity of the IELs, the degree of the severity and the localization of category IV prostatitis. HP is a chronic and dynamic inflammatory process affecting the whole prostate gland. The increased number of IELs suggests the immune or autoimmune character of category IV prostatitis, BPH and inflammatory preneoplastic (PIN) lesions in the prostatic tumor environment.

Careful assessment key in managing prostatitis

Prostatitis is a common condition estimated to affect up to 30% of men in their lifetime, it is most prevalent in men aged between 35 and 50. Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis. Acute bacterial prostatitis presents with acute onset pelvic pain which may or may not be related to voiding, lower urinary tract symptoms, sometimes haematuria or haematospermia and systemic symptoms such as fever and rigors. A documented history of recurrent urinary tract infections is the key feature of chronic bacterial prostatitis. Duration of symptoms > 3 months defines chronicity. The key symptom of chronic pelvic pain syndrome is pain. Patients may describe pain during or after ejaculation as their predominant symptom. Clinical assessment includes a thorough history and examination. A digital rectal examination should be performed after a midstream urine (MSU) sample has been collected for urine dipstick, microscopy and culture. The prostate should be checked for nodules. In acute bacterial prostatitis the MSU is the only laboratory investigation required. Chronic pelvic pain syndrome may be multifactorial and part of a more generalised pain disorder. Pelvic floor muscle abnormalities, altered neuroendocrine pathways, chemically induced inflammation, bacterial infection, autoimmune processes, dysfunctional voiding as well intraprostatic ductal reflux mechanisms have all been identified in men with chronic pelvic pain syndrome.

Antibiotics are not beneficial in the management of category III prostatitis: a meta analysis

PURPOSE

To determine whether antibiotics are beneficial in the management of category III prostatitis.

MATERIALS AND METHODS

The PubMed, Medline and Embase databases were searched for all published documents from January 1, 1965 to September 1, 2012 without language restriction. The randomized controlled trials that mentioned comparable groups of antibiotics treatment versus placebo or other control group for patients with category III prostatitis were included based on specific criteria. The quality of studies was assessed by the modified Jadad scale, and Revman 5.0 software was used for data syntheses and analysis.

RESULTS

Seven studies which met the selection criteria were included in this review. All of them were high quality according to the modified Jadad scale. A random effect model was applied because of the high heterogeneity. The meta-analysis showed that summary association between category III prostatitis and antibiotics were not statistically significant.

CONCLUSION

Our meta-analysis reveals that antibiotics are not beneficial in the management of category III prostatitis. Therefore, we may reduce the usage of antibiotics in such a population.

[Common TCM syndrome pattern of chronic pelvic pain syndrome relates to plasma substance p and beta endorphin]

OBJECTIVE

To investigate the relationship of the common Traditional Chinese Medicine (TCM) syndrome pattern of chronic pelvic pain syndrome (CPPS) with the contents of substance p and beta endorphin in the plasma, and provide reference data for the clinical diagnosis, differentiation and treatment of CPPS by TCM.

METHODS

We observed 98 cases of CPPS, which were classified into a lower-part damp-heat invasion group (group A, n = 32), a blood stasis-induced collateral obstruction group (group B, n = 34), and a damp-heat stagnation group (group C, n = 32) according to the TCM syndrome differentiation. Another 35 normal healthy young men were enrolled as controls. We measured the contents of substance p and beta endorphin in the plasma by immunoradiometry and ELISA, and analyzed their relationship with the TCM syndrome pattern.

RESULTS

The contents of plasma substance p were significantly higher in groups A ([1135.76 +/- 166.45] pg/ml), B ([1 337.84 +/- 170.81] pg/ml), and C ([1 210.01 +/- 162.27] pg/ml) than in the control ([574.99 +/- 113.09] pg/ml) (all P < 0.01), while the contents of plasma beta endorphin in groups A ([212.70 +/- 29.49] pg/ml), B ([157.99 +/- 24.01] pg/ml), and C ([180.81 +/- 20.20] pg/ml) were remarkably lower than that in the control ([274.73 +/- 27.64] pg/ml) (all P < 0.01).

CONCLUSION

In the plasma of CPPS patients, the content of substance p is significantly elevated and that of beta endorphin markedly reduced, which suggests that they may be involved in the inflammatory reaction of CPPS. The levels of plasma substance p and beta endorphin can be used as valuable reference for the TCM classification of chronic prostatitis.

Prostatitis and chronic prostatitis/chronic pelvic pain syndrome

The prevalence of prostatitis is extremely high, with up to 16% of men diagnosed with prostatitis at some point throughout their lifetime. However, the etiology appears to be multifactorial and standard treatment regimens have been altered significantly in recent years. The purpose of this review is to examine the changing scientific views on the causes and treatment of prostatitis, chronic prostaitis and chronic pelvic pain syndrome. We review the infectious and noninfectious etiology of the disease, examining the role of antimicrobial treatment in eradicating infection as well as ameliorating symptoms. Current NIH classifications, which stratify prostatitis into four categories, are discussed, as is the NIH Chronic Prostatitis Symptom Index, the primary tool used to assess symptomatology. Diagnostic examinations are studying the need for the four-glass test and its practical replacement by the two-glass test. Multimodal treatment therapy is then discussed, including recent data on biofeedback and evaluation of the role of pelvic floor dysfunction in prostatitis.

[Expressions of differential proteins in the expressed prostatic secretion of patients with III A chronic prostatitis]

OBJECTIVE

To study the expressions of differential proteins in the expressed prostatic secretion (EPS) of patients with III A chronic prostatitis and healthy men.

METHODS

We collected EPS samples from 35 patients with III A chronic prostatitis and 18 age-matched healthy men, and detected the differentially expressed proteins in EPS by MALDI-TOF/MS. Based on the data obtained, we conducted a statistical analysis on the mass-to-charge (m/z) ratios of different proteins and a retrieval analysis on the relevant proteins using the protein database.

RESULTS

In the comparative studies of the III A chronic prostatitis patients and healthy men, 5 proteins were detected as at least 2-fold differentially expressed, which were probably brevinin-2Eg, big endothelin-1, alpha-defensin 15, beta-defensin 134 and prostatic steroid-binding protein C2. The m/z ratios were significantly up-regulated in 3 372, 3 487, 425 and 5 325 Da proteins (P < 0.01) and down-regulated in 10631Da (P < 0.01).

CONCLUSION

Proteins are differentially expressed in the EPS of III A chronic prostatitis patients and healthy men, and these proteins may be significantly correlated with the development and progression of III A chronic prostatitis.

[Bladder gasification and stasis dispersion combined with antibiotic therapy for IIIA chronic prostatitis]

OBJECTIVE

To evaluate the clinical efficacy of bladder gasification and stasis dispersion combined with antibiotic therapy in the treatment of III A chronic prostatitis.

METHODS

We conducted a randomized controlled clinical study on 120 III A prostatitis patients that all met the diagnostic criteria. We divided the patients into groups A, B and C of equal number to receive oral medication of sparfloxacin, sparfloxacin + tamsulosin, and sparfloxacin + herbal decoction, respectively, all for a course of 4 weeks. We evaluated the primary therapeutic indexes according to the total scores of the patients on traditional Chinese medicine (TCM) syndrome and NIH-CPSI and the secondary therapeutic indexes based on the count of white blood cells (WBC) in the expressed prostatic secretion (EPS).

RESULTS

After treatment, the total scores on TCM syndrome and NIH-CPSI were significantly reduced in groups B (42.15 +/- 10.29 and 13.25 +/- 6.04) and C (41.26 +/- 11.25 and 12.38 +/- 7.19) than in A (49.43 +/- 11.09 and 17.62 +/- 5.84) ( P < 0.05), and so was the WBC count in EPS in group C (7.76 +/- 15.73) than in groups A (11.45 +/- 10.33) and B (12.28 +/- 13.81) (P < 0.05). The difference between pre- and post-treatment scores on TCM syndrome was more significant in group C (12.65 +/- 11.76) than in B (8.55 +/- 10.15) (P < 0.05).

CONCLUSION

Bladder gasification and stasis dispersion combined with antibiotic therapy is effective for the treatment of III A chronic prostatitis, and therefore deserves wide clinical application.

[UPOINT system: a new diagnostic/therapeutic algorithm for chronic prostatitis/chronic pelvic pain syndrome]

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition in urological outpatients, and is often improperly treated for its multifactorial etiology and non-specific clinical phenotype. Doctor Shoskes proposed a clinical phenotype system for CP/CPPS--the UPOINT system, which is a new diagnostic/therapeutic algorithm addressing 6 CP/CPPS phenotypic domains, including the urinary, psychosocial, organ specific, infection, neurological/systemic and muscle tenderness domains. Under the guidance of UPOINT, doctors can give a multimodal therapy for patients with CP/CPPS according to its clinical phenotype, and several clinical studies have demonstrated obvious clinical benefit from the UPOINT-based therapy.

Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition; however, many of the traditional therapies used in clinical practice fail to show efficacy when subjected to large randomized placebo-controlled trials. This may be because CP/CPPS is a heterogeneous syndrome rather than a specific disease which would explain the failure of "one size fits all" therapy. In order to direct appropriate therapy, we have developed a six-point clinical phenotyping system to evaluate patients with chronic urologic pelvic pain. The clinical domains are urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles, which produces the acronym UPOINT. Each domain is diagnosed clinically and is associated with specific therapies. This approach is simple and has proven effective in our hands for patients even after many years of failed therapies.

[UPOINT: a novel phenotypic classification system for chronic prostatitis/chronic pelvic pain syndrome]

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition obsessing urologists and patients. It is also known as a heterogeneous syndrome, with varied etiologies, progression courses and responses to treatment. Based on the deeper insights into its pathogenesis and re-evaluation of its clinical trials, a novel phenotypic classification system UPOINT has been developed, which clinically classifies CP/CPPS patients into six domains: urinary (U), psychosocial (P), organ-specific (O), infection (I) , neurologic/systemic (N) and tenderness of pelvic floor skeletal muscles (T), and directs individualized and multimodal therapeutic approaches to CP/CPPS. This review systematically summarizes the theoretical foundation, clinical characteristics of UPOINT and treatment strategies based on the UPOINT phenotypic classification system.

[Physical factors for the treatment of patients with chronic bacterial prostatitis]

This lecture is based on the review of the literature data concerning the application of physical factors (including sinusoidal modulated currents, laser radiation, ultrasound, medicamental ultrafonophoresis, ozonotherapy, etc) for the rehabilitative treatment of patients presenting with chronic bacterial prostatitis.

Prostatitis syndrome, an overview

Prostatitis is one on the common health problem affecting males in all age group. It is classified by the National Institute of Health (NIH) into four major types according to the underlying cause, clinical presentation and treatment. Abacterial chronic prostatitis represents the commonest type and it is the least understood in terms of aetiology and pathogenesis. The treatment is prolonged and it is unsatisfactory in the majority of cases resulting in deterioration of the general health and quality of life. This article provides a general review on prostatitis with special emphasis on abacterial chronic prostatitis.

Inflammation and benign prostatic hyperplasia

Prostatitis, a histologic diagnosis, has evolved over the years to describe a clinical syndrome that was believed to be associated with prostatic inflammation. Similarly, benign prostatic hyperplasia (BPH), another histologic diagnosis, has evolved to describe a clinical syndrome believed to be associated with prostatic enlargement. Recent explorations of the interrelationships between these prostate-associated histologic and clinical conditions have generated much interest and excitement. This article describes these relationships and their impact on the management of, in particular, BPH.

Citrate in expressed prostatic secretions has the feasibility to be used as a useful indicator for the diagnosis of category IIIB prostatitis

INTRODUCTION

Normal human prostatic secretion is remarkably rich in citrate (EPS-citrate). Prostate inflammation will result in reduction of EPS-citrate level. So EPS-citrate was determined to investigate whether EPS-citrate level was also decreased in category IIIB prostatitis and whether it is feasible for EPS-citrate to be used as a diagnostic marker for category IIIB prostatitis.

MATERIALS AND METHODS

21 category II outpatients, 25 category IIIA outpatients, 25 category IIIB outpatients and 21 normal controls without any prostatic diseases were included. All category II, IIIA and IIIB outpatients had not received any management. The EPS-citrate was determined by high-performance liquid chromatography.

RESULTS

The mean EPS-citrate values were 3.32 +/- 0.79, 3.41 +/- 0.88, 4.37 +/- 0.77 and 8.55 +/- 1.20 mg/ml in groups II, IIIA, IIIB and normal controls, respectively. Compared to normal controls, the EPS-citrate levels were significantly decreased in category II, IIIA and IIIB patients. Furthermore, there was no overlap of EPS-citrate values between category IIIA and IIIB patients and the normal control group.

CONCLUSIONS

The EPS-citrate level is decreased in category IIIB prostatitis and it is feasible for EPS-citrate to be used as a useful diagnostic indicator for category IIIB prostatitis.

[Clinical significance of C-reactive protein concentration in the expressed prostatic secretion from chronic prostatitis patients]

OBJECTIVES

To discuss the correlation of C-reactive protein (CRP) concentration in the EPS of chronic prostatitis (CP) patients with CP types, WBC count in EPS, lecithin corpuscles (LLZXT) and chronic prostatitis symptom index (CPSI).

METHODS

According to the NIH classification standard, 196 cases of CP were diagnosed by the pro and post massage test (PPMT) and EPS routine, of which 68 were chronic bacterial prostatitis (Type II ), 76 inflammatory chronic non-bacterial prostatitis/chronic pelvic pain syndrome (Type III A) and 52 non-inflammatory chronic non-bacterial prostatitis/chronic pain syndrome (Type III B). Another 50 healthy volunteers were enrolled as normal controls. The CRP concentration in the EPS of all the patients was determined by immunoturbidimetry and 196 groups of data were obtained.

RESULTS

The average concentration of CRP was significantly higher in the CP group ( [2.945 +/- 1.996] mg/L) than in the control ( [1.101 +/- 0.440] mg/L) (P < 0. 01) , and it decreased progressively from the Type II to Type III A and Type III B group, with statistical difference between Type III B and Type II or Type III A (P < 0. 01 ), but not between Type II and Type III A (P = 0.058). The CRP concentration was correlated negatively with LLZXT (r = -0.33, P < 0.01) and positively with WBC count (r = 0.63, P < 0.01) and the score on the first 6 items of CPSI (r = 0. 28, P < 0. 01).

CONCLUSION

The CRP concentration in EPS, with its significant role in the pathogenesis of CP, may serve as a basis for the diagnosis and classification of CP as well as an objective index for assessing the therapeutic effect on the disease.

Prostatitis: Infection, neuromuscular disorder, or pain syndrome? Proper patient classification is key

Prostatitis is a broad term used to describe inflammation of the prostate that may be associated with a myriad of lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. The condition affects 5% to 10% of the male population and is the most common urologic diagnosis in men younger than 50 years. Prostatitis is classified into four categories, including acute and chronic bacterial forms, a chronic abacterial form, and an asymptomatic form. The bacterial forms are more readily recognized and treated, but symptoms in most affected men are not found to have an infectious cause. Indeed, chronic abacterial prostatitis (also known as chronic pelvic pain syndrome) is both the most prevalent form and also the least understood and the most challenging to evaluate and treat. This form of prostatitis may respond to non-prostate-centered treatment strategies such as physical therapy, myofascial trigger point release, and relaxation techniques. Because the various forms of prostatitis call for vastly different treatment approaches, appropriate evaluation, testing, and differential diagnosis are crucial to effective management.

[Chronic prostatitis: critical review of its current nosologic definition, classification and potential carcinogenesis]

Updated critical review of chronic prostatitis as a nosologic, anatomic-clinical entity of supposed microbiological or inflammatory origin. Scientific reasoning about the role of amicrobial inflammation in both caudal and cranial prostate, after new progresses, to reconsider the convenience of maintaining the current classification of chronic prostatitis, mainly in the section referred to "histological prostatitis". Analysis of scientific evidences relating prostatitis and "pelvic pain", the dominant syndrome in many patients and basement of the current terminological proposal: prostatitis-pelvic pain. The role of inflammation in the genesis of BPH and prostate cancer. Justification and convenience of a new term in logic consensus on prostatitis.

The Prostate has Secretory Dysfunction for Category IIIA and IIIB Prostatitis

PURPOSE

We investigated whether the prostate has secretory dysfunction for category IIIA and IIIB prostatitis.

MATERIALS AND METHODS

Normal human prostatic secretions are remarkably rich in citrate, which is considered the most useful marker for determining prostate secretory function. It is certain that the prostate has secretory dysfunction for category I and II prostatitis, while it is not clear for category IIIA and IIIB prostatitis. To clarify this question expressed prostatic secretion citrate and pH were determined in 21, 25 and 25 outpatients with category II, IIIA and IIIB prostatitis, respectively, and in 21 normal controls without any prostatic disease. Outpatients with category II disease served as positive controls, while normal controls served as negative controls. No outpatients with category IIIA and IIIB prostatitis underwent treatment.

RESULTS

Mean +/- SD expressed prostatic secretion citrate was 3.32 +/- 0.79, 3.41 +/- 0.88, 4.37 +/- 0.77 and 8.55 +/- 1.20 mg/ml in groups II, IIIA, IIIB and normal controls, respectively. Compared to normal controls expressed prostatic secretion citrate was significantly decreased in category II, IIIA and IIIB cases. Furthermore, there was no overlap of expressed prostatic secretion citrate values between category IIIA and IIIB cases, and the normal control group.

CONCLUSIONS

The prostate has secretory dysfunction for category IIIA and IIIB prostatitis, which suggests that the prostate may be involved in category IIIA and IIIB prostatitis.

[Prostatitis--pelvic pain syndrome]

Prostatitis is classified according to the National Institute of Health Prostatitis Classification. The term Chronic Pelvic Pain Syndrome (CPPS) covers the symptomathology and clinical findings. The main symptoms are pain and voiding disorders. Acute bacterial prostatitis is only seen in 5% of cases. The vast majority of symptoms are found in CPPS, and urodynamic investigation is crucial in order to identify bladder neck dysfunction which occurs in a considerable number of patients.

[Clinical observation on treatment of chronic prostatitis syndrome type III B by Tiaoshen Tonglin Decoction]

OBJECTIVE

To observe the clinical effect of Tiaoshen Tonglin Decoction (TTD)) on chronic prostatitis syndrome (CPS) and its effects on urinary flow rate (UFR), uric acid (UA) content and pH value in expressed prostate secretions (EPS).

METHODS

One hundred and eight patients with CPS were randomly assigned to two groups, the treatment group (56 cases) treated with TTI) and the control group (52 cases) with terazosin tablet, both for 60 days. The changes of chronic prostatitis symptom index (NIH-CPSL), established by the National Institutes of Health, U.S.A., UA and pH in EPS, as well as UFR were observed before and after treatment.

RESULTS

The cure rate and the total effective rate in the treatment group were higher than those in the control group respectively (P < 0.05); after treatment, the UA level, pH value in EPS and NIH-CPSI decreased significantly in the treatment group (P < 0.01), lower than those in the control group, which had significant change (P < 0.05); the maximum UFR and average UFR of both groups were improved markedly after treatment (P < 0.05) with insignificant difference between the groups.

CONCLUSION

TTD can improve the UFR, decrease the NIH-CPSI score, pH value and UA level in the EPS, is an effective recipe for treatment of CPS.

Role of α-Blockers in Type III Prostatitis: A Systematic Review of the Literature

PURPOSE

We examined the evidence for the effectiveness of alpha-blockers for type III prostatitis.

MATERIALS AND METHODS

Studies were identified through a search of MEDLINE, EMBASE and The Cochrane Library as well as a manual search of bibliographies of identified articles and abstract books of recent major international urology conferences. Inclusion criteria included randomized, placebo controlled trials of treatment for type III prostatitis and use of the National Institutes of Health-Chronic Prostatitis Symptom Index outcome measure.

RESULTS

Six unique trials in a total of 386 patients met inclusion criteria. One study showed no difference between alpha-blockers and placebo in terms of total or domain National Institutes of Health-Chronic Prostatitis Symptom Index scores and another did not report the p value. All of the remaining 4 studies showed a statistically significant difference in the total score in favor of alpha-blockers, while only 2 showed improved quality of life. Individual treatment effects were statistically significant more often when treatment was administered for 3 months or longer. Despite a common tool for outcome assessment meta-analysis of the results in individual trials was not possible due to differences in the manner of interpreting outcomes and reporting data.

CONCLUSIONS

The current published literature is insufficient to conclude with certainty that alpha-blockers are effective for type III prostatitis. Future studies should incorporate uniformity in data collection and reporting with improved health related quality of life as the end point of therapy.

Inflammatory disorders of the prostate and the distal genital tract

Inflammatory disease of the prostate and distal genital tract is emerging as a major health problem because it is estimated that up to 15% of adult men may be affected at some point in their lives. Clinically, the diagnosis of "prostatitis" refers to multiple disorders that cause pelvic pain and discomfort, ranging from acute bacterial infection to complex conditions that may not necessarily be caused by prostatic inflammation. Because the traditional etiology-based classification system did not always correlate with symptoms and therapeutic efficacy, a new classification of prostatitis has been suggested by the National Institutes of Health. New imaging techniques such as high-resolution transrectal ultrasonography (TRUS) and MR imaging provide exquisite anatomic detail and often play a crucial role in the evaluation of these patients.

[Acute and chronic prostatitis, how will we manage it ten years from now?]

Pelvic pain syndrom arises in an increasing number of men during their life. The present classification of prostatitis in four categories facilitates a comprehensive review of its diagnosis and treatment. The development of techniques related to molecular biology will favour a deeper knowledge in the future.

Validity and Reliability of the Arabic Version of the National Institutes of Health Chronic Prostatitis Symptom Index

INTRODUCTION

In order to accurately assess the extent of chronic pelvic pain syndrome (CPPS) and to objectively measure symptoms for natural history studies and to assess the outcome parameters for clinical trials, the National Institutes of Health (NIH) Chronic Prostatitis Collaborative Research Network developed and validated the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). The aim of the current study was to develop and validate a fluent and comprehensive Arabic version of the NIH-CPSI.

METHODS

This study consisted of 80 consecutive male patients affected by CPPS and 80 healthy controls who were asked to complete the Arabic version of the NIH-CPSI. The translation was performed by a group consisting of an andrologist and professional translators. Psychometric data were collected.

RESULTS

Of the 160 subjects enrolled, 82 (50 patients and 32 controls) completed the study. The total Arabic NIH-CPSI scores and the scores of each subscale differed significantly between the two groups with good discriminant validity. The questionnaire had also a high internal consistency.

CONCLUSION

The present study provides the Arabic version of the NIH-CPSI and recognizes it as a valid and reliable tool in the assessment of local patients with CPPS.

[Classification, etiology, diagnosis and treatment of prostatitis. Other types of prostatitis. Acute and chronic prostatitis]

Prostatitis is a highly prevalent nosologic entity and hence has an enormous financial impact on health systems as well as negative repercussions on patients' quality of life. The symptoms are ambiguous, diagnostic methods are controversial and treatments are long and produce inconsistent results; consequently, although not life-threatening, prostatitis has become one of those diseases that is difficult both for the patient and for the physician who attempts to help, sometimes without success. Although an infectious etiology is accepted in most cases, there are major controversies about both the diagnostic methods used and their interpretation. Recently the National Institutes of Health in the USA has proposed a new classification of this disease to substitute that used for the last twenty years. This new classification may provide a more effective approach to the diagnosis and treatment of this insidious disease.

Clinical Approach to the Prostate: An Update

Prostatic disease continues to present clinicians with challenges. Although giant strides have been made in the medical and surgical management of benign prostatic hyperplasia, many fundamental questions about its pathogenesis, progression, and treatment efficacy remain unanswered. Prostate cancer also continues to be an area in which progress is needed despite major recent advancements. Numerous debates that include the value of prostate-specific antigen screening and appropriate roles for each of the numerous therapeutic modalities await resolution. For millions of patients who suffer from prostatitis, a major breakthrough is yet to come. Current treatment regimens for prostatitis remain ineffective at best. Contemporary approaches to the pathogenesis, diagnosis, and treatment of benign prostatic hyperplasia, prostate cancer, and prostatitis are discussed in this review.

Chronic prostatitis: Charlottesville to Seattle

PURPOSE

Since few men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have culturable bacteria by traditional approaches, we used sensitive molecular methods to determine presence of fastidious microorganisms.

MATERIALS AND METHODS

We evaluated 135 men with CP/CPPS by standardized clinical evaluation, and by lower tract localization cultures and chamber counts of expressed prostatic secretions of leukocytes. We excluded from study patients with bacteriuria, bacterial prostatitis, urethritis or positive urethral cultures. Prostate biopsy was obtained using a double-needle technique to limit contamination. We chose molecular approaches because previous studies had used culture antigen detection in urine, urethral swabs and expressed prostatic secretions. However, interpretation of such studies is complicated because urogenital samples often acquire bacteria while passing through the urethra. We used specific and broad-spectrum polymerase chain reaction (PCR) assays.

RESULTS

Only 10 (8%) of the 135 subjects had positive specific PCR assays, including Mycoplasmia genitalium, Chlamydia trachomatis and Trichomonas vaginalis. Our findings suggested that C. trachomatis, T. vaginalis and M. genitalium may be identified in some patients with CP/CPPS, even among men with no evidence of urethritis and with negative urethral cultures and other assays. The broad-spectrum PCR assays provided the most provocative findings. DNA encoding tetracycline resistance was identified in 25% of subjects, and 77% of subjects had evidence of 16S rDNAs. The white blood cell concentration in the prostatic secretions correlated with identification of 16S rDNAs in prostate tissue (p <0.01).

CONCLUSIONS

Delineating the precise role of these organisms in the etiology of CP/CPPS may help define better diagnostic and treatment algorithms.

A proposal of subcategorization of bacterial prostatitis: NIH category I and II diseases can be further subcategorized on analysis by therapeutic and immunological procedures

AIM

We propose preliminarily that acute (category I of the NIH consensus definition) and chronic prostatitis (category II) can be subcategorized into primary and recurrent diseases based on the precise analysis of the clinical course and the immunological parameters in prostatic secretions of our cases.

METHODS

Five patients with stone-free, acute febrile prostatitis and nine patients with acute episodes of afebrile urinary infection were included. The expressed prostatic secretions (EPS) were collected soon after the acute illnesses subsided after medication administration and they were examined microscopically, bacteriologically, and serologically. First-line medications were cefem antibiotics with conventional doses for febrile cases and low doses for afebrile cases. They were administered for at least 2 weeks. Second-line conventional medication with sulfamethoxazole-trimethoprim or levofloxacin was given only to the patients in whom remaining prostatic infections were revealed.

RESULTS

The first-line medications were successful in all patients and they promptly became asymptomatic in 1 week. All the EPS were infected except for two afebrile cases. Prostatic infections were eradicated by second-line conventional medications. In a patient with afebrile prostatitis whose EPS were free of macrophages and immunoglobulin (Ig)M, the eradication of prostatic pathogens was achieved without second-line antibacterial medication.

CONCLUSIONS

Bacterial prostatitis could be classified into primary and recurrent chronic infections in each of the febrile (category I) and afebrile (category II) illnesses. A cefem regimen in varying doses was a clue for differential diagnosis as it did not affect the pathogens in the prostatic ducts or acini unless heavy urine reflux occurred in the ductal draining systems. Macrophages and immunoglobulins, especially IgM, in the EPS were useful immunological parameters to differentiate primary and recurrent infections of the prostate. Fluoroquinolones or sulfamethoxazole-trimethoprim should not be employed in acute urinary infections in male patients until the confirmation of prostatic infection to avoid injudicious use of them, which might cause an increasing prevalence of resistant uropathogens in the community. The evacuation of the prostate by repetitive massage seemed to be effective to enhance the prompt eradication of pathogens from the prostatic tissue and to keep patients asymptomatic throughout the course of the disease by preventing tissue pressure elevation.

[Prostatitis syndrome: consensus of the 6th International Consultation in Paris, 2005]

The classification of prostatitis into four categories is based on the well accepted NIH definition. Based on this classification, the consensus conference has made suggestions on the diagnostic management and therapy for all types of prostatitis.

Prostatitis/chronic pelvic pain syndrome

We review the diagnosis, categorization, and treatment of prostatitis/chronic pelvic pain syndrome based on the National Institutes of Health (NIH) classification. Prostatitis is an extremely common syndrome that afflicts 2%-10% of men. Formerly a purely clinical diagnosis, prostatitis is now classified within a complex series of syndromes (NIH category I-IV prostatitis) that vary widely in clinical presentation and response to treatment. Acute bacterial prostatitis (category I) and chronic bacterial prostatitis (category II) are characterized by uropathogenic infections of the prostate gland that respond well to antimicrobial treatment. In contrast, chronic prostatitis/chronic pelvic pain syndrome (category III), which accounts for 90%-95% of prostatitis cases, is of unknown etiology and is marked by a mixture of pain, urinary, and ejaculatory symptoms with no uniformly effective therapy. Asymptomatic inflammatory prostatitis (category IV) is an incidental finding of unknown clinical significance. This review describes the current status of prostatitis syndromes and explores the future prospects of new diagnostic tools and therapies.

[Detection and significance of 16S rDNA in the prostatic secretions of patients with chronic prostatitis]

OBJECTIVE

To evaluate the expression and significance of 16S rDNA in prostatic secretions (EPS) of chronic prostatitis.

METHODS

16S rDNA was detected in EPS of 116 patients with chronic prostatitis by PCR.

RESULTS

16S rDNA were positively expressed in all 29 cases of II type chronic bacterial prostatitis and 71 out of 87 cases of III type chronic prostatitis (82%). The positive rates were 94% (45/48) and 67% (26/39) in lIIA and IIIB chronic prostatitis respectively. There was a statistical difference in 16S rDNA positive rate between IIIA and IlB chronic prostatitis (P < 0.01).

CONCLUSION

Detection of 16s rDNA may be a useful index for the diagnosis and classification of chronic prostatitis.

[Prostatitis--a frequently unrecognized disease]

The term "prostatitis" includes several entities ranging from the acute bacterial inflammation of the prostate gland to the chronic pelvic pain syndrome. Since both acute and chronic bacterial prostatitis are clearly defined by the documented detection of microbial agents, a standardised antimicrobial treatment eventually leads to a predictable rate of cure. However, the most common type is the chronic abacterial prostatitis, called "chronic pelvic pain syndrome" (CPPS) which is subdivided into an inflammatory and a noninflammatory form. CPPS affects men of all ages and is the most common urological diagnosis in men younger than 50 years. Chronic prostatitis/CPPS shares features with other chronic pain syndromes, including a poorly understood etiology, low correspondance of symptoms and objective findings, application of various treatments and frequent failure to be alleviated by medical treatment. Due to the intricacy of the syndrome a thorough clinical evaluation is required to define the causes, consequences and optimal management of this important health problem.

[Basic diagnostic algorithm in chronic pelvic pain syndrome]

A basic diagnostic algorithm is proposed to improve efficiency of diagnosis of chronic inflammatory prostatitis. It is the sequence of the most necessary methods of examination which helps to clear a category of disease according to classification NIH (1995). A total of 57 patients with symptoms of prostatitis and quantity of leukocytes in the prostatic secretions < 15 per high power field. Use of this diagnostic algorithm allowed diagnosis of category IIIA in 36.8% patients free of inflammatory changes in the first expressed prostatic secretions and category IIIB in 8.8% patients with leukocytic count > 10, but < 15 per high power field. Thus, use of basic diagnostic algorithm in diagnosis of chronic prostatitis changed a category of chronic prostatitis in 45.6% cases among patients examined conventionally.

INCIDENCE AND CLINICAL CHARACTERISTICS OF NATIONAL INSTITUTES OF HEALTH TYPE III PROSTATITIS IN THE COMMUNITY

PURPOSE

Few population-based epidemiological studies of prostatitis have been performed. We used coded physician diagnoses and subsequent chart reviews to estimate the incidence and clinical characteristics of physician diagnosed National Institutes of Health (NIH) type III prostatitis.

MATERIALS AND METHODS

Computer searches of the Kaiser Permanente Northwest (Portland, Oregon) database were performed on the 2-year interval May 2002 to May 2004 to identify new diagnoses of chronic prostatitis (International Classification of Diseases, 9th Revision code 601.1) and prostatitis not otherwise specified (International Classification of Diseases, 9th Revision code 601.9). Of the 1,223 men identified with these coded diagnoses, chart reviews were performed on a random subset of 413 (33.8%). Patients were categorized based on NIH prostatitis definitions of type I/II-evidence of pyuria and/or bacteriuria on urinalysis or culture, type III-presence of at least 1 of the pain or urinary symptoms in the NIH Chronic Prostatitis Symptom Index (pain in the perineum, testicles, tip of penis, pubic or bladder area, dysuria, ejaculatory pain, incomplete emptying, urinary frequency), type IV-inflammation on prostate biopsy and Other-symptoms other than those listed.

RESULTS

Of the 413 patients 57 were previously diagnosed with prostatitis (prevalent cases), 46 had no evidence of a prostatitis diagnosis in the medical record and 7 were treated by physicians outside of the Kaiser Permanente Northwest plan. Of the remaining 303 the distribution was 58 type I/II, 189 type III, 33 type IV and 23 Other. The incidence of physician diagnosed type III prostatitis was 3.3 per 1,000 person-years. If those with isolated urinary symptoms were excluded from analysis, the incidence decreased to 2.8 per 1,000 person-years. The mean age of those with type III prostatitis was 52.9 years (range 29 to 82). The most common presenting symptoms were dysuria, urinary frequency and perineal pain. Symptom duration at presentation was less than 3 months in 44%, 3 months or greater in 31% and unspecified in 25%. The majority (78%) of new prostatitis diagnoses was made by primary care physicians.

CONCLUSIONS

These data indicate that prostatitis is commonly diagnosed in the community setting, and that type III prostatitis accounts for the majority of these diagnoses. The duration and complexity of symptoms are less than those reported in established prostatitis research cohorts. Most prostatitis diagnoses in the community are made by nonurologists.

Role of bacteria in chronic prostatitis/chronic pelvic pain syndrome

Throughout the past century, we have refined our understanding of prostatitis, moving from using a primarily clinical definition to considering it as a complex inflammatory condition. The inconsistency in identifying uropathogens in patients with symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has led to controversy in therapeutic management. There is compelling evidence that the normal prostate has minimal inflammation and no bacteria. Clinicians using the Meares/Stamey criteria identified uropathogens localized to the prostate in only 6% to 8% of CP/CPPS patients. This suggests that bacteria may have a role in less than 10% of men with CP/CPPS. That some patients respond to antimicrobials could suggest that eradication of bacteria reduces symptoms. However, the beneficial effect of antimicrobial drugs may not be due to their antibacterial action, but to their anti-inflammatory action. The normal prostate shows minimal inflammation, but only 50% of CP/CPPS patients exhibit prostatic leukocytosis. Prudence demands that we examine the function of the white blood cells--the cytokines produced. Several basic science advances allowed new avenues of research regarding the detection of molecular evidence of causative uropathogens. New research brings new controversy and unexpected findings, but further refines our understanding of the immune system and the CP/CPPS disease process.

Prostatitis and serum prostate-specific antigen

Prostatitis is an inflammatory condition of the prostate and has been divided into four categories according to the National Institutes of Health classification. This article reviews the various types of prostatitis and their effect on serum prostate-specific antigen levels. Various proposed mechanisms of this elevation include leakage of prostate-specific antigen (PSA) into the blood stream, hypervascularity, and altered vascular permeability secondary to inflammation. Acute prostatitis can lead to an increase in PSA, which usually returns to normal levels with appropriate antibiotics within 1 to 3 months. Patients with chronic prostatitis have a less well-defined decrease in PSA after an antibiotic course. Whether a course of antibiotics prior to biopsy increases the yield has not been well established. Asymptomatic inflammation of the prostate has been recognized to be an important confounding factor in patients with an elevated PSA. Inflammation has been proposed to be a precursor of prostate adenocarcinoma.

[Chronic prostatitis. Chronic pelvic pain syndrome]

The symptom complex called prostatitis represents a multifactorial problem of unclear etiology. Standardized diagnostic and therapeutic approaches do not exist. Controlled studies which fulfil evidence-based medical criteria are missing. A review of the currently available literature leads to the conclusion that a multimodal therapy concept should be developed and examined.