Elsevier

Urology

Volume 60, Issue 6, December 2002, Pages 959-963
Urology

Adult urology
Symptoms and inflammation in chronic prostatitis/chronic pelvic pain syndrome

https://doi.org/10.1016/S0090-4295(02)01963-5Get rights and content

Abstract

Objectives

To evaluate the possibility that patients with inflammatory and noninflammatory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) might present with different symptoms. Patients with CP/CPPS present with characteristic symptoms without bacteriuria. The new National Institutes of Health consensus suggests that CP/CPPS can be divided into inflammatory and noninflammatory categories.

Methods

Standardized symptom surveys were completed by 130 subjects who met the criteria for CP/CPPS after clinical examination and urethral, urine, expressed prostatic secretion (EPS), and seminal fluid analysis evaluations.

Results

When classified by either EPS or postprostatic massage urine (VB3) findings, subjects with and without inflammation had similar symptoms. However, when classified using the combination of EPS, VB3, and seminal fluid analysis, subjects with inflammatory CP/CPPS had more severe (P <0.02) and more frequent symptoms, in particular, difficulty reaching erection (P <0.01), weak urinary stream (P <0.01), urinary frequency (P = 0.03), and penile pain (P = 0.04).

Conclusions

The increased severity and frequency of symptoms among patients with inflammatory CP/CPPS provide empirical support for the new consensus classification on the basis of the combination of EPS, VB3, and seminal fluid analysis findings.

Section snippets

Population and clinical evaluation

The subjects were older than 18 years with symptoms for 3 months or longer. None had taken antimicrobial agents for 6 weeks or more and none had bacteriuria. After a standardized history and physical examination, urethral swabs were obtained for gram staining and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis,6 and Trichomonas vaginalis.7 Patients had microscopy and cultures of first-voided urine, mid-stream urine, EPS, and VB3 specimens to

Subjects

Of 348 patients evaluated, 130 (37%) met the study criteria. The reasons for exclusion included failure to provide semen or to provide this specimen within the specified interval (176 patients, 51%), failure to complete all symptom items (86 patients, 25%), and WBCs on the urethral smear or first-voided urine sample (65 patients, 19%). Some patients were excluded for more than one reason.

Of the 130 subjects, 48 (37%) had EPS WBCs, 22 (17%) had VB3 WBCs, and 46 (35%) had SFA WBCs. Of the 130

Comment

Patients with inflammatory CP/CPPS presented with more severe and more frequent symptoms than did those with noninflammatory CP/CPPS. Subjects with WBCs had higher or similar (but never lower) levels of symptoms as assessed by the total UWSS and the scores for each of the 21 items. The inflammatory group also had comparable or higher scores on each NIH-CPSI item.

These findings were surprising. Our 1991 report describing 75 patients with chronic prostatitis6 used the definition of nonbacterial

Conclusions

Patients with inflammatory CP/CPPS have more frequent and more severe symptoms than do patients without inflammation. To assess inflammation accurately, it is necessary to evaluate the SFA in addition to the EPS and VB3. The critical clinical question is whether patients with CPPS and inflammation should receive different treatment than patients without inflammation.

References (25)

Cited by (24)

  • A prospective study on association of prostatic calcifications with sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

    2014, Journal of Sexual Medicine
    Citation Excerpt :

    Recently, Shoskes et al. [18] claimed that prostatic calcifications are commonly present in patients with CP/CPPS and significantly correlate with greater intraprostatic inflammation or bacterial colonization, and longer symptoms duration. Several studies have suggested that ED and CP/CPPS may be linked by a shared inflammatory process originating from a prostatic source [19-21]. However, no studies have reported the contribution of prostatic calcifications to sexual dysfunction in this condition.

  • Demographic and Clinical Characteristics of Chronic Prostatitis: Prospective Comparison of the University of Sciences Malaysia Cohort With the United States National Institutes of Health Cohort

    2007, Journal of Urology
    Citation Excerpt :

    Epidemiological studies suggest that symptoms of chronic prostatitis occur in 5% to 15% of men in many populations,6 but few studies included detailed demographic, clinical and laboratory evaluations. Furthermore, the available studies that included detailed patient symptoms, previous medical history, clinical and laboratory investigations are from tertiary centers in North America and Europe.10–13 This study adds substantial new data.

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This study was partially supported by grant RO1 DK38955 from the National Institutes of Health.

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