Evaluation of the cytokines interleukin 8 and epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic secretions

Objectives. Chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a disorder characterized by pelvic pain and varying degrees of inflammation exhibited in expressed prostatic secretions (EPS). To provide objective parameters of inflammation, we measured the cytokines interleukin 8 (IL-8) and epithelial neutrophil activating peptide 78 (ENA-78) in EPS of healthy men, men with benign prostatic hyperplasia (BPH), men with bacterial prostatitis (BP), and men with chronic prostatitis/CPPS.Methods. Enzyme-linked immunosorbent assays of the EPS for IL-8 and ENA-78 were done in 63 men: control (n = 9), BPH (n = 6), BP (n = 3), inflammatory CPPS (National Institutes of Health [NIH] category IIIa) (n = 17), noninflammatory CPPS (NIH category IIIb) (n = 17), and asymptomatic inflammatory prostatitis (NIH category IV) (n = 11).Results. IL-8 was detectable in all patients, and ENA-78 was detectable in all except 2 patients (threshold of detection 10 pg/mL for IL-8, 15 pg/mL for ENA-78). Mean levels of IL-8 [ENA-78] were similar in control (3010 pg/mL [423 pg/mL]), BPH (3341 pg/mL [98 pg/mL]), and IIIb (2751 pg/mL [335 pg/mL]) groups. Both cytokine levels were higher in BP (11,175 pg/mL [13,761 pg/mL]), IIIa (10,418 pg/mL [2240 pg/mL]), and IV (8571 pg/mL [1865 pg/mL]) groups. A statistically significant difference between the control group versus BP, IIIa, and IV (P <0.05) groups was found for IL-8 but not for ENA-78.Conclusions. IL-8 and ENA-78 are frequently elevated in the EPS of men with BP, CPPS IIIa, and asymptomatic inflammatory prostatitis category IV. These cytokines are direct mediators of leukocyte accumulation and activation at inflammatory sites and may be responsible, in part, for the presence of inflammatory reaction in the prostate.     

Evaluation of symptoms in men with chronic pelvic pain

According to the National Institutes of Health classification system, chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is subdivided into an inflammatory (category IIIa) and a non-inflammatory (category IIIb) form. The difference is based on the presence or absence of white blood cells in expressed prostatic secretions, urine after prostatic massage, or semen. This is the only criterion which allows a differentiation between the IIIa and IIIb forms. The symptoms, i.e. pain and urinary complaints of various degrees, are thought to be similar in both forms. These symptoms can be assessed with the Chronic Prostatitis Symptom Index (CPSI) and the International Prostate Symptom Score (IPSS), which are both available in a validated German translation. One hundred and six patients with CPPS were evaluated with CPSI and IPSS. Urinary symptoms troubled all patients. Men with category IIIa had significantly more urinary symptoms when compared to men with category IIIb. There was no difference between the two groups regarding pain and impact on the quality of life. Although pain is thought to be the hallmark of CPPS, the contribution of urinary troubles to the symptoms must not be underestimated.     

Correlation of beta-endorphin and prostaglandin E2 levels in prostatic fluid of patients with chronic prostatitis with diagnosis and treatment response

PURPOSE: The chronic pelvic pain syndrome is a clinically defined symptom complex of unclear etiology. We have noted increased oxidative stress in the prostatic fluid of these patients, implying an active inflammatory response. Immune cells can produce the natural opioid beta-endorphin at the site of injury, which may modulate pain. We measured beta-endorphin and the inflammatory marker prostaglandin E2 in the expressed prostatic secretions of men with prostatitis, and correlated the results with symptoms. MATERIALS AND METHODS: Expressed prostatic secretions samples from 70 patients and 8 asymptomatic controls were collected and frozen. beta-Endorphin and prostaglandin E2 were measured by enzyme-linked immunosorbent assay. Results were stratified according to prostatitis category and compared in individuals before and after therapy. RESULTS: In symptomatic patients beta-endorphin and prostaglandin E2 were not significantly different in categories II, IIIa and IIIb expressed prostatic secretions but they were higher than in controls. The mean beta-endorphin level plus or minus standard error of mean in symptomatic patients was significantly higher (23.8 +/- 11 ng./ml. versus 8.7 +/- 4.7, p = 0.0001) and mean prostaglandin E2 was lower (6.01 +/- 2.9 ng./ml. versus 3.01 +/- 2.9, p = 0.001) after successful therapy with antibiotics or antioxidant phytotherapy, Prosta-Q (Farr Laboratories, Santa Clarita, California). CONCLUSIONS: We observed a correlation of higher prostaglandin E2 and lower beta-endorphin in symptomatic men with chronic prostatitis. Increased oxidative stress and inflammation may induce prostaglandin E2 production that would inhibit beta-endorphin release. Treatment with therapeutic agents that decrease oxidative stress, such as antibiotics and antioxidant phytotherapy, may function at least partially by increasing beta-endorphin and decreasing prostaglandin E2.     

Seminal oxidative stress in patients with chronic prostatitis

OBJECTIVES: An association between prostatitis and male infertility has been suspected, yet is poorly understood. Prostatitis is often associated with granulocytes in the prostatic fluid that generate reactive oxygen species (ROS), known to impair male fertility. We compared ROS, the total antioxidant capacity (TAC), and a novel index of oxidative stress (ROS-TAC score) in patients with chronic prostatitis and in healthy controls. METHODS: Semen specimens from 36 men with chronic prostatitis (National Institutes of Health category IIIa), 8 men with prostatodynia (National Institutes of Health category IIIb), and 19 controls attending our urologic clinic were examined according to the World Health Organization criteria. Leukocytospermia was measured by the Endtz test (myeloperoxidase assay). ROS and TAC production was measured by chemiluminescence assay. A composite ROS-TAC score was also calculated in patients and controls. RESULTS: The sperm concentration, percentage of motility, and morphology among the groups did not differ. The mean +/- standard error log-transformed ROS level was significantly higher in patients with leukocytospermia (3.2 +/- 0.6) than in patients without leukocytospermia (1.8 +/- 0.2; P = 0.04) and controls (1.3 +/- 0.3, P = 0.01). TAC was significantly lower in patients with or without leukocytospermia (859.69 +/- 193.0 and 914.9 +/- 65.2, respectively) than in controls (1653.98 +/- 93.6, P = 0.001). The mean ROS-TAC score of controls (50.0 +/- 4.1) was significantly higher than those of patients with chronic prostatitis and leukocytospermia (8.2 +/- 9.2) and those without leukocytospermia (34.2 +/- 2.9; P <0.001). CONCLUSIONS: Men with chronic prostatitis or prostatodynia have seminal oxidative stress, irrespective of their leukocytospermia status. These observations may help shed light on the long-standing controversy surrounding prostatitis and infertility.     

Endotoxins in the prostatic secretions of chronic prostatitis patients

AIM: To evaluate the clinical significance of the quantitative determinations of endotoxins in the expressed prostatic secretions (EPS) of chronic prostatitis (CP) patients. METHODS: The EPS of 45 patients with CP and 15 normal volunteers were obtained for microscopic examination, bacterial culture and endotoxin determination. The level of endotoxins was determined by the Limulus-amebocyte-lysate test with chromogenic substrate. RESULTS: Patients with CP had higher mean levels of endotoxins in EPS than normal volunteers [52.06 +/- 32.83 EU/L vs. 4.77 +/- 4.14 EU/L (P <0.05)]. The levels of endotoxins in CP type II, type IIIa and type IIIb were 68.62 +/- 34.78 EU/L, 45.30 +/- 23.33 EU/L and 15.83 +/- 5.31 EU/L, respectively [type II vs. type IIIa (P >0.05), type IIIb vs. normal controls (P <0.05), type II/type IIIa vs. normal controls P >0.05)]. CONCLUSION: CP patients have elevated levels of endotoxins in the EPS, which suggests that inflammation is a feature of this disease. EPS endotoxin determination is not only helpful in diagnostic confirmation, but also in evaluating the response to treatment in CP patients.     

前列腺按摩液中IL-8和TNF-α测定在慢性前列腺炎诊断、分型中的临床意义

目的 :探讨检测前列腺按摩液 (EPS)中细胞因子白细胞介素 8(IL 8)和肿瘤坏死因子α(TNF α)在慢性前列腺炎诊断、分型中的意义。　方法 :ELISA法检测 78例临床诊断的慢性前列腺炎患者 [其中慢性前列腺炎(CBP)组 12例 ,慢性非细菌性前列腺炎 /慢性骨盆疼痛综合征 (CPPS)ⅢA组 38例 ,CPPSⅢB组 2 8例 ]和 12例正常对照者EPS中IL 8和TNF α浓度。分析各组EPS中IL 8和TNF α浓度差异。　结果 :CBP组和CPPSⅢA组EPS中IL 8水平 [(10 96 7.5± 3477.7) pg/ml;(92 6 8.4± 2 0 34.6 ) pg/ml]和TNF α水平 [(84 .1± 5 4 .7) pg/ml;(32 .6± 18.6 ) pg/ml]显著高于CPPSⅢB组和正常对照组EPS中的IL 8水平 [(2 72 6 .1± 2 77.5 ) pg/ml;(2 80 0 .0± 32 0 .2 )pg/ml]和TNF α水平 [(12 .6± 7.1)pg/ml;(12 .9± 10 .1)pg/ml](P均 <0 .0 1)。　结论 :检测EPS中IL 8、TNF α水平可能有助于CBP、慢性非细菌性前列腺炎 /慢性骨盆疼痛综合征的分型诊断。     

Mycoplasmas in semen of chronic prostatitis patients

OBJECTIVE: To evaluate the occurrence of mycoplasmas in the semen of chronic prostatitis patients. MATERIAL AND METHODS: Genital mycoplasmas (Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum) were sought in the semen of 121 chronic prostatitis patients [38 National Institutes of Health (NIH) category IIIa, 59 NIH category IIIb and 24 NIH category IV] and 40 controls. The commercially available kit Mycoplasma IST was applied to the semen samples of all 161 men, and polymerase chain reaction (PCR) to those of 60 randomly selected men. RESULTS: Ureaplasmas were found in all study groups (at frequencies ranging from 12% to 25%) using the Mycoplasma IST test, but M. hominis was found only in one NIH category IIIb patient. Using PCR, most of the ureaplasmas appeared to be U. parvum, which was found in all prostatitis groups (18% of NIH category IIIa, 15% of NIH category IIIb and 25% of NIH category IV patients) but not in the controls. M. genitalium was found in 18% of the NIH category IIIa patients. All of the mycoplasmas occurred significantly more frequently in prostatitis patients than in controls and in NIH category IIIa patients than in controls. CONCLUSION: Mycoplasmas occur more frequently in the semen of prostatitis patients than in that of healthy controls, with U. parvum being the most frequently occurring species.     

慢性前列腺炎/慢性盆腔疼痛综合征诊治中值得商榷的问题

慢性前列腺炎 /慢性盆腔疼痛综合征是一种常见的疾病 ,影响生活质量。病因及发病机制不完全明了。尚无理想的治疗方法 ,更缺乏以循证医学为基础的处理指南。尚有许多值得商榷之处 ,如前列腺检查标本中白细胞的重要性和炎症的作用 ,细菌的重要性和感染的作用 ,白细胞及细菌和症状严重程度间的相关性 ,如何区分 Ⅲa和 Ⅲb型前列腺炎 ,抗菌素治疗的作用 ,为什么Ⅲb型前列腺炎无炎症而有症状、而Ⅳ 型前列腺炎有炎症而无症状。有关各型前列腺炎的病因和诊断治疗 ,尚需设计良好和大样本量的研究以进一步确定。     

Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls

PURPOSE: Chronic prostatitis has been traditionally characterized by inflammation and/or infection of the prostate gland, objectively categorized by white blood cells and cultured bacteria in prostate specific specimens. We compared leukocyte counts and localization rates for bacterial cultures of segmented urine samples (VB1, VB2, VB3), expressed prostatic secretion (EPS) and semen in men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to men without pelvic pain (controls). MATERIALS AND METHODS: A total of 463 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study and 121 age matched men without urinary symptoms had leukocyte counts performed and 5-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, EPS, VB3) and semen. All risk factor comparisons between case and control analyses were tested using generalized Mantel-Haenszel methods, and multivariable models were developed using logistic regression methods, adjusting for clustering by clinical center within both methods. RESULTS: Men with CP/CPPS had statistically higher leukocyte counts in all segmented urine samples and EPS, but not in semen compared to asymptomatic control men. However, the control population also had a high prevalence of leukocytes. Of the men with CP/CPPS 50% and 32% had 5 or more, or 10 or more white blood cells (WBCs) per high power field, respectively, in EPS compared to 40% and 20% of the control population. Similarly, 32% and 14% of the patients with CP/CPPS had 5 or more, or 10 or more WBCs per high power field in VB3 compared to 19% and 11% in the control population. Localization of uropathogenic bacteria in EPS, VB3 and/or semen was similar in men with CP/CPPS (8.0%) and asymptomatic men (8.3%). CONCLUSIONS: Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and EPS but not in semen as compared to controls. There is no difference in rates of localization of bacterial cultures for men with CP/CPPS compared to control men. The high prevalence of WBCs and positive bacterial cultures in the asymptomatic control population raises questions about the clinical usefulness of the standard 4-glass test as a diagnostic tool in men with CP/CPPS.     

Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men: a preliminary investigation

The expressed prostatic secretions (EPSs) of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), infertile men and normal men were subjected to microbiological study. EPSs were collected from the subjects, which included 26 normal men, 11 infertile patients and 51 CP/CPPS patients. DNA was extracted from each specimen, and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers. The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men, but without any difference among the three patient groups. The denaturing gradient gel electrophoresis (DGGE) method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues. Principal component analysis (PCA) and partial least squares (PLS) analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups. Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients (P<0.05). Two bands were identified as priority factors in the discrepancy of category IIIA and category IIIB prostatitis patients (P<0.05). According to this research, the ecological balance of the prostate and low urethra tract, when considered as a microenvironment, might play an important role in the maintenance of a healthy male reproductive tract.     

Chronic prostatitis/chronic pelvic pain pyndrome): seminal markers of inflammation

The new prostatitis classification proposes the inclusion of seminal leukocytes in the diagnosis of inflammatory chronic pelvic pain syndrome (CPPS). The present study has been performed to clarify the role of seminal leukocytes and inflammatory seminal plasma parameters in order to contribute to the differential diagnosis between inflammatory (category IIIA) and non-inflammatory (category IIIB) CPPS. A total of 112 consecutive symptomatic patients (mean age 37.3 years; range 21-64) attending our prostatitis outpatient clinic were investigated. Men with evidence for bacterial infection were excluded by prior standardized lower urinary tract localization studies. Men were categorized into inflammatory and non-inflammatory CPPS according to the leukocyte analysis in expressed prostatic secretions (EPS) and urine after prostatic massage (VB 3). Ejaculate analysis was performed after lower urinary tract localization studies. Inflammatory markers included peroxidase positive leukocytes (PPL) and PMN-elastase. Receiver operating characteristic curves were constructed to analyze cutpoints provided that the differences were significant. Increased leukocyte counts in EPS/VB 3 were found in 64 men, while in 48 this was not the case. No differences could be detected in relation to patients' age ( P>0.05). In men with category IIIA prostatitis, PPL and elastase in the seminal fluid were significantly increased ( P<0.001). For PPL and elastase, a cutpoint of 0.113 x 10(6)/ml and 280 ng/ml, respectively, were suggested. Increased PPL (>0.113 x 10(6)/ml) and elastase (>280 ng/ml) in the seminal fluid indicate inflammatory disease provided that the ejaculate analysis is performed on the same day after lower urinary tract localization studies.     

慢性非细菌性前列腺炎患者前列腺液16SrRNA基因的检测及其临床意义

目的 探讨应用聚合酶链反应（PCR）检测慢性非细菌性前列腺炎（CPPS）患者前列腺液（EPS）中细菌基因,并与CPPS患者的临床治疗效果做相关性分析。方法 以16SrRNA基因为靶序列,设计引物及寡核苷酸探针,采用PCR法检测标准菌株及135例CPPS患者前列腺液中细菌基因。所有CPPS患者均应用抗生素和中成药规范治疗,每2周为1疗程,每2周复查EPS常规1次,必要时适当调整药物。治疗3个月时,进行疗效评估。结果 135例CPPS患者中16SrRNA检测结果阳性为78例,阳性率为57．78％。16SrRNA阳性组患者有效率84．6％,阴性组有效率52．6％;16SrRNA阳性组患者疗效明显优于阴性组。结论 大部分CPPS患者的前列腺液中可以检测到细菌的16SrRNA基因,提示细菌感染在CPPS的发病中有重要作用。     

The NIH Consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia

The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.     

IL-1beta and TNF-alpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis

PURPOSE: Chronic Prostatitis, or Chronic Pelvic Pain Syndrome [CPPS], is a common disorder characterized by pelvic pain and varying degrees of inflammation in expressed prostatic secretions (EPS). In search of markers to more clearly define CPPS, we compared proinflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) levels in EPS from men with CPPS, to healthy men and men with Benign Prostatic Hyperplasia (BPH). METHODS: 78 men: controls (n = 16), BPH (n = 14), CPPS IIIA [>/=10 white blood cells per high power field (WBC/hpf) in EPS] (n = 18), CPPS IIIB [<10 WBC/hpf in EPS] (n = 20), and asymptomatic inflammatory prostatitis (AIP) (n = 10) were evaluated for EPS WBC, and IL-1beta and TNF-alpha by ELISA. RESULTS: IL-1beta and TNF-alpha levels in EPS were usually detectable in men with CPPS IIIA (89% and 45%, respectively) or AIP (90%; 100%), but less often in controls (31%; 17%), BPH (57%; 15%), and CPPS IIIB (35%; 15%) respectively. IL-1beta and TNF-alpha levels were higher in CPPS IIIA versus CPPS IIIB, and in AIP versus controls or BPH (p's <0.001). Cut-points for IL-1beta and TNF-alpha discriminated AIP from controls (predictive values = 94% and 83%, respectively) and CPPS IIIA from CPPS IIIB (predictive values 84% and 100%). Overall, there was a correlation between IL-1beta and TNF-alpha (p <0.003), but no correlation between WBC and IL-1beta (p <0.1) or TNF-alpha (p <0.50). CONCLUSIONS: Cytokines are frequently present and elevated in the EPS from men with CPPS IIIA and AIP and provide a novel means for identification, characterization and potential management of men with CPPS that differs from traditional methods based on WBC.     

Prostatitis: the role of antibiotic treatment

The prostatitis syndrome is commonly found in urologic practice and is classified according to the NIDDK/NIH, in which bacterial prostatitis (acute and chronic) is distinguished from chronic pelvic pain syndrome (CPPS). In acute bacterial prostatitis (NIH category I), antibiotic treatment is mandatory and successful in most cases. In chronic bacterial prostatitis (NIH category II), antibiotics must be selected according to suitable pharmacokinetic/pharmacodynamic parameters and therapy should be prolonged. The success varies according to the etiologic pathogen and the course of the infection. In inflammatory CPPS (NIH category IIIA) antibiotics can be tried initially and continued, if symptoms improve. There is no consensus regarding the role of antibiotic treatment in patients with non-inflammatory CPPS (NIH category IIIB) and asymptomatic prostatitis (NIH category IV).     

巨噬细胞炎性蛋白-1α在前列腺按摩液中的表达及意义

目的:检测前列腺按摩液(EPS)中巨噬细胞炎性蛋白-1α(MIP-1α)的mRNA和蛋白表达水平,探讨其在慢性前列腺炎分型中的意义。方法:50例临床诊断的慢性前列腺炎患者,其中慢性细菌性前列腺炎(CBP)16例,慢性非细菌性前列腺炎/慢性骨盆疼痛综合征(CPPS)23例,分为ⅢA型11例,ⅢB型12例。无症状性炎症性前列腺炎Ⅳ型11例。收集EPS。同时选取15例健康自愿者做正常对照。RT-PCR法扩增MIP-1αmRNA,统计分析各组mRNA表达差异。ELISA法检测MIP-1α的蛋白表达水平,统计分析各组EPS的MIP-1α浓度差异。结果:RT-PCR半定量分析显示,MIP-1αmRNA在CPPSⅢA组和CPPSⅢB组的表达显著高于其他各组(P<0.05)。ELISA分析显示,MIP-1α蛋白浓度在CPPSⅢA组[(1 174.3±89.2)pg/ml]和CPPSⅢB组[(842.3±76.2)pg/ml]也显著高于正常组[(198.0±37.8)pg/ml]、CBP组[(347.0±61.6)pg/ml]及Ⅳ型组[(292.0±56.4)pg/ml](P<0.05)。结论:从mRNA和蛋白水平检测EPS中MIP-1α可能有助于慢性前列腺炎的分型诊断。     

The Challenge of Erectile Dysfunction in the Man with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, is common and has significant impact on quality of life through pain and lower urinary tract symptoms. A high proportion of men with CP/CPPS suffer from some form of sexual dysfunction including erectile dysfunction, premature ejaculation, and painful ejaculation. While well described, the pathophysiology of these sexual symptoms has not been well studied. This review will focus on what we know regarding the incidence and potential mechanisms for sexual dysfunction in CP/CPPS and discuss diagnostic and therapeutic options.     

Classification and diagnosis of prostatitis: a gold standard?

The National Institutes of Health Classification System for prostatitis has now been accepted by the North American and International urology community. This categorization system consists of category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome - CP/CPPS) and category IV asymptomatic inflammatory prostatitis. The evaluation of a patient with category I and category II bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The clinical tests for the evaluation of CP/CPPS can be classified as mandatory, recommended and optional. Mandatory evaluations include history and physical examination, urinalysis and urine culture. Recommended evaluations include lower urinary tract localization tests, symptom index, flow rate, residual urine determination and urine cytology. Optional evaluations include semen analysis and culture, urethral swab, urodynamics, cystoscopy, imaging, and prostate specific antigen determination. The physician must individualize a rational diagnostic strategy for each patient. There is no 'gold standard' for the diagnosis and evaluation of patients presenting with prostatitis.     

Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome is a prevalent and multifactorial condition. Many patients have the condition for years despite conventional therapies. We assess the outcomes of multimodal therapy in patients with long-standing chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: A total of 53 patients with chronic prostatitis treated at our clinic with a minimum followup of 6 months were assessed by the National Institutes of Health-Chronic Prostatitis Symptom Index and by a global assessment score. Treatments included antibiotics, prostatic massage, anti-inflammatory phytotherapy, alpha-blockers and neuromuscular agents. RESULTS: Mean age patient was 45 years and median symptom history was 3.5 years. Based on localizing cultures, and microscopy of urine and prostatic fluid 13% of the cases were category II, 41% were category IIIa and 46% were category IIIb. Mean followup from the last visit was 417 days (range 185 to 1,247). Mean changes +/- SE from the initial to the final score on the National Institutes of Health-Chronic Prostatitis Symptom Index were 10.4 +/- 3.3 to 5.9 +/- 4.4 for pain, 4.2 +/- 2.9 to 2.0 +/- 2.7 for urinary, 8.2 +/- 2.9 to 4.7 +/- 3.4 for quality of life and 22.7 +/- 6.6 to 13.2 +/- 9.5 for total score (p <0.0001). Based on a global subjective assessment 43 of the patients (80%) were better, 8 were the same and 3 were worse. At final assessment 39% of the patients were on no therapy, 22% were on an alpha-blocker, 37% were on quercetin, 13% were on neuromuscular agents and 9% were on antibiotics. CONCLUSIONS: An approach using stepwise therapy with antibiotics, anti-inflammatories and neuromuscular agents can be successful in the majority of patients with long-standing chronic prostatitis.     

慢性前列腺炎疗效与患者精神状况及相关因素Cox回归分析

目的:筛选验证与慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)相关的精神心理因素,采用Cox回归分析方法研究这些精神心理因素及其他相关因素对CP/CPPS治疗效果的影响,为CP/CPPS治疗过程中有针对性的精神心理干预提供科学依据。方法:连续调查于我院就诊的291名CP/CPPS患者(病例组)的年龄、文化程度、职业、性格类型、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、病程、NIH慢性前列腺炎症状指数(NIH-CP-SI)和前列腺液白细胞计数,同时选择相同年龄阶段的健康男性100名(对照组)进行病例对照研究,筛选验证与CP/CPPS相关的精神心理因素。调查结束后,病例组所有患者均接受为期6周的统一方案治疗并进行随访(6周),以治疗是否有效为终结事件,以治疗见效时间为时间变量,采用单因素和多因素Cox回归分析研究与CP/CPPS相关的精神心理因素及其他可能影响CP/CPPS治疗效果的因素,筛选能够影响CP/CPPS治疗效果的相关因素。结果:病例组回收有效问卷258份,对照组回收有效问卷87份。病例组SAS和SDS评分分别为(42.8±11.43)分和(48.15±11.49)分,均显著高于对照组[SAS(32.12±9.68)分,SDS(35.12±10.81)分,P<0.01]。病例组焦虑、抑郁以及焦虑或/和抑郁障碍的检出率分别为25.97%、21.71%和34.50%,均显著高于对照组(P<0.01);内向性格和外向性格的检出率亦分别高于和低于对照组(P<0.01);提示焦虑、抑郁和内向性格与CP/CPPS具有正联系,而外向性格与CP/CPPS具有负联系。病例组接受为期6周统一治疗后的总有效率达70.54%,Cox回归分析显示,在上述与CP/CPPS相关的4个因素(焦虑、抑郁、内向性格、外向性格)和另外可能影响CP/CPPS治疗效果的4个因素(年龄、病程、前列腺液中白细胞计数、CPSI)中,对CP/CPPS治疗效果有确切负性影响的危险因素有焦虑、抑郁和病程。结论:焦虑和抑郁等精神心理障碍在CP/CPPS发生、发展及治疗转归过程中具有重要作用;在CP/CPPS治疗过程中,应充分重视患者的精神心理状况,必要时应有针对性地给予适当的精神心理干预。