Clinical classification of chronic prostatitis： a preliminary investigation

Aim: To propose a practical clinical classification for the chronic prostatitis (CP). Methods: The clinical fea-tures and the findings in the expressed prostatic secretion (EPS) in 804 cases of CP patients were retrospectively ana-lyzed. Results: Four types of CP were identified based on the clinical manifestations and the amounts of whiteblood cells (WBC) and lecithin in EPS. They were the latent type (85 cases; 10.6%), the common type (423 cases;52.6%), the persisting type (104 cases; 12.9%), and the active type (192 cases, 23.9%). The therapeutic efficacyfor these 4 subtypes were 40.4%, 76.8%, 30.8% and 37%, respectively; a statistical difference was noticed be-tween the common type and the persisting type (P < 0.01 ). Conclusion: The method of classification proposed bythe authors may help clinicians in the diagnosis and predicting the prognosis of CP. (Asian J Androl 2000 Dec; 2:311-313)     

Endotoxins in the prostatic secretions of chronic prostatitis patients： a need for further biomarkers through the use of proteomics

Dear Sir,Dai et al.[1]must be commended on their usefulinvestigation of the clinical significance of endotoxins inthe expressed prostatic secretions (EPS) of chronic pros-tatitis (CP) patients.However,we take issue with theirconclusion.The conclusion that EPS endotoxin deter-mination is helpful in diagnostic confirmation is plausible,however,the conclusion that it is also useful in evaluat-ing the response to treatment in CP patients is not sup-ported by the findings of their study.CP may expressendotoxin,but unless we can demonstrate that there is anear linear reduction in endotoxin levels,following treat-ment of patients,one cannot make the conclusion that itwill be helpful in evaluating response to treatment.Thisis complicated by the recent doubts raised about classifi-cation systems of CP by several groups,including Nickelet al.[2].     

Prevalence of premature ejaculation in young and middle-aged men in Korea： a multicenter intemet-based survey from the Korean Andrological Society

In this study, we aimed to investigate the prevalence and perception of premature ejaculation （PE） in young and middle-aged Korean men. The study was conducted using an Internet-assisted questionnaire. A total of 2 037 Korean male adults, aged 20 years or older, were randomly sampled based on age and residency. The questionnaire developed by the PE Study Group of the Korean Andrological Society includes four categories （overall sexual function, symptoms, distress and treatment） with a total of 16 questions. For each question, symptoms were evaluated by a scale ranging from 0 to 10. Intravaginal ejaculation latency time was ‘5-10 min＇ in 38.6%, followed by ‘longer than 10 min＇ in 2919%, ‘2-5 min＇ in 23.6%, ‘1-2 min＇ in 5.4% and ‘shorter than 1 min＇ in 2.5%. In our series, 27.5% of respondents reported having PE. Control over ejaculation within a recent 3-month period was 6.2 points on average. Respondent complaints of PE-related stress averaged 7.1 points and stress-related complaints from sexual partners averaged 7.1 points. The effect of PE on sexual life was 6.8 points. Of the respondents determined as having PE, 42.6% responded that they were inclined to receive treatment. Results from this study suggest that the prevalence of PE diagnosed by the respondent on his own was approximately 27.5% in young and middle-aged men in Korea. PE-related stress had a significant effect on the stress, sexual activity and quality of life of the respondent and his sexual partner.     

Trends in the incidence of cryptorchidism and hypospadias of registry-based data in Korea： a comparison between industrialized areas of petrochemical estates and a non-industrialized area

This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients (males) during the first 4 years after a live birth in a population, nationally and regionally (a non-industrialized area (Chuncheon) and petrochemical estates (Yeocheon and Ulsan)), between 2000 and 2005. The data (numerator) for new patients were acquired from the National Health Insurance Review Agency, and the data (denominator) for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon (throughout the study period) and in Ulsan (2001, 2002, 2004 and 2005) than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.     

Factors influencing practices for chronic prostatitis: A nationwide survey of urologists in South Korea

BACKGROUND: We investigated the influence of physicians' attitudes on the treatment of chronic prostatitis, and attempted to correlate demographic and professional characteristics with patterns of therapy regarding chronic prostatitis. METHODS: Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire which explored practice characteristics, attitudes, and diagnostic and treatment strategies for the management of chronic prostatitis. The returned questionnaires were statistically analysed. RESULTS: Of the 850 questionnaires sent, 302 were returned, and 275 of those were included in the final analysis (response rate 32.4%). Multivariate logistic regression analysis indicated that the type of hospital (P < 0.001) and belief that culture tests helped diagnose chronic prostatitis (P = 0.001) were the most determinant factors with respect to the routine performance or non-performance of culture tests. Most Korean urologists (96.4%) prescribed antibiotics for the primary treatment of chronic prostatitis. Even when primary antibiotic treatment was unsuccessful, urologists frequently prescribed a second course of antibiotics (57.8%). In the multivariate model used, the likelihood of prescribing antibiotics as a secondary treatment varied by the type of hospital, with 0.4-fold odds (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21-0.87; P = 0.019) of the practice occurring in university hospitals, as opposed to primary clinics. According to the same model, the belief that culture tests help to diagnose chronic prostatitis was also an independent influencing factor (OR, 2.29; 95% CI, 1.39-3.77; P = 0.001), whereas the actual performance of culture tests had no statistical significance. CONCLUSION: Our findings suggest that the personal beliefs and professional characteristics of physicians may influence the diagnosis and treatment of chronic prostatitis in Korea.     

Questionnaire survey of Japanese urologists concerning the diagnosis and treatment of chronic prostatitis and chronic pelvic pain syndrome

OBJECTIVES: We performed a questionnaire survey to investigate various issues in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome by Japanese urologists and to clarify the circumstances surrounding prostatitis in Japan. METHODS: Japanese urologists (n = 1869) were surveyed by mail using a 17-item questionnaire to determine current diagnostic and treatment practices for prostatitis/chronic pelvic pain syndrome. RESULTS: Only 1.5% (11/739) of urologists diagnosed chronic prostatitis/chronic pelvic pain syndrome using the 4-glass test, while most did so using the 2-glass test (voided bladder [VB]2 and VB3, or VB2 and expressed prostatic secretion [EPS]). Approximately half (55.2%; 412/746) did not perform urine cultures to differentiate chronic bacterial prostatitis from chronic abacterial prostatitis/chronic pelvic pain syndrome. Approximately half (46%; 343/746) did not count the number of leukocytes in VB2 or VB3/EPS to differentiate chronic abacterial prostatitis from chronic pelvic pain syndrome. Although many urologists (63.8%; 459/720) thought that chronic abacterial prostatitis/chronic pelvic pain syndrome was not an infectious disease, many chose antimicrobial agents as the primary treatment. More than half (52.2%; 384/735) of all urologists felt pessimistic about dealing with chronic prostatitis/chronic pelvic pain syndrome compared to treating benign prostatic hypertrophy or prostate cancer, because of the high number of complaints by patients and their own lack of confidence in diagnosing and treating the condition. CONCLUSION: There is much confusion and frustration among Japanese urologists about chronic prostatitis/chronic pelvic pain syndrome. Further studies are needed to elucidate its etiology and pathogenesis, and to establish guidelines for its diagnosis and treatment.     

慢性骨盆疼痛综合征的综合性治疗

目的 :探讨慢性骨盆疼痛综合征 (CPPS)的诊疗方法。　方法 :分析 16 5例CPPS患者的病史和实验室检查结果 ,依据美国国立卫生研究院 (NIH)前列腺炎的诊断标准 ,对患者进行分类。综合性治疗 6～ 8周。ⅢA型患者以广谱抗生素及α1受体阻滞剂治疗为主 ,ⅢB型则分别给予α1受体阻滞剂、镇静剂、镇痛肌松剂治疗 ;全部患者均配合精神心理及物理疗法 ,部分患者加服中成药。根据慢性前列腺炎症状指数 (CPSI)评分判断疗效。　结果 :治疗 6周后显效 12 1例 (73.3% ) ,有效 2 6例 (15 .8% ) ,无效 18例 (10 .9% )。　结论 :综合性治疗是CPPS有效的治疗方法。     

慢性前列腺炎/慢性骨盆疼痛综合征治疗新进展

慢性前列腺炎(CP)尤其是慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)(Ⅲ型)的发病机制至今尚不完全清楚,人群发病率可达2.5%~16.0%,为50岁以下男性最常见的泌尿外科疾病。20世纪90年代以来,在美国国立卫生研究院慢性前列腺炎协作研究网(NIH-CPCRN)、国际前列腺炎协作网(IPCN)等国际研究机构的协调下,各国研究者对CP的病因、诊断、治疗等诸方面进行了较以往更大规模的深入研究。CPPS是CP中最常见的也是疗效最差的一种类型,本文综述了近几年来CP/CPPS治疗新进展,探讨了其目前治疗所面临的主要问题及可能的原因,并对CP/CPPS治疗的前景予以展望。     

Cryotherapy alleviates symptoms in chronic prostatitis/chronic pelvic pain syndrome: The first results

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is an intractable disease. This study aimed to assess the efficacy of cryotherapy in the therapy of CP/CPPS. One hundred and seventy-two patients with CP/CPPS were randomised to receive cryotherapy or sham cryotherapy. The follow-up assessments were done at weeks 4, 12 and 24 using Visual Analogue Scale (VAS), International Prostate Symptom Score (IPSS) and National Institutes of Health-developed Chronic Prostatitis Symptom Index. The per-protocol analysis was performed. Eighty-two patients in the cryotherapy group and 76 patients in the sham group completed the treatment. The most obvious improvement (67%) of the VAS was observed in the cryotherapy group after 4 weeks, and although the improvement slightly weakened by 24 weeks (62.6%), a significant improvement from the treatment remained apparent. IPSS improved by 75% after 4 weeks and remained stable after 24 weeks. The response rates were 78.0%, 73.2% and 70.1% at weeks 4, 12 and 24 in the cryotherapy group, which were higher than 17.1%, 13.2% and 10.5% in the sham group (each p < .001). These results indicated that cryotherapy could alleviate voiding symptoms, ameliorate pain and improve the quality of life in people with CP/CPPS. It holds promise as a novel strategy to treat CP/CPPS.     

Epidemiologic risk factors for chronic prostatitis

Chronic prostatitis/chronic pelvic pain syndrome is a multifactorial problem, which affects men of all ages and in all demographics. Recent studies have shown that the prevalence of prostatitis is approximately 2-10% among unselected men in North America, Europe and Asia. This data clearly indicates that chronic prostatitis constitutes an important problem in international health care. Nevertheless, the aetiology and pathogenesis of chronic prostatitis have yet to be clearly delineated, despite the numerous efforts which have been made, with regard to both basic and clinical research. In fact, factors other than leucocytes and bacteria have been shown to contribute to the symptoms typically associated with prostatitis. Studies of the epidemiology and determinants of prostatitis risk factors may also provide clues to the general aetiology of prostatitis. Other epidemiological data appears to indicate that certain as-yet-unknown factors might be associated with an increased tendency towards the development of chronic prostatitis. However, findings from most studies are considered to represent only preliminary data, because of the small sample sizes or lack of generalizability inherent to most of the studies. The identification and characterization of these relevant risk factors might accelerate or augment the development of preventive, diagnostic, and therapeutic strategies for the treatment of these syndromes.     

Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study

OBJECTIVES: To examine the cross-sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: In all, 463 men enrolled in the National Institutes of Health (NIH) Chronic Prostatitis Cohort Study from seven clinical centres (six in the USA and one in Canada) reported baseline screening symptoms using the NIH Chronic Prostatitis Symptom Index (CPSI). The CPSI provides scores for pain, urinary symptoms and QoL. In addition, a demographic profile, including age and partner (living with another) status, and a depressive symptom score were obtained. Regression modelling of QoL, adjusting for between-centre variability, examined the unique effects of age, partner status, urological symptoms, depressive symptoms and pain. RESULTS: Urinary scores, depressive symptoms and pain intensity scores significantly predicted QoL for patients with CP/CPPS (higher CPSI QoL scores indicated more impairment; median 8.0, range 0-12). On average, for every 1-point increase in urinary scores, there was a corresponding increase in QoL score of 0.118 points (P = 0.001); for every 1-point increase in pain intensity score, there was a corresponding increase in QoL score of 0.722 points (P < 0.001); and for every 1-point decrease in depressive symptoms (lower scores equal poorer mood), the QoL score increased (poorer quality of life) by 0.381 points (P < 0.001). Age and partner status did not significantly contribute to poorer QoL. Urinary scores and depressive symptoms were significant predictors (P < 0.001) of pain in patients with CP/CPPS. CONCLUSIONS: These data show that depressive symptoms and pain intensity significantly predict a poorer QoL in patients with CP/CPPS, and that these effects are independent of partner status, age and urinary status. In particular, pain intensity was the most robust predictor of a poorer QoL. Further data relating pain and psychological factors to CP/CPPS are highly recommended, to aid in determining specific factors for pain and its impact on QoL. These data are essential if empirically guided efforts to manage pain are to progress.     

A case-control study of chronic prostatitis/chronic pelvic pain syndrome and colorectal cancer

Study Type – Symptom prevalence (case control) Level of Evidence 2b What's known on the subject? and What does the study add? Associations are well established between intestinal infection/inflammation or inflammatory bowel diseases and colorectal cancer (CRC). Our study found an association between CRC and previously diagnosed chronic prostatitis/chronic pelvic pain syndrome. Patients with CRC had a 1.45‐fold higher risk of having a previous diagnosis of chronic prostatitis/chronic pelvic pain syndrome than controls. This phenomenon was found to be more prominent in subjects younger than 60 years.

OBJECTIVE

• ? To estimate the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and colorectal cancer (CRC) using a nationwide population‐based data set.

PATIENTS AND METHODS

• ? This case–control study used data sourced from the Taiwan Longitudinal Health Insurance Database.
• ? The cases comprised 2899 patients with CRC and 14 995 randomly selected subjects as controls.
• ? We used conditional logistic regression to examine the association between CRC and previous diagnosis of CP/CPPS.

RESULTS

• ? Of the sampled patients, 531(3.05%) had been diagnosed with CP/CPPS before the index date, with 123 (4.24% of the patients with CRC) coming from the cases and 408 individuals (2.81% of patients without CRC) coming from the controls.
• ? Conditional logistic regression analysis revealed that cases were more likely to have CP/CPPS than controls (odds ratio 1.45, 95% CI 1.17–1.79, P < 0.001) after adjusting for the monthly income, geographic location, urbanization level, hypertension, diabetes, renal disease, obesity and cystic kidney disease.
• ? In subgroup analysis, we found the magnitude of the association to be higher in subjects younger than 60 years (age 40–49, odds ratio 2.01; 95% CI 2.04–3.58 and aged 50–59, 2.40, 95% CI 1.48–3.87, both P < 0.001) than among other age groups.

CONCLUSION

• ? We conclude that CP/CPPS patients are at higher risk for CRC, especially in males under 60 years of age.