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Prostatitis: revisión de una patología enigmática y su relación con la fertilidad masculina
Abstract
Introducción La prostatitis, término que involucra cuatro categorías de inflamación de la próstata, es considerada una patología enigmática por su complejidad en el diagnóstico e involucra el uso indiscriminado de antibióticos sin obtener evidencia de la infección. El objetivo de esta revisión es describir una patología de mal diagnóstico y de gran magnitud sobre la fertilidad masculina.
Materiales y Métodos Se realizó una revisión de la literatura científica a conveniencia en la base de datos PubMed, empleando los términos prostatitis, prevalencia, dolor pélvico crónico y diagnóstico.
Resultados La prevalencia de prostatitis varía entre 1,8% y 65% en los estudios evaluados, la prevalencia depende de la metodología empleada y del tipo de población evaluada.
Conclusión Se requiere determinar la prevalencia de prostatitis en la población en general, con el fin de mejorar las ayudas diagnósticas y el tratamiento para evitar la propagación de microorganismos.
... On the other hand, prostatitis is considered the most common urological disorder in men younger than 50 years; it has a variable prevalence, between 1.8 to 65% [8] that depends of methodology, with an general average of 14.2%. Prostatitis is positively associated with age, being 1.7 times higher in men from 40 to 49 years compared to individuals from 20 to 39 years, and 3.1 times higher in people from 50 to 59 years [9]. ...
... Prostatitis has an acute or chronic presentation, the pathophysiology is not fully clarified, but under the concept of intraprostatic reflux, bacterial prostatitis can be explained. This reflux by dragging bacteria from the urethra causes acute inflammation of the gland (acute bacterial prostatitis); when the immune response is not as strong, a slower process known as chronic bacterial prostatitis originates [8,21]. Bacterial prostatitis has implications for fertility, and altered seminal parameters have been reported in the semen of patients, which could be associated with bacteriospermia, because bacteria can induce harmful effects on sperm [22]. ...
Prostatitis and premature ejaculation are urological problems that impact sexual and reproductive health in males frequently. The aim of this narrative review is to provide an overview of the relationship between premature ejaculation and prostatitis. A narrative review literature was performed in the PubMed and SCOPUS databases. The most relevant aspects of the etiology of premature ejaculation were detailed, and the causal relationship between prostatitis and premature ejaculation was explored. Treatment should consider the pathophysiology and diagnosis; this is a significant challenge for the urologist. A total of 45 original articles were compiled in a table within the main findings. Both alterations are associated with a decrease in the quality of life and have a negative impact on the couple's relationship. The timely treatment offers improvement or complete recovery for the patients.
Background: Bacterial infections have been recognized with infertility, bacteria are capable of agglutinating and immobilizing spermatozoa. The aim of present study was to determine bacterial pathogens in semen culture from infertile men and their antibiotic susceptibility pattern in vitro.
Method: Semen samples were collected for routine culture and antibiotic susceptibility test and were processed according to the standard microbiology techniques.
Results: A total of 347 semen specimens were cultured, of which 62 (17.8%) showed significant bacterial growth. Eight different species of bacterial organisms were isolated out of them 37% isolates were gram positive and 62.9% isolates were gram negative. The commonest isolates were Escherichia coli (41.9%) followed by Staphylococcus aureus (17.7%), Streptococcus faecalis (11.2%), Klebsiella pneumoniae (9.6%), Staphylococcus saprophyticus (8%), and Pseudomonas aeruginosa (4.8%). The maximum numbers of culture positive cases (46.7%) were found in patients 31-40 year age group. Both
gram positive and gram negative organisms were sensitive to nitrofurantoin (91.5%) and (71.7%) followed by ampicillin- sulbactam (73.9%) and (58.9%), levofloxacin (56.5%) and (71.7%) and gentamycin (56.5%) and (53.8%) respectively. E. coli was found susceptible to nitrofurantoin (76.9%), followed by levofloxacin (69.2%), ampicillin sulbactam (57.6%) and gentamycin (61.5%) and co-trimoxazole (50%). Staphylococcus aureus was found 81.83% sensitive to nitrofurantoin followed by lavofloxacin (63.6%) and gentamycin (54.5%).
Conclusion: For empirical treatment nitrofurantion seems to be drug of choice followed by lavofloxacin and ampicillin sulbactam. The regular screening of bacterial pathogen in infertile man seems necessary because it affects infertility in several ways.
Background: N. gonorrhoeae is a major cause of urethritis, prostatitis and epididymitis in men. In the male urogenital tract, the bacteria or soluble products of their metabolism may interact with sperm, and alter their quality. Aims: To determine the in vitro effect of incubation of N. gonorrhoeae and soluble products of their metabolism on sperm quality and assess the bacteria-sperm interaction. Methods: Soluble products of bacterial metabolism and 0.5 McFarland concentration of N. gonorrhoeae were incubated with semen samples from healthy volunteers. Conventional (motility and viability) and functional sperm parameters (potential of mitochondrial membrane integrity and sperm membrane lipid peroxidation, detection of reactive oxygen species, chromatin integrity and expression of annexin V) were quantified using microscopy and cytometry flow, respectively. To assess the interaction of N. gonorrhoeae to human sperm microscopic observation was performed. Results: N. gonorrhoeae can join the sperm and decreases sperm viability after 1.5 hours of incubation with human sperm (84.5% vs 66.5%, p<0.05), without affecting the functional sperm parameters. Conclusion: N. gonorrhoeae interacts with human sperm affecting sperm viability.
Purpose:
This study aims to estimate the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) by conducting a meta-analysis.
Methods:
Relevant publications were searched using PubMed, Embase, CBM, China National Knowledge Infrastructure, VIP and Wanfang databases up to August 2015. Studies that reported the prevalence of erectile dysfunction, premature ejaculation and total sexual dysfunction in men with CP/CPPS were included.
Results:
A total of 24 studies involving 11,189 men were included. Overall prevalence of sexual dysfunction in men with CP/CPPS was 0.62 (95 % CI 0.48-0.75), while the prevalence of erectile dysfunction and premature ejaculation was 0.29 (95 % CI 0.24-0.33) and 0.40 (95 % CI 0.30-0.50), respectively. From 1999 to 2010, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.65 (95 % CI 0.45-0.83), 0.27 (95 % CI 0.22-0.33) and 0.41 (95 % CI 0.27-0.55), respectively. From 2011 to 2014, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.50 (95 % CI 0.22-0.75), 0.35 (95 % CI 0.29- 0.40) and 0.39 (95 % CI 0.37-0.41), respectively.
Conclusion:
The prevalence of sexual dysfunction in men with CP/CPPS was high, even though overall sexual dysfunction demonstrated a slightly decreasing trend. Furthermore, erectile dysfunction prevalence rate had an increasing trend in recent years. More prospective studies are needed to evaluate sexual dysfunction improvement with better management of CP/CPPS.
Objective:
This study aimed to determine the incidence of Ureaplasma urealyticum and Mycoplasma hominis infections in infertile and fertile men and to investigate their effects on the semen quality. The study also aimed to analyze the drug susceptibility of UU and MH to provide guidance for reasonable antibiotic use.
Methods:
A total of 19,098 semen specimens were obtained from infertile men at our hospital from January to December 2014. In addition to these specimens, 3368 semen specimens of sperm were obtained from donors at the sperm bank of our hospital from January 2011 to December 2014. Semen analysis was performed using the methods outlined by the World Health Organization.
Results:
The prevalence of UU and MH significantly differed between infertile and fertile men. The mean progressive motility, total motility, and normal forms in the semen samples of infertile males positive for UU significantly differed from the corresponding values of uninfected men. However, the semen parameters did not differ between MH-infected and uninfected men. In the antibiotic sensitivity test, UU, MH, and UU mixed with MH were all found susceptible to doxycycline and josamycin with drug resistance rates below 6 %, but both species were highly resistant to ciprofloxacin.
Conclusions:
Clinical assessment revealed a significant relationship between UU and MH infections and male infertility. UU was found to significantly affect sperm quality, but this was not the case with MH. Doxycycline and josamycin should be preferred for clinically treating UU and MH infections.
Although chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and CP/CPPS, most of which were limited by their cross-sectional study design and lack of control for possible confounders. To address these limitations, we performed a cohort study of major lifestyle factors (obesity, smoking, and hypertension) with CP/CPPS risk in the Health Professionals Follow-up Study (HPFS), a large ongoing cohort of US-based male health professionals.
The HPFS includes 51,529 men aged 40-75 years at baseline in 1986. At enrollment and every two years thereafter, participants have completed questionnaires on lifestyle and health conditions. In 2008, participants completed an additional set of questions on recent CP/CPPS pain symptoms modified from the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), as well as questions on approximate date of symptom onset. Participants with NIH-CPSI pain scores ≥8 who first experienced symptoms after 1986 were considered incident CP/CPPS cases (n=653) and those who completed CP/CPPS questions but did not report CP/CPPS-related pain were considered non-cases (n=19,138).
No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking, and hypertension with CP/CPPS risk (all odds ratios ≤1.34).
In this large cohort study, none of the lifestyle factors examined was associated with CP/CPPS risk. As the etiology of CP/CPPS remains unknown, additional prospective studies are needed to elucidate modifiable risk factors for this common condition.
Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Full text available at: dx.doi.org/10.1016/j.juro.2015.05.100
Objectives
To improve awareness and recognition of these conditions among non-specialists and patients.To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non-specialist and specialist settings.To promote efficient referral of care between non-specialists and specialists and the involvement of the multidisciplinary team (MDT).Patients and Methods
The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months).Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014).A Delphi panel process was used where high-quality, published evidence was lacking.ResultsCBP and CP/CPPS can present with a wide range of clinical manifestations. The 4 main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS - voiding or storage symptoms), psychological issues and sexual dysfunction.Patients should be managed according to their individual symptom pattern. Options for first-line treatment include antibiotics, alpha-adrenergic antagonists (if voiding LUTS are present) and simple analgesics.Repeated use of antibiotics such as quinolones should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause.Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures.An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, GPs, cognitive behavioural therapists/psychologists, sexual health specialists) is recommended.Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle.Conclusion
Chronic prostatitis can present with a wide variety of signs and symptoms.Identification of individual symptom patterns and a symptom-based treatment approach are recommended.Further research is required to evaluate management options for CBP and CP/CPPS.This article is protected by copyright. All rights reserved.
Chronic bacterial prostatitis (CBP) is caused by bacterial infection and maintains a condition of lower urinary tract infection. It may be a cause of male infertility. However, studies showed inconsistent results regarding the effect of CBP on several parameters of semen. Hence, we conducted a meta-analysis to examine the effect of CBP on basic semen parameters. A systematic review was conducted with Medline, PubMed, EMBASE, and two Chinese databases (CNKI and WANG FANG) to identify relevant studies that involved the effect of CBP on semen parameters up to July 2014. Both RevMan5.2 and STATA 12.0 software were used for the statistical analysis. Based on the inclusion and exclusion criteria, seven studies were included. The study illustrated that sperm vitality, sperm total motility, and the percentage of progressively motile sperm from CBP patients were significantly lower than controls (SMD(95%CI) -0.81[-1.14, -0.47], -1.00[-1.28, -0.73], -0.41 [-0.70, -0.12], P<0.05, respectively). However, CBP had no significant effect on semen volume, sperm concentration and the duration of semen liquefaction. In summary, our study revealed that there was a significant negative effect of CBP on sperm vitality, sperm total motility, and the percentage of progressively motile sperm. Additional, studies with larger number of subjects are needed.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the risk factors of impaired male fertility potential. Studies have investigated the effect of CP/CPPS on several semen parameters but have shown inconsistent results. Hence, we performed a systematic literature review and meta-analysis to assess the association between CP/CPPS and basic semen parameters in adult men.
Systematic literature searches were conducted with PubMed, EMBASE and the Cochrane Library up to August 2013 for case-control studies that involved the impact of CP/CPSS on semen parameters. Meta-analysis was performed with Review Manager and Stata software. Standard mean differences (SMD) of semen parameters were identified with 95% confidence intervals (95% CI) in a random effects model.
Twelve studies were identified, including 999 cases of CP/CPPS and 455 controls. Our results illustrated that the sperm concentration and the percentage of progressively motile sperm and morphologically normal sperm from patients with CP/CPPS were significantly lower than controls (SMD (95% CI) -14.12 (-21.69, -6.63), -5.94 (-8.63, -3.25) and -8.26 (-11.83, -4.66), respectively). However, semen volume in the CP/CPPS group was higher than in the control group (SMD (95% CI) 0.50 (0.11, 0.89)). There was no significant effect of CP/CPPS on the total sperm count, sperm total motility, and sperm vitality.
The present study illustrates that there was a significant negative effect of CP/CPPS on sperm concentration, sperm progressive motility, and normal sperm morphology. Further studies with larger sample sizes are needed to better illuminate the negative impact of CP/CPPS on semen parameters.
While many investigators have studied symptomatic prostatitis, little research has been done with regard to asymptomatic (NIH-IV) prostatitis.
To describe the prevalence of and risk factors for NIH-IV prostatitis among a large male population.
The study population was comprised of 1,868 men at the second phase recruitment of a population-based cohort in China. Asymptomatic and symptomatic men were defined by the National Institutes of Health Chronic Prostatitis (CP) Symptom Index. Meanwhile, EPS specimens and their leukocyte count were collected. Lifestyle and demographic characteristics were obtained through a questionnaire.
Prevalence of NIH-IV prostatitis was 21.1% among 1,868 asymptomatic men aged 19-78 years and increased with age. After adjusteing for potential confounding variables (age, smoking habits, alcohol drinking habits, education, physical activity, hypertension, dyslipidemia, obesity and diabetes), age remained a significant factor for NIH-IV prostatitis (OR = 1.35; 95% CI = 1.06-1.71; P = 0.01) and the risk of NIH-IV prostatitis was significantly higher in smokers≧15 pack/years than non-smokers (OR = 1.33; 95% CI = 1.01-1.75; P = 0.03). In addition, compared with non-drinkers, the OR of NIH-IV prostatitis in drinkers ≧1 drinks/week was 1.35 (95% CI = 1.03, 1.77, p = 0.02) after adjusting for the other variables above. In addition, having less than a college education may be a risk factor for NIH-IV prostatitis, although a statistically significant difference did not exist in our data (OR = 1.22; 95% CI = 0.97-1.52; P = 0.08).
Our findings suggest that NIH-IV prostatitis is prevalent in China. Age, smoking, drinking and lower education levels were associated with an increased risk of NIH-IV prostatitis. The prevalence of NIH-IV prostatitis should be taken into account when estimating the total prevalence of CP in future studies.
The etiology of chronic prostatitis syndromes in men is controversial, particularly when positive cultures for established uropathogens are lacking. Although identification of bacteria in prostatic fluid has relied on cultivation and microscopy, most microorganisms in the environment, including some human pathogens, are resistant to cultivation. We report here on an rRNA-based molecular phylogenetic approach to the identification of bacteria in prostate fluid from prostatitis patients. Positive bacterial signals were seen for 65% of patients with chronic prostatitis overall. Seven of 11 patients with bacterial signals but none of 6 patients without bacterial signals were cured with antibiotic-based therapy. Results indicate the occurrence in the prostate fluid of a wide spectrum of bacterial species representing several genera. Most rRNA genes were closely related to those of species belonging to the genera Corynebacterium, Staphylococcus, Peptostreptococcus, Streptococcus, and Escherichia. Unexpectedly, a wide diversity of Corynebacterium species was found in high proportion compared to the proportions of other bacterial species found. A subset of these 16S rRNA sequences represent those of undescribed species on the basis of their positions in phylogenetic trees. These uncharacterized organisms were not detected in control samples, suggesting that the organisms have a role in the disease or are the consequence of the disease. These studies show that microorganisms associated with prostatitis generally occur as complex microbial communities that differ between patients. The results also indicate that microbial communities distinct from those associated with prostatitis may occur at low levels in normal prostatic fluid.
At coitus, human sperm are deposited into the anterior vagina, where, to avoid vaginal acid and immune responses, they quickly
contact cervical mucus and enter the cervix. Cervical mucus filters out sperm with poor morphology and motility and as such
only a minority of ejaculated sperm actually enter the cervix. In the uterus, muscular contractions may enhance passage of
sperm through the uterine cavity. A few thousand sperm swim through the uterotubal junctions to reach the Fallopian tubes
(uterine tubes, oviducts) where sperm are stored in a reservoir, or at least maintained in a fertile state, by interacting
with endosalpingeal (oviductal) epithelium. As the time of ovulation approaches, sperm become capacitated and hyperactivated,
which enables them to proceed towards the tubal ampulla. Sperm may be guided to the oocyte by a combination of thermotaxis
and chemotaxis. Motility hyperactivation assists sperm in penetrating mucus in the tubes and the cumulus oophorus and zona
pellucida of the oocyte, so that they may finally fuse with the oocyte plasma membrane. Knowledge of the biology of sperm
transport can inspire improvements in artificial insemination, IVF, the diagnosis of infertility and the development of contraceptives.
Chronic Prostatitis is a common and debilitating condition affecting 5-12% of men worldwide. The most common form is category III, or Chronic Pelvic Pain Syndrome. Cutting-edge clinical research has led to advancements in the diagnosis and treatment of prostatitis, a group of conditions that is at once extremely common, poorly understood, inadequately treated and under-researched. In Chronic Prostatitis / Chronic Pelvic Pain Syndrome, the author provides today’s most current information covering the four categories of prostatitis (acute, chronic bacterial, CPPS and asymptomatic inflammation). A diverse international group of contributors that includes Urologists (academic, primary care and front line private practice), scientists, psychologists, and pain specialists from the National Institutes of Health provide the reader with novel approaches to helping their patients. The chapters in this important new work cover general evaluation of the prostatitis patient, the approach to acute prostatitis, chronic bacterial prostatitis and chronic pelvic pain syndrome, evidence behind individual therapies and ancillary topics such as erectile dysfunction, infertility, the link between chronic prostatitis and prostate cancer, male interstitial cystitis and the potential etiologic role of calcifying nanoparticles. Chronic Prostatitis / Chronic Pelvic Pain Syndrome offers novel approaches to diagnosing this condition as well as providing ways in which to ease the suffering of the patient with prostatitis.
Los espermatozoides viajan por el tracto reproductivo femenino en búsqueda del oocito con el fin de fecundarlo. En su recorrido interactúan con diferentes sustancias y microorganismos que alteran la biología espermática, interfiriendo con el éxito reproductivo. El objetivo de este trabajo fue evaluar la capacidad que tienen los espermatozoides humanos de interactuar y transportar las bacterias Escherichia coli (E. coli) y Enterococcus faecalis (E. faecalis).
Las infecciones del tracto genitourinario están relacionadas con un alto porcentaje de casos de infertilidad masculina, sin embargo, en la gran mayoría estas infecciones suelen ser asintomáticas y los microorganismos responsables no siempre son identificados. El objetivo de este trabajo fue detectar la presencia de las bacterias Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae) y Ureaplasma urealyticum (U. urealyticum) en el semen de voluntarios aparentemente sanos.
El contacto de los espermatozoides con algunas especies bacterianas y sus factores solubles tiene un efecto negativo en la calidad seminal, alterando la función reproductiva del hombre. El objetivo de este trabajo fue determinar el efecto de 2 bacterias enteropatógenas (Escherichia coli [E. coli] y Enterococcus faecalis [E. faecalis]) y sus factores solubles sobre la calidad espermática.
The aim of this study was to describe the prevalence of and risk factors for prostatitis-like symptoms and its relation to erectile dysfunction (ED) among southern Chinese men. Data were collected from 2790 men attending the Fangchenggang Area Male Healthy and Examination Survey from September 2009 to December 2009. The prostatitis-like symptoms were assessed by the NIH Chronic Prostatitis Symptom Index and ED was assessed using the 5-item International Index of Erectile Function. Lifestyle and demographic characteristics were obtained through a questionnaire. Prevalence of prostatitis-like symptoms was 12.4% among 2790 Chinese men aged 20–84 years. In smokers who smoked ≥20 cigarettes per day (age-adjusted OR = 1.29; 95% CI = 1.00–1.66; p = 0.04), physical inactivity (age-adjusted OR = 1.31; 95% CI = 1.03–1.66; p = 0.02) was a significant risk factor for prostatitis-like symptoms. Alcohol consumption (daily drinking) also was a risk factor for prostatitis-like symptoms, although the differences were not statistically significant (age-adjusted OR = 1.36; 95% CI = 0.96–1.92; p = 0.07). Those with diabetes may also be at higher risk for prostatitis-like symptoms (age-adjusted OR = 1.37; 95% CI = 0.85–2.21; p = 0.19). In addition, men with ED were more likely to have had prostatitis-like symptoms (age-adjusted OR = 1.86; 95% CI = 0.47–2.36; p < 0.0001), and the ORs increased with increasing severity of ED status (mild ED, mild to moderate ED, and moderate to severe ED were 1.57, 2.62, and 3.24, respectively. Test for trend, p = 0.0001). Our results show that prostatitis-like symptoms are prevalent in Southern China affecting men of all ages. Smoking, drinking, lack of physical activity, and elevated plasma glucose level were associated with an increased risk of prostatitis-like symptoms. In addition, our results reveal that ED accounted for a large proportion (61.5%) among men with prostatitis-like symptoms; we also confirm the magnitude of ED associated with prostatitis-like symptoms. Thus, interventions to evaluate and improve ED might help ameliorate prostatitis-like symptoms and vice versa.
Background: The interaction between sperm with some bacteria species and their soluble factors are the deterioration of semen quality by altering the reproductive function of man. Aim: The aim of this study was to determine the effect of soluble factors Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus capitis on semen quality. Methods: The soluble factors product of bacterial metabolism of the strains of S. aureus and S. capitis methicillin sensitive and S. aureus and S. epidermidis resistant to oxacillin, were incubated with semen samples from 20 volunteers. Subsequently, conventional seminal parameters were measured and functional quantified by microscopy and flow cytometry, respectively. Results: A decrease was observed in sperm motility with soluble factors of S. aureus, this decrease was higher with the sensitive strain that with oxacillin resistant strain and the negative effect on motility was immediate. By incubating the sperm with soluble factor from oxacillin-sensitive S. aureus, all functional parameters were affected except the chromatin integrity and reduced release of reactive oxygen species, mean fluorescence intensity in oxacillin resistant S. aureus strain was decrease in membrane lipid peroxidation and annexin V expression. Conclusions: This study reports the negative effect of soluble factors of bacteria either S. aureus sensitive and resistant to oxacillin, over conventional and functional sperm parameters, and therefore in their reproductive function.
Background: Microorganisms can find the optimal conditions for survival in semen, causing damage to the spermatozoa and triggering processes of infertility or reproductive tract infections. Therefore, understanding the role of the microorganisms present in semen can help to improve the diagnosis of infertility cases where the only apparent cause is infectious processes. Objective: To describe and correlate semen parameters and bacterial growth in ejaculate. Methods: Identification of microorganisms isolated in 43 clinical spermocultures and 28 research spermocultures. We assessed colony-forming unit counts and sperm characteristics of research spermocultures. In addition, semen parameters were evaluated in each ejaculate. Results: Bacterial growth was obtained in 14 (32.6%) of the 43 clinical spermocultures and 15 (53.6%) of the 28 research spermocultures. The isolated microorganisms were Enterococcus faecalis, Escherichia coli, Morganella morganii, Staphylococcus coagulase negative, Klebsiella pneumoniae and mixed microbiota. Finally, in this study a large growth of aerobic cocci was observed. We did not find association between the decline in the quality of semen parameters and microorganisms. Conclusion: The presence of bacteria in semen does not affect semen quality.
CD64 is a 72-kDa transmembrane glycoprotein, the highest affinity receptor of immunoglobulin (IgG), and a member of the IgG superfamily. The CD64 expression by leukocytes in the prostatic fluid was determined by flow cytometry to explore the clinical significance of this glycoprotein in the diagnosis of chronic prostatitis (CP).
Prostatic fluid samples collected from 116 CP patients and 27 normal cases were subjected to bacterial culture and leukocyte CD64 expression determination using flow cytometry with monoclonal antibodies.
The leukocyte CD64 expression levels of the pathogen groups were significantly higher than those of the normal groups, especially those of Staphylococcus simulans (3879.26 ± 764.52/cell) and Staphylococcus auricularis (2903.14 ± 137.61/cell). The leukocyte CD64 expression in the prostatic fluid was more rapidly and accurately detected by flow cytometry than by bacterial culture.
CD64 expression by leukocytes in the prostatic fluid correlated with bacterial infection and may serve as a marker for the early diagnosis of CP.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Objective:
To evaluate the incidence of prostatitis-like symptoms (PLS) in men with or without PE, and the differences among the 438 outpatients with the four PE syndromes.
Subjects and methods:
Between January 2012 and January 2013, 438 consecutive heterosexual men complaining of PE and another 493 male healthy subjects without the complaint were included in this study. Each of them completed a detailed face-to-face questionnaire for information of demographics, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function-5 (IIEF-5). Each patient was classified as one of the four PE subtypes: lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), or premature-like ejaculatory dysfunction (PLED).
Results:
There were no significant difference between patients and control subjects regarding demographics. In the PE group, the prevalence of PLS were 32%, showing statistical significance compared with control subjects (15.8%, P<0.001). And the NIH-CPSI score was 10.0±7.9, showing significant difference compared with control subjects (6.0± 5.4, P<0.001). Among the four PE syndromes, patients with PLED had the highest prevalence of PLS (42.3%, P<0.001), but the difference of NIH-CPSI scores among the four PE syndromes was not significant (P=0.055).
Conclusions:
PLS were more common in patients with PE. Also, patients had worse NIH-CPSI scores than the control subjects. Therefore, patients with PLED had the highest incidence of PLS.
Changes in levels of oxidative damage products in semen and their relationship to seminal fluid viscosity (SFV) have recently received increasing research interest. We analysed whether SFV was associated with ROS generation, levels of cytokines TNF-alpha (TNF-α), IL-6 and IL-10 and seminal leucocyte concentration, and whether ROS production was related to the extent of infections/inflammations at one (prostatitis) or two (prostato-vesiculitis) male accessory glands. We studied 169 infertile patients, with chronic bacterial prostatitis (PR, n = 74) and/or bilateral prostato-vesiculitis (PV, n = 95), as diagnosed by the ultrasound (US) criteria. Healthy fertile men (n = 42) served as controls. In the PV patient group, SFV, semen characteristics and ROS production had median values that were significantly higher than those found in PR patients and controls, although other sperm variables had values significantly lower than those found in PR patients or controls. In PV infertile patients, ROS generation and pro-inflammatory cytokines levels were higher than those found in PR infertile patients and controls, although seminal IL-10 levels in PV and PR patients were lower than those found in the controls. In PR patients, the levels of SFV were positively related to TNF-α (r = 0.67; P < 0.01), fMLP-stimulated ROS production in the 45% Percoll fraction (r = 0.687, P < 0.01) and the 90% Percoll fraction in basal condition (r = 0.695, P < 0.01), and after fMLP-stimulation (r = 0.688, P < 0.01). Thus, our data indicated that seminal hyperviscosity is associated with increased oxidative stress in infertile men and increased pro-inflammatory interleukins in patients with male accessory gland infection, more when the infection was extended to the seminal vesicles.
Nutraceuticals are food products that that can provide medical or health benefits by preventing or treating disease processes. The high costs associated with assisted reproductive techniques for male infertility have led consumers to find less expensive alternatives for potential treatment. Nutraceuticals are widely available and have many antioxidant properties. This articles reviews the current English literature regarding readily available nutraceuticals and their potential effects on male infertility and potential side effects with excess intake.
Background:
Chronic bacterial prostatitis (CBP) is frequently diagnosed in men of fertile age, and is characterized by a disabling array of symptoms, including pain in the pelvic area (for example, perineum, testicles), voiding symptoms (increased frequency and urgency, also at night; pain or discomfort at micturition), and sexual dysfunction. Cure of CBP can be attempted by long-term therapy with antibacterial agents, but relapses are frequent. Few antibacterial agents are able to distribute to the prostatic tissue and achieve sufficient concentrations at the site of infection. These agents include fluoroquinolones, macrolides, tetracyclines and trimethoprim. After the introduction of fluoroquinolones into clinical practice, a number of studies have been performed to optimize the antimicrobial treatment of CBP, and to improve eradication rates and symptom relief.
Objectives:
To assess and compare the efficacy and harm of antimicrobial treatments for chronic bacterial prostatitis.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, other national or international databases and abstracts from conference proceedings on 8 August 2012.
Selection criteria:
We included all randomized controlled comparisons of one antimicrobial agent versus placebo or one or more comparator antimicrobial agents, combined or not with non-antimicrobial drugs. We also included trials comparing different doses, treatment durations, dosing frequencies, or routes of administration of antimicrobial agents. We excluded studies in which patients were not diagnosed according to internationally recommended criteria, or were not subjected to lower urinary tract segmented tests.
Data collection and analysis:
Study data were extracted independently by two review authors. Study outcomes were microbiological efficacy (pathogen eradication), clinical efficacy (symptom cure or improvement, or symptom scores) at test-of-cure visits or at follow-up, or both, and adverse effects of therapy. Secondary outcomes included microbiological recurrence rates.Statistical analysis was performed using a fixed-effect model for microbiological outcomes and a random-effects model for clinical outcomes and adverse effects. The results were expressed as risk ratios for dichotomous outcomes (with 95% confidence intervals) or as standardized mean differences for continuous or non-dichotomous variables.
Main results:
We identified 18 studies, enrolling a total of 2196 randomized patients. The oral fluoroquinolones ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin and prulifloxacin were compared. There were no significant differences in clinical or microbiological efficacy or in the rate of adverse effects between these fluoroquinolones. In chlamydial prostatitis, (i) azithromycin showed improved eradication rates and clinical cure rates compared to ciprofloxacin, with no significant differences regarding adverse effects; (ii) azithromycin was equivalent to clarithromycin, both microbiologically and clinically; (iii) prulifloxacin appeared to improve clinical symptoms, but not eradication rates, compared to doxycycline. In ureaplasmal prostatitis, the comparisons ofloxacin versus minocycline and azithromycin versus doxycycline showed similar microbiological, clinical and toxicity profiles.
Authors' conclusions:
The microbiological and clinical efficacy, as well as the adverse effect profile, of different oral fluoroquinolones are comparable. No conclusions can be drawn regarding the optimal treatment duration of fluoroquinolones in the treatment of CBP caused by traditional pathogens.Alternative antimicrobial agents tested for the treatment of CBP caused by traditional pathogens are co-trimoxazole, beta-lactams and tetracyclines, but no conclusive evidence can be drawn regarding the role of non-fluoroquinolone antibiotics in the treatment of CBP caused by traditional pathogens.In patients with CBP caused by obligate intracellular pathogens, macrolides showed higher microbiological and clinical cure rates compared to fluoroquinolones.
Objective Identifying the main aetiological agents of sexually transmitted infections (STI) in a high-risk population from the city of Montería, Colombia. Methodology The population consisted of 69 sex-workers (high-risk group) and 16 housewives (low-risk group) living in the city of Montería. Specimens were cultured by standard microbiological methods and by the AMPLICOR CT/NG molecular technique. Results Patients were aged 18-44 (26.1 average age). It was determined that 17,4% of the high-risk population were positive for G. vaginalis, 15,9 % for C. trachomatis, 4,3 % for N. gonorrhoeae and 2,9 % for T. vaginalis and Candida albicans and, in the low-risk population, 56,3 % for G. vaginalis, 12,5 % for C. trachomatis, 6,3 % for N. gonorrhoeae and 12,5 % for C. albicans. It was found that 70 % of the sex-workers had 5-10 sexual relationships per week, 10 % 11-15 per week and 20 % 16-20 per week (average above 1 000 annual partners). 15,4 % of the sex-workers did not use protection during their sexual relationships. Conclusions The high rates of infection found in the populations studied presume a high risk of transmission, making it a priority to intervene in these groups to prevent the spread of HIV and STI.
Purpose:
As part of the RICE (RAND Interstitial Cystitis Epidemiology) study, we developed validated case definitions to identify interstitial cystitis/bladder pain syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Using population based screening methods, we applied these case definitions to determine the prevalence of these conditions in men.
Materials and methods:
A total of 6,072 households were contacted by telephone to screen for men who had symptoms of interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome. An initial 296 men screened positive, of whom 149 met the inclusionary criteria and completed the telephone interview. For interstitial cystitis/bladder pain syndrome 2 case definitions were applied (1 with high sensitivity and 1 with high specificity), while for chronic prostatitis/chronic pelvic pain syndrome a single case definition (with high sensitivity and specificity) was used. These case definitions were used to classify subjects into groups based on diagnosis.
Results:
The interstitial cystitis/bladder pain syndrome weighted prevalence estimates for the high sensitivity and high specificity definitions were 4.2% (3.1-5.3) and 1.9% (1.1-2.7), respectively. The chronic prostatitis/chronic pelvic pain syndrome weighted prevalence estimate was 1.8% (0.9-2.7). These values equate to 1,986,972 (95% CI 966,042-2,996,924) men with chronic prostatitis/chronic pelvic pain syndrome and 2,107,727 (95% CI 1,240,485-2,974,969) men with the high specificity definition of interstitial cystitis/bladder pain syndrome in the United States. The overlap between men who met the high specificity interstitial cystitis/bladder pain syndrome case definition or the chronic prostatitis/chronic pelvic pain syndrome case definition was 17%.
Conclusions:
Symptoms of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome are widespread among men in the United States. The prevalence of interstitial cystitis/bladder pain syndrome symptoms in men approaches that in women, suggesting that this condition may be underdiagnosed in the male population.
This study was performed to evaluate the prevalence of erectile dysfunction (ED) and to explore its correlation to chronic prostatitis in China. A cross-sectional investigation from a large cohort study of Chinese men was used in this survey. A questionnaire consisting of general information regarding socio-demographics, chronic disease history, sexual function, the National Institutes of Health-Chronic Prostatitis Symptom Index, and the International Index of Erectile Function-5 (IIEF-5) was administered to 15 000 Chinese men aged from 15 to 60. The prevalence of ED was determined from the patient's self-evaluation and IIEF-5 score. The eligible individual both was married and had intercourse experience. In total, there were 12 743 respondents, giving a response rate of 84.95%. Among 7372 eligible men, ED prevalence as assessed by self-report and IIEF-5 score was 12.0% and 17.1%, respectively. Among 771 men with prostatitis-like symptoms, ED prevalence as assessed by self-report and IIEF-5 score was 39.3% and 30.1%, respectively. Among 370 men suffering from chronic prostatitis, ED prevalence as assessed by self-report and IIEF-5 score was 40.5% and 35.1%, respectively. The prevalence of self-reported and IIEF-5 score-assessed ED had high correlation with increasing age among all eligible men, men with prostatitis-like symptoms, and men with chronic prostatitis (Pt<.05, Ps<.05, Pcp<.05). ED prevalence as assessed by both self-report and IIEF-5 score was higher in men with prostatitis-like symptoms and with chronic prostatitis than in the general group (Ps<.05, Pcp<.05). The prevalence of ED was higher in the prostatitis population than in the general population with either self-reported or IIEF-5 score assessment. The prevalence was higher with self-reported than with IIEF-5 assessment in men with prostatitis. Estimates of ED prevalence among men with prostatitis should not rely on self-reporting alone in that this is likely to overestimate the true prevalence.
Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life of men. We evaluated the prevalence of premature ejaculation (PE) in Chinese men with chronic pelvic pain syndrome and studied its correlation to chronic prostatitis.
A total of 15,000 men (aged 15-60 years) were randomly recruited to take part in a survey to provide questionnaire-elicited information for sociodemographics, sexual function, National Institutes of Health-Chronic Prostatitis Symptom Index, and International Index of Erectile Function 5-item questionnaire. The eligible subjects of the present investigation were married with sexual activity.
Responses were collected from 12 743 men (84.95%). Of these men, 1071 (8.4%) reported having prostatitis-like symptoms. The incidence of chronic prostatitis was 4.5% (n = 571) for the entire group. Of the 7372 eligible men, the incidence of prostatitis-like symptoms, chronic prostatitis, and PE was 10.5% (n = 771), 5.0% (n = 370), and 15.3% (n = 1127), respectively. The group with PE had worse National Institutes of Health-Chronic Prostatitis Symptom Index scores (P < .05) and lower International Index of Erectile Function 5-item questionnaire scores (P < .05) than the patients without PE. Also, the percentage of prostatitis-like symptoms in the PE group was greater than that in the non-PE group (P < .05). The prevalence of PE was 64.1% and 36.9% in the prostatitis-like symptom and chronic prostatitis group, respectively, of the 7372 eligible men.
The results of our study showed a high prevalence of PE in patients with chronic prostatitis. An examination of the prostate, physically and microbiologically, should be considered during the assessment of patients with PE.
Study Type - Prognosis (cohort) Level of Evidence 2a.
To provide a summary, using the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), of the prevalence of prostatitis-like symptoms in a population-based sample of Australian men.
Participants were Australian men aged 16-64 years recruited as part of the Australian Longitudinal Study of Health and Relationships: a nationally representative study. In all, 1346 men completed an extensive questionnaire which included the NIH-CPSI. The index identifies six types of urogenital pain, the presence of urinary problems, and effects on quality of life. Men who reported perineal and/or ejaculatory pain or discomfort and a total NIH-CPSI pain score of > or =4 were considered as having prostatitis-like symptoms.
Based on a weighted population of 1373 men, some form of urogenital pain was reported by 105 (7.6%) men; with 2.8% of men reporting more than one type of urogenital pain. The mean (range) NIH-CPSI pain score for men reporting pain was 6.2 (5.6-6.8); for all men the mean score was 0.5 (0.4-0.6). About 20% of men (284) were considered to have urinary problems. The mean urinary symptom score for all men was 0.9 (0.9-1.0). The mean total NIH-CPSI score for men reporting pain was 13.3 (12.0-14.7) and for all men it was 2.6 (2.3-2.8). The estimated prevalence of prostatitis-like symptoms was approximately 2%.
Using the NIH-CPSI the estimated prevalence for urogenital pain in Australian men is 8%; an estimated 3% of men experience pain from more than one urogenital location. The estimated prevalence of prostatitis-like symptoms in Australian men is 2%. Almost a third of Australian men experiencing urogenital pain or prostatitis-like symptoms would be less than satisfied if this was to be ongoing for the rest of their life.
We studied the prevalence of prostatitis-like symptoms and identified their associated risk factors in a population based Chinese sample.
A volunteer group of 15,000 eligible men residing in Beijing, Anhui, Xi'an, Guangzhou and Gansu cities or provinces were invited randomly to take part in the survey to complete a questionnaire that elicited information regarding sociodemographics, Eysenck personality questionnaire, current stress and health ratings, lifestyle, medical history, expressed prostatic secretion evaluation, score of the National Institutes of Health Chronic Prostatitis Symptom Index and International Index of Erectile Function-5.
Information on 12,743 (84.95%) men was collected. Of these men 1,071 (8.4%) reported prostatitis-like symptoms (mean National Institutes of Health Chronic Prostatitis Symptom Index pain score 7.55 +/- 3.22). The percent of chronic prostatitis was 4.5% (571) among the symptoms group according to past urological history and expressed prostatic secretion evaluation. Subjects with prostatitis-like symptoms (mean age 34.56 +/- 13.48 years) had higher mean pain and urinary symptoms scores (7.53 +/- 3.22 and 2.84 +/- 2.72, respectively) compared with subjects without prostatitis-like symptoms (1.18 +/- 2.32 and 0.72 +/- 1.66 for pain and urinary symptoms scores, respectively, mean age 30.7 +/- 10.17) (pain and symptoms scores, p <0.05). The quality of life score was 6.03 +/- 2.88 and 3.83 +/- 2.55 in groups with symptoms or nonsymptoms, respectively (p <0.05).
Prostatitis-like symptoms are a multifactorial problem affecting men of all ages (15 to 60 years) and demographics, and the prevalence is high in China. The syndrome is closely related to alcohol consumption, cigarette smoking, frequent intercourse, as well as fatigue, pressure and too little sleep. These findings suggest that risk factors for this condition are largely modifiable and highlight potential targets for future prevention.
To estimate the prevalence and examine the extent that pain, urinary symptoms, depression and pain catastrophizing predict the quality of life (QoL) in Canadian male adolescents, as the prevalence and impact of chronic prostatitis (CP)-like symptoms in adolescents is unknown.
Participants completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the Patient Health Questionnaire-depression screen (PHQ-D), and the Pain Catastrophizing Scale (PCS). CP-like case identification was based on NIH-CPSI report of pain/discomfort in perineum and/or with ejaculation and NIH-CPSI total pain score (0-20) of >or=4 (mild) and >or=8 (moderate-severe). The point prevalence was estimated and regressions used to examine predictors of diminished QoL gathered from the NIH-CPSI.
The prevalence of at least mild CP-like symptoms in 264 Canadian adolescents aged 16-19 years (mean age 17.5, sd 1.1) was 8.3%, with 3% reporting moderate-severe CP-like symptoms. Pain, urinary symptoms, depression and catastrophizing were correlated with diminished QoL. Additionally, catastrophizing predicted diminished QoL when the variance of pain, urinary symptoms and depression were simultaneously considered in the analysis.
Similar to that reported by older cohorts, these data provide the first point-prevalence estimate of CP-like symptoms in adolescents. These findings suggest increased vigilance to a potential diagnosis of adolescent CP syndrome and indicate that psychological features (i.e. catastrophizing) are significant in diminished QoL. Adolescent male chronic pelvic pain is an important and understudied area for future investigations.
Transrectal ultrasonography (US) provides excellent anatomic detail of pathologic changes in the seminal vesicles and ejaculatory ducts. Fifty-two patients with US findings of seminal vesicle dilatation or cysts, ejaculatory duct cysts, or seminal vesicle or ejaculatory duct calculi were given questionnaires concerning a broad spectrum of genito-urinary symptoms. Compared with age-matched controls with normal US findings, patients with calculi in the seminal vesicles or ejaculatory ducts had a significantly increased prevalence of hematospermia and ejaculatory pain (P less than .01), and patients with cystic dilatation of the seminal vesicles were more likely to have perineal pain. Large midline cysts containing calculi or debris were symptomatic and probably represent müllerian duct remnants. Small cysts of the ejaculatory ducts were asymptomatic. Transrectal US may provide clinical insight into the causes of significant genitourinary symptoms that may previously have been ascribed to chronic nonbacterial prostatitis or have been considered to be idiopathic.
To define the prevalence of bacterial prostatitis and urinary tract infection (U.T.I) among benign prostatic hyperplasia patients (B.H.P) undergoing prostatectomy trans urethral resection of prostate (T.U.R.P.), 100 consecutive patient has their preoperative and post-operative urine cultures along with tissue culture of the resected prostatic tissue. Our data suggests that significant incidence (42%) of bacterial growth in prostatic tissue-occurs in patients with B.H.P. Pre-existing U.T.I. is not a reliable indicator by which this group could be identified pre-operatively and prostatic infection could be treated.
To describe the occurrence of a physician-assigned diagnosis of prostatitis in a community-based cohort.
A sampling frame of all Olmsted County, Minnesota, male residents was used to randomly select a cohort of men between 40 and 79 years old by January 1, 1990, to participate in a longitudinal study of lower urinary tract symptoms. The 2115 participants (response rate 55%) completed a previously validated self-administered questionnaire that assessed the prevalence of lower urinary tract symptoms, including a history of prostatitis. Subsequently, all inpatient and outpatient community medical records of participants were reviewed retrospectively for a physician-assigned diagnosis of prostatitis from the date of initiation of the medical record through the date of the last follow-up.
The overall prevalence rate of a physician-assigned diagnosis of prostatitis was 9%. Men identified with the diagnosis of "prostatitis" had symptoms of dysuria and frequency and rectal, perineal, suprapubic, and lower back pain. Among men with a previous diagnosis of prostatitis, the cumulative probability of subsequent episodes of prostatitis was much higher (20%, 38%, and 50% among men 40, 60, and 80 years old, respectively).
These findings indicate that the community-based prevalence of a physician-assigned diagnosis of prostatitis is high, of similar magnitude to that of ischemic heart disease and diabetes. Furthermore, once a man has an initial episode of prostatitis, he is more likely to suffer chronic episodes than men without a diagnosis. Although the pathologic mechanisms underlying these diagnoses are not certain, these data provide a first step toward understanding how frequently the diagnosis occurs in the community.
The National Institutes of Health (NIH) chronic prostatitis symptom index was used to determine the prevalence of prostatitis-like symptoms among men (age 20 to 74 years) at risk in a community based study.
The study was a cross-sectional postal survey of men age 20 to 74 years in Lennox and Addington counties, which included a large rural area, 1 major town and a suburban area with a stable population of men representative of Canadian demographics. The questionnaire collected information on 2 domains of chronic prostatitis identified in the NIH chronic prostatitis symptom index, including pain (location, severity and frequency), voiding function (irritative, obstructive), demographics, quality of life, general health and health seeking behavior. The self-reported pain score was used to identify prostatitis-like symptoms in the most discriminating domain. Based on analysis of the index final validation study comparing patients with prostatitis to normal controls and those with benign prostatic hyperplasia, the 2 questions most specific for prostatitis, including perineal and/or ejaculatory pain/discomfort, and a total pain score (0 to 21) 4 or greater were used to identify men with significant prostatitis-like symptoms.
A total of 2,987 eligible men received the survey, and it was completed by 868 (29%). Of the men 84 (9.7%) were identified as having chronic prostatitis-like symptoms (mean NIH chronic prostatitis symptom index pain score 9.1 +/- 0.3). The average age of the prostatitis population was 50 years compared with 52 years for men without prostatitis-like symptoms. Prevalence was 11.5% in men younger than 50 years and 8.5% in men 50 years or older. Of the sampled population 57 (6.6%) men had prostatitis-like symptoms and an index pain score 8 or greater (moderate to severe). The index voiding score (0 to 10) was 4.1 +/- 0.5 in men younger than 50 years compared with 1.5 +/- 0.1 for normal controls, and 4.7 +/- 0.4 in those 50 years or older compared with 1.9 +/- 0.1 for normal controls. Of the prostatitis group 60% sought medical help for their symptoms.
In our opinion this community based study using the new prostatitis symptom index confirms that chronic prostatitis-like symptoms are common.
We surveyed the prevalence of chronic prostatitis-like symptoms in young men using the National Institutes of Health (NIH) Chronic Prostatitis Symptom Index (CPSI) and determined the clinical validity of the NIH-CPSI among men in the community. Of 29,017 men aged 20 years dwelling in the community, 8,705 men were randomly selected at a 30.0% sampling fraction and a total of 6,940 men (a response rate 79.7%) completed a self-administered questionnaire. Six percent reported having pain or discomfort in more than one area . About 5% did not feel that the bladder emptied fully after urinating more than 1 time in 5 and 10.5% had to urinate again within 2 h more than 1 time in 5. As the scores for pain or discomfort increased, those for urinary symptoms and impact on quality of life increased (P < 0.001; Armitage test). As the scores for urinary symptoms increased, those for pain or discomfort and impact on quality of life also increased (P < 0.001; Armitage test). The community-based prevalence of chronic prostatitis-like symptoms were found to be high in young men as well as in older men. Our findings indicate that men with pain or urinary symptoms experience a negative impact on their quality of life and the NIH-CPSI provides a valid measure for the general population.
To investigate the prevalence of chronic prostatitis in men with premature ejaculation. The etiology of premature ejaculation is currently considered psychological in nature. However, the possibility that urologic, hormonal, or neurologic factors may contribute to this condition should be considered in its management.
We evaluated segmented urine specimens before and after prostatic massage and expressed prostatic secretion specimens from 46 patients with premature ejaculation and 30 controls by bacteriologic localization studies. The incidence of premature ejaculation in the subjects with chronic prostatitis was also evaluated.
Prostatic inflammation was found in 56.5% and chronic bacterial prostatitis in 47.8% of the subjects with premature ejaculation, respectively. When compared with the controls, these novel findings were statistically significant (P <0.05).
Considering the role of the prostate gland in the mechanism of ejaculation, we suggest a role for chronic prostate inflammation in the pathogenesis of some cases of premature ejaculation. Since chronic prostatitis has been found with a high frequency in men with premature ejaculation, we stress the importance of a careful examination of the prostate before any pharmacologic or psychosexual therapy for premature ejaculation.
Prostatitis is an ill-defined condition whose symptoms overlap with benign prostatic hyperplasia (BPH). Little is known about the prevalence and correlates of prostatitis, or factors that distinguish prostatitis from BPH. We examined these issues in a large, nationwide sample of healthy men.
In 1992, 31,681 United States health professionals without prostate cancer provided information on urological diagnoses, lower urinary tract symptoms, and demographic, clinical and lifestyle factors. We calculated age adjusted odds ratios and 95% confidence intervals for these correlates predicting a history of prostatitis. We also compared characteristics of men with prostatitis to those with BPH.
The prevalence of a self-reported history of prostatitis was 16%. Men reporting a history of BPH had 7.7-fold greater odds of a history of prostatitis, those with moderate or severe lower urinary tract symptoms had 1.8 and 2.8-fold greater odds, respectively, those with a history of sexually transmitted disease had 1.8-fold greater odds and those reporting stress at home or work had 1.5- and 1.2-fold greater odds, respectively. The 2,163 men with prostatitis alone were younger and had less severe urinary tract symptoms (but a similar pattern of symptoms) than the 4,575 men with BPH alone.
Self-reported prostatitis was common among healthy men of all ages but there was considerable overlap with self-reported BPH. Prostatitis had several identifiable correlates that may aid in its recognition.
There is a pressing need to determine the causes and consequences of, and optimal therapy for the chronic prostatitis-chronic pelvic pain syndrome.
New data suggest that bacterial infection may be critical in some patients. We examined the rationale for and technical approaches to hypothesis driven studies of bacteria in the chronic prostatitis-chronic pelvic pain syndrome.
The first hypothesis was that patients with the chronic prostatitis-chronic pelvic pain syndrome have prostatic bacteria that distinguish them from controls. In pilot studies patients with inflamed expressed prostatic secretions were more likely to have bacterial DNAs, that is 16S ribosomal DNAs. Current goals are to clone, sequence and compare ribosomal DNAs from patients and controls to determine which bacteria are most specific to the chronic prostatitis-chronic pelvic pain syndrome and which should be targeted in clinical trials. The second hypothesis was that bacterial viability correlates with the severity of the chronic prostatitis-chronic pelvic pain syndrome. Quantitative assays for bacterial elongation factor messenger RNA (tufA messenger RNA) provide tools to correlate bacterial viability with patient characteristics, will provide insights into the potential value of antimicrobial therapy and identify characteristics that distinguish patients most likely to respond. The third hypothesis was that patients with prostatic bacteria have similar bacteria in expressed prostatic secretions or on seminal fluid analysis and, furthermore, these bacteria differ from bacteria in controls. These studies would determine whether expressed prostatic secretions or seminal fluid analysis can be used to identify prostatic bacteria and may result in clinical methods for noninvasive diagnosis of prostatic infection.
These studies should provide important insights into the causes of the chronic prostatitis-chronic pelvic pain syndrome and may elucidate optimal clinical evaluation and treatment in patients.
To study the prevalence of prostatitis-like symptoms in a generally healthy population.
A population-based cross-sectional survey was conducted in Singapore to evaluate "prostatitis-like symptoms" (PS), lower urinary tract symptoms (LUTS),erectile dysfunction (ED), and quality of life (QoL). Respondents with pain or discomfort in the perineum, testicles, tip of penis or bladder/suprapubic region were identified as having prostatitis-like symptoms.
Altogether, 1087 males aged 21 to 70 were evaluated. While at least 20% of them had some degree of LUTS, only 2.67% (29 out of 1087) had pain or discomfort suggestive of prostatitis. Six men had pain in the bladder or suprapubic region, two in the perineum, six at the tip of penis and 26 had pain during micturition (11 subjects had more than one location of pain). Only two men had severe pain while seven had moderate and the rest had mild pain. The mean age of subjects with PS was 43.14. In terms of racial distribution, 2.23% (18) of Chinese, 3.15% (4) of Malay, 4.49% (4) of Indians and 12.12% (3) of other ethnic origin had PS. Those who had PS had worse erectile function (International Index of Erectile Function (IIEF) 11.92 vs. 17.16, p < 0.003) and a worse QoL score (2.96 vs. 1.38, p < 0.001) than those without PS. Those with PS were more bothered and worried about their symptoms.
The prevalence of prostatitis-like symptoms in a largely Chinese population is 2.67%. Prostatitis-like symptoms have a negative impact on the quality of life and erectile function.
We describe a community based study to estimate the prevalence of prostatitis-like symptoms using questions similar to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).
Study subjects were a randomly selected sample of Olmsted County, Minnesota white men 40 to 79 years old in January 1990 who participated in a longitudinal study of lower urinary tract symptoms. Subjects were evaluated biennially using self-administered questionnaires. In 2000 questions similar to the NIH-CPSI were incorporated into the questionnaire and questionnaire responses were used to categorize men as having prostatitis-like symptoms.
Of 1,541 men 182 (12%) had at least 1 urogenital pain symptom. Pubic (76 men, 4.9%) and testicular (73, 4.7%) pain were the most frequent pain symptoms. A total of 34 men with prostatitis-like symptoms (2.2%) had higher mean pain (6.7 versus 0.5), urinary symptom (3.5 versus 2.1) and quality of life impact (3.7 versus 1.9) scores compared to men who did not (all p <0.001). Pain frequency (OR 39.2, 95% CI 18.8, 81.9) and pain intensity (OR 21.5, 95% CI 8.7, 52.9) were more strongly associated with prostatitis-like symptoms than urinary symptom score (OR 2.8, 95% CI 1.4, 5.6) or quality of life impact score (OR 4.5, 95% CI 1.9, 10.7).
Although urogenital pain is common among community dwelling men, prostatitis-like symptoms based on the modified questions from the NIH-CPSI are less common. While pain measures may be useful in distinguishing between men with and without prostatitis-like symptoms, the urinary symptom and quality of life impact scores could partly reflect benign prostatic hyperplasia.
We review the epidemiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and the role of infectious agents, emphasizing critical data necessary to define current research issues. The epidemiologic literature is limited, but the worldwide prevalence appears to be in the range of 2% to 10%, indicating that CP/CPPS represents an important international health problem. Recent molecular studies have documented bacterial DNA sequences in prostate tissue from CP/CPPS patients. These data suggest that colonization and/or infection occurs in the prostates of many patients with CP/CPPS. Further molecular research is needed to define the role of bacteria in the etiology of CP/CPPS.
We evaluated the prevalence and relationship of serum prostate specific antigen (PSA) levels in a screening population of men diagnosed with National Institutes of Health (NIH) category IV prostatitis.
In September of 2001, 300 men were randomly selected from our prostate cancer awareness screening program to be evaluated for NIH category IV prostatitis. After informed consent was obtained all patients completed the NIH prostate cancer awareness survey and had a serum sample obtained for PSA before examination. Expressed prostatic secretions were obtained from 227 of the 300 participants. Patients were classified according to findings on examination of the expressed prostatic secretions. The records were entered into our data base and subsequently reviewed.
The prevalence of NIH category IV prostatitis was 32.2% in our population of men. Patient age, American Urological Association symptom scores and clinical prostate gland size did not differ between men with or without evidence of prostatitis on expressed prostatic secretion examination. Men with NIH category IV prostatitis had a mean serum PSA level of 2.3 which was significantly higher (p <0.0004) than those without prostatitis (mean PSA 1.4).
These data suggest that NIH category IV prostatitis is fairly prevalent (32.2%) among men in the general population who present for prostate cancer screening and appears to contribute to increased serum PSA levels in some men.
To investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis.
The study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests.
On the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68%) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32%) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70%) of the 40 patients categorized as chronic pelvic pain syndrome.
Tc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.
To report a prospective, multicentre descriptive study designed to determine the prevalence of the diagnosis of prostatitis in male outpatients examined by urologists in Italy, and to further examine the diagnostic evaluation and treatment of patients identified with a clinical diagnosis of prostatitis.
Between July 2001 and October 2001, 70 urologists, representing a cross-section of urological centres in Italy, counted and recorded the overall total of men reported in the clinic and that of patients diagnosed with prostatitis over a 5-week period. Data on demographics, previous diagnoses, symptoms, physical examination, laboratory data and therapy instituted were collected. Patients with a diagnosis of prostatitis completed questionnaires on symptom frequency and severity, and quality of life.
In all, 8503 patients were included in the primary outcome analysis; 1148 were identified with prostatitis (12.8%; mean age 47.1 years, range 16-83) with all age ranges equally represented, and 68% had had their first symptom within the last year. The most common presenting symptoms were severe, bothersome urinary frequency, obstructive voiding symptoms, perineal, suprapubic and penile pain or discomfort. The self-administered questionnaire confirmed that the most frequently reported and most severe symptoms at the time of evaluation were irritative voiding symptoms, perineal and suprapubic pain and discomfort. Over three-quarters of the patients were dissatisfied with their quality of life. While 98% of the patients had a digital rectal examination and expressed prostatic secretion was successfully recovered in 44%, < 3% of the patients had the traditional Meares-Stamey four-glass test. The most common treatment prescribed was drug therapy (not antibiotic).
The prevalence of a clinical diagnosis of prostatitis in urology outpatient practice in Italy was 12.8%. The prevalence, diagnosis, evaluation and treatment of prostatitis reported in this prospective study was very similar to that reported in other retrospective series from other countries.
To investigate the prevalence and risk factors of sexual dysfunction in Chinese men with chronic prostatitis.
A questionnaire survey was conducted among 2000 men diagnosed as having chronic prostatitis using the National Institutes of Health Chronic Prostatitis Index and analysis of expressed prostatic secretions. The survey was designed to elicit information about age, height, weight, occupation and history of disease and treatment. The erectile capacity of the men was assessed using the five-question version of the International Index of Erectile Function.
Of the 2000 men with chronic prostatitis selected, 1786 completed the survey; the overall prevalence of sexual dysfunction in these patients was 49%. The prevalence of premature ejaculation and erectile dysfunction accounted for 26% and 15%, respectively; 7.7% had both premature ejaculation and erectile dysfunction. There was a negative correlation between prevalence and age, and with the duration of chronic prostatitis (both P < 0.001).
The prevalence rate of sexual dysfunction in Chinese men with chronic prostatitis is high and related to age.
To determine the prevalence and importance of pain/discomfort on ejaculation (prostatitis-like symptom) in men with lower urinary tract symptoms (LUTS) diagnosed with clinical benign prostatic hyperplasia (BPH).
Baseline data from 5096 men reporting LUTS suggestive of BPH, and enrolled in the ALF-ONE study by general practitioners and urologists in Europe, Asia, Latin America, the Middle East and Canada, were analysed to determine the prevalence and significance of pain/discomfort on ejaculation. All the men were asked to complete the International Prostate Symptom Score (IPSS) questionnaire, the bother score (IPSS question 8), and the Danish Prostate Symptom Score sexual-function questionnaire (DAN-PSSsex) which assesses three symptoms (rigidity of erection, amount of ejaculate and pain/discomfort on ejaculation) and their bothersomeness.
There were 3700 sexually active men who had an evaluable answer to the DAN-PSSsex question related to pain/discomfort on ejaculation. Of these, 688 (18.6%) reported pain/discomfort on ejaculation and 609 (88%) considered it was a problem. Patients with painful ejaculation had more severe LUTS and reported greater bother (P < 0.001). Of men with painful ejaculation, 72% reported erectile dysfunction, of whom 91% considered it a problem, and 75% reported reduced ejaculation, of whom 81% considered it a problem. By contrast, of men with no ejaculatory discomfort, 57% reported erectile dysfunction, of whom 79% considered it a problem, and 56% reported reduced ejaculation, of whom 57% considered it a problem. A history of urinary tract infection was reported by 12% of men in the ejaculatory pain group, compared with 7% in the LUTS-only group, while 5% of men in the ejaculatory pain group reported macroscopic haematuria, compared to 3% in the LUTS-only group. Men with ejaculatory pain were slightly younger, but there were no significant differences in duration of LUTS, history of acute urinary retention, prostate-specific antigen concentrations or maximum urinary flow rate compared to the LUTS-only group.
Of sexually active men with LUTS suggestive of BPH, approximately 20% complain of specific prostatitis-like symptoms of pain/discomfort on ejaculation, and these men clearly differ from those who present with LUTS only. For most the symptom is a significant bother. Men with BPH and painful ejaculation have more severe LUTS and reported greater bother, and had a higher prevalence of erectile dysfunction and reduced ejaculation, than men with LUTS only. Evaluation and treatment strategies should address this population of men with symptoms suggestive of both prostatitis and BPH.
To describe the prevalence and correlates of self-reported history of prostatitis in terms of lower urinary tract symptoms and associated dissatisfaction in community-dwelling older men.
We performed a cross-sectional analysis from a prospective cohort study of 5821 men aged 65 years and older recruited from six clinical centers.
Overall, 1439 men (25%) self-reported a history of prostatitis. Men with a history of prostatitis were more likely to self-report a history of prostate cancer (26% versus 7%; P < 0.0001) and a history of benign prostatic hyperplasia (83% versus 38%; P < 0.0001) within a lifetime compared with men without a history of prostatitis. Men with a history of prostatitis also had a greater mean American Urological Association symptom score (mean +/- SD, 10.1 +/- 7.1 versus 7.7 +/- 5.9; P < 0.0001) than men without a history of prostatitis. Also, a greater percentage of men with a history of prostatitis reported being dissatisfied with their present urinary condition than did men without a history of prostatitis (21% versus 11%; P < 0.0001). We found positive associations for a history of prostatitis with a history of benign prostatic hyperplasia (odds ratio 8.0, 95% confidence interval 6.8 to 9.5), a history of prostate cancer (odds ratio 5.4, 95% confidence interval 4.4 to 6.6), and dissatisfaction with current urinary condition (odds ratio 1.2, 95% confidence interval 1.01 to 1.5).
A self-reported history of prostatitis is common in older men and was associated with self-reported prostate cancer and benign prostatic hyperplasia and increased severity of lower urinary tract symptoms and associated dissatisfaction. Because of the potential detection bias, recall bias, and the cross-sectional nature of the study, limiting causal inference, the associations among these urologic conditions require additional study.