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CHRONIC PELVIC PAIN SYNDROME – A MULTINATIONAL STUDY IN 1,563 PATIENTS
Vol. 187, No. 4S, Supplement, Monday, May 21, 2012
Patients who have received ciprofloxacin within 3 months of TRUSBx should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months. Source of Funding: Vancouver Coastal Health Research Institute
1081 TARGETED PROPHYLAXIS PRIOR TO TRANSRECTAL PROSTATE BIOPSY: A COMPARISON OF BROTH ENRICHMENT TO DIRECT PLATING FOR THE EVALUATION OF RECTAL CULTURES. Michael Liss*, Kristen Nakamura, Ellena Peterson, Irvine, CA INTRODUCTION AND OBJECTIVES: To compare broth enhancement to direct plating of rectal swabs for the recovery of ciprofloxacin resistant organisms; information that can be used to tailor prophylactic antimicrobial therapy prior to transrectal prostate biopsy. METHODS: Rectal swabs from 50 men undergoing a transrectal prostate biopsy were obtained from Long Beach VA Medical Center over a 4 month period (7/2011-11/2011). Participant demographics and rectal specimens were obtained prior to transrectal prostate biopsy. Rectal swabs were placed directly into 5 ml of brain heart infusion broth containing either 1 g/mL or 10 g/mL of ciprofloxacin (Hardy Diagnostics), incubated overnight at 35 °C and then subcultured to MacConkey agar containing the corresponding concentration of ciprofloxacin. The third swab was plated directly to MacConkey agar without ciprofloxacin and to MacConkey agar containing 1 g/mL or 10 g/mL ciprofloxacin. All enteric gram-negative bacilli were characterized on the Vitek II, using GN and AST-GN30 cards for identification and susceptibility testing, respectively. RESULTS: Swabs were obtained from 50 patients. Samples from eight of these patients yielded no growth (16%) and thus were eliminated from further analysis. Of the remaining cultures from 42 patients the following was recovered: 54.8% (23/42) grew normal flora only from the MacConkey agar without added antibiotic; 21.4% (9/42) grew ciprofloxacin resistant enterics from all media used; 2 ciprofloxacin resistant organisms were recovered only from subcultures of the 1 g/mL broth. Seven of the samples resulted in false positive growth (ciprofloxacin susceptible) when subcultured from the 1 g/mL ciprofloxacin containing broth in contrast to one false positive resulting from the 10 g/mL containing broth. Direct plating using both plates with 1 g/mL and 10 g/mL, yielded a sensitivity, specificity, positive and negative predictive values (PPV and NPV) of 82%, 100%, 100%, and 94%, respectively. Broth enhancement predictive values (sensitivity, specificity, PPV, NPV, respectively) were: 1g broth, 100%, 77%, 61% and 100%; and 10ug broth, 82%, 97%, 90% and 94%. CONCLUSIONS: While broth enhancement may increase the yield of FQ-R organisms it also increases the number of false positives. Direct plating of rectal swabs onto MacConkey agar containing 1 g/mL or 10 g/ mL ciprofloxacin gives the lowest false positives but may fail to isolate a low number of resistant organisms. Source of Funding: None
1082 NATIONAL INSTITUTE OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX (CPSI) SYMPTOM EVALUATION IN PATIENTS WITH CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME – A MULTINATIONAL STUDY IN 1,563 PATIENTS. Florian Wagenlehner*, Giessen, Germany; Olivier van Till, Leiderdorp, Netherlands; Vittorio Magri, Gianpaolo Perletti, Milano, Italy; Jos Houbiers, Leiderdorp, Netherlands; Wolfgang Weidner, Giessen, Germany; Curtis Nickel, Kingston, Canada INTRODUCTION AND OBJECTIVES: The assessment of CP/ CPPS patients in everyday practice and clinical studies rely on the CPSI scores for symptom appraisal, inclusion criteria for clinical trials, follow up and response evaluation. We investigated multiple data
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bases of CP/CPPS patients to determine the prevalence and impact of pain locations and types to improve our strategy of individualized phenotypically guided treatment. METHODS: Four major databases with CPSI scores for nonselected CP/CPPS clinic patients from Canada, Germany, Italy and USA were included. The individual question scores, sub-total and total scores of the CPSI are described and correlated with each other. RESULTS: In this data base analysis, 1,563 CP/CPPS patients were included. Perineal pain/discomfort was the most prevalent pain symptom (63%) followed by testicular pain/discomfort (58%). Pain/ discomfort was reported less often in the pubic area (42%) and penis (32%) while reports during ejaculation and voiding were 45% and 43% respectively. Severity of pain correlated well with frequency of pain (r⫽0.650). No specific pain localization/type was associated with more severe pain. Correlation of the pain subdomain with QoL (r⫽0.682) was higher than the urinary subdomain (r⫽0.336). QoL is considered the gold standard in a patient’s general condition and wellbeing. Individually, pain frequency (r⫽0.589) and pain severity (r⫽0.633) correlated better with QoL than pain localization (r⫽0.420). In order to define disease severity categories ANOVA of different pain domain and total CPSI cut-off levels and their impact on QoL was calculated resulting in optimal cut-off levels: pain severity (0-10) – mild, 0 to 3; moderate, 4 to 6; severe, 7 to 10; total CPSI (0-43) – mild, 0 to 14; moderate, 15 to 26; severe 27 to 43. European patients had a significantly higher number of pain localizations and symptoms compared to North-American patients (p⬍0.0001). CONCLUSIONS: Pain has more impact on QoL than urinary symptoms. Pain severity and frequency are more important than pain localization/type. Cut-off levels for disease severity categories have been identified which will prove valuable in symptom assessment and development of therapeutic strategies. Source of Funding: None
1083 CANNABIS (MARIJUANA) USE IN MEN WITH CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME Dean Tripp*, J. Curtis Nickel, Katz Laura, Jessica V. Ginting, Kingston, Canada; Ware Mark, Montreal, Canada; Darcy Santor, Ottawa, Canada INTRODUCTION AND OBJECTIVES: To examine the prevalence of cannabis use among men with CP/CPPS, to estimate the dose size and frequency of cannabis use, and to describe the patient reported indications for its use in this population. METHODS: Parallel online and clinic questionnaire surveys were conducted to assess cannabis use among men with CP/CPPS. As a check on study generalizability, comparisons between the online data (n⫽365) and clinic data (n⫽60) showed no clinically meaningful differences in the outcome variables of quality of life (QoL), suicidal ideation, pain and urinary symptoms were evident between these groups. RESULTS: Forty nine percent of this sample reported cannabis use (n⫽206). Of those reporting cannabis use, 29% (n⫽59) indicated use for pain relief (pain users) and 71% (n⫽147) for recreation. The pain users (mean age⫽38.26⫾13.78), were younger than recreational users (42.37⫾12.18) and individuals who reported never using cannabis (45.29⫾13.73)(p⫽.001). More pain users reported cannabis was of pain reduction benefit in comparison to recreational users (Chisq⫽3.83, p⫽.05). No differences were found between recreational and pain users in degree of side effects (Chisq⫽4.43, p⫽.22), reasons for stopping (Chisq⫽4.84, p⫽.18), or use frequency (Chisq⫽5.48, p⫽.07). There were no differences in dose smoked between the pain and recreational users (Chisq⫽5.80, p⫽.12), but a difference was found in dose eaten between these two groups with 20% of pain users reporting consuming more than 1 gram per dose versus only 7% of recreational users reporting consuming this dosage. (Chisq⫽12.51, p⫽.002). Pain users reported more pain (F⫽4.04, p⫽.05), poorer CP/CPPS QoL/impact (F⫽8.61, p⫽.004), and more suicidal thoughts (F⫽6.59, p⫽.01) than recreational users.
Patients who have received ciprofloxacin within 3 months of TRUSBx should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months. Source of Funding: Vancouver Coastal Health Research Institute
1081 TARGETED PROPHYLAXIS PRIOR TO TRANSRECTAL PROSTATE BIOPSY: A COMPARISON OF BROTH ENRICHMENT TO DIRECT PLATING FOR THE EVALUATION OF RECTAL CULTURES. Michael Liss*, Kristen Nakamura, Ellena Peterson, Irvine, CA INTRODUCTION AND OBJECTIVES: To compare broth enhancement to direct plating of rectal swabs for the recovery of ciprofloxacin resistant organisms; information that can be used to tailor prophylactic antimicrobial therapy prior to transrectal prostate biopsy. METHODS: Rectal swabs from 50 men undergoing a transrectal prostate biopsy were obtained from Long Beach VA Medical Center over a 4 month period (7/2011-11/2011). Participant demographics and rectal specimens were obtained prior to transrectal prostate biopsy. Rectal swabs were placed directly into 5 ml of brain heart infusion broth containing either 1 g/mL or 10 g/mL of ciprofloxacin (Hardy Diagnostics), incubated overnight at 35 °C and then subcultured to MacConkey agar containing the corresponding concentration of ciprofloxacin. The third swab was plated directly to MacConkey agar without ciprofloxacin and to MacConkey agar containing 1 g/mL or 10 g/mL ciprofloxacin. All enteric gram-negative bacilli were characterized on the Vitek II, using GN and AST-GN30 cards for identification and susceptibility testing, respectively. RESULTS: Swabs were obtained from 50 patients. Samples from eight of these patients yielded no growth (16%) and thus were eliminated from further analysis. Of the remaining cultures from 42 patients the following was recovered: 54.8% (23/42) grew normal flora only from the MacConkey agar without added antibiotic; 21.4% (9/42) grew ciprofloxacin resistant enterics from all media used; 2 ciprofloxacin resistant organisms were recovered only from subcultures of the 1 g/mL broth. Seven of the samples resulted in false positive growth (ciprofloxacin susceptible) when subcultured from the 1 g/mL ciprofloxacin containing broth in contrast to one false positive resulting from the 10 g/mL containing broth. Direct plating using both plates with 1 g/mL and 10 g/mL, yielded a sensitivity, specificity, positive and negative predictive values (PPV and NPV) of 82%, 100%, 100%, and 94%, respectively. Broth enhancement predictive values (sensitivity, specificity, PPV, NPV, respectively) were: 1g broth, 100%, 77%, 61% and 100%; and 10ug broth, 82%, 97%, 90% and 94%. CONCLUSIONS: While broth enhancement may increase the yield of FQ-R organisms it also increases the number of false positives. Direct plating of rectal swabs onto MacConkey agar containing 1 g/mL or 10 g/ mL ciprofloxacin gives the lowest false positives but may fail to isolate a low number of resistant organisms. Source of Funding: None
1082 NATIONAL INSTITUTE OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX (CPSI) SYMPTOM EVALUATION IN PATIENTS WITH CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME – A MULTINATIONAL STUDY IN 1,563 PATIENTS. Florian Wagenlehner*, Giessen, Germany; Olivier van Till, Leiderdorp, Netherlands; Vittorio Magri, Gianpaolo Perletti, Milano, Italy; Jos Houbiers, Leiderdorp, Netherlands; Wolfgang Weidner, Giessen, Germany; Curtis Nickel, Kingston, Canada INTRODUCTION AND OBJECTIVES: The assessment of CP/ CPPS patients in everyday practice and clinical studies rely on the CPSI scores for symptom appraisal, inclusion criteria for clinical trials, follow up and response evaluation. We investigated multiple data
THE JOURNAL OF UROLOGY姞
e439
bases of CP/CPPS patients to determine the prevalence and impact of pain locations and types to improve our strategy of individualized phenotypically guided treatment. METHODS: Four major databases with CPSI scores for nonselected CP/CPPS clinic patients from Canada, Germany, Italy and USA were included. The individual question scores, sub-total and total scores of the CPSI are described and correlated with each other. RESULTS: In this data base analysis, 1,563 CP/CPPS patients were included. Perineal pain/discomfort was the most prevalent pain symptom (63%) followed by testicular pain/discomfort (58%). Pain/ discomfort was reported less often in the pubic area (42%) and penis (32%) while reports during ejaculation and voiding were 45% and 43% respectively. Severity of pain correlated well with frequency of pain (r⫽0.650). No specific pain localization/type was associated with more severe pain. Correlation of the pain subdomain with QoL (r⫽0.682) was higher than the urinary subdomain (r⫽0.336). QoL is considered the gold standard in a patient’s general condition and wellbeing. Individually, pain frequency (r⫽0.589) and pain severity (r⫽0.633) correlated better with QoL than pain localization (r⫽0.420). In order to define disease severity categories ANOVA of different pain domain and total CPSI cut-off levels and their impact on QoL was calculated resulting in optimal cut-off levels: pain severity (0-10) – mild, 0 to 3; moderate, 4 to 6; severe, 7 to 10; total CPSI (0-43) – mild, 0 to 14; moderate, 15 to 26; severe 27 to 43. European patients had a significantly higher number of pain localizations and symptoms compared to North-American patients (p⬍0.0001). CONCLUSIONS: Pain has more impact on QoL than urinary symptoms. Pain severity and frequency are more important than pain localization/type. Cut-off levels for disease severity categories have been identified which will prove valuable in symptom assessment and development of therapeutic strategies. Source of Funding: None
1083 CANNABIS (MARIJUANA) USE IN MEN WITH CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME Dean Tripp*, J. Curtis Nickel, Katz Laura, Jessica V. Ginting, Kingston, Canada; Ware Mark, Montreal, Canada; Darcy Santor, Ottawa, Canada INTRODUCTION AND OBJECTIVES: To examine the prevalence of cannabis use among men with CP/CPPS, to estimate the dose size and frequency of cannabis use, and to describe the patient reported indications for its use in this population. METHODS: Parallel online and clinic questionnaire surveys were conducted to assess cannabis use among men with CP/CPPS. As a check on study generalizability, comparisons between the online data (n⫽365) and clinic data (n⫽60) showed no clinically meaningful differences in the outcome variables of quality of life (QoL), suicidal ideation, pain and urinary symptoms were evident between these groups. RESULTS: Forty nine percent of this sample reported cannabis use (n⫽206). Of those reporting cannabis use, 29% (n⫽59) indicated use for pain relief (pain users) and 71% (n⫽147) for recreation. The pain users (mean age⫽38.26⫾13.78), were younger than recreational users (42.37⫾12.18) and individuals who reported never using cannabis (45.29⫾13.73)(p⫽.001). More pain users reported cannabis was of pain reduction benefit in comparison to recreational users (Chisq⫽3.83, p⫽.05). No differences were found between recreational and pain users in degree of side effects (Chisq⫽4.43, p⫽.22), reasons for stopping (Chisq⫽4.84, p⫽.18), or use frequency (Chisq⫽5.48, p⫽.07). There were no differences in dose smoked between the pain and recreational users (Chisq⫽5.80, p⫽.12), but a difference was found in dose eaten between these two groups with 20% of pain users reporting consuming more than 1 gram per dose versus only 7% of recreational users reporting consuming this dosage. (Chisq⫽12.51, p⫽.002). Pain users reported more pain (F⫽4.04, p⫽.05), poorer CP/CPPS QoL/impact (F⫽8.61, p⫽.004), and more suicidal thoughts (F⫽6.59, p⫽.01) than recreational users.