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CLINICAL IMPACT OF LEUKOCYTES IN CHRONIC ABACTERIAL PROSTATITIS
THE JOURNAL OF UROLOGY®
120
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
Infection/Inflammation of Genitourinary Tract: Prostate and Genitalia (II) Podium 10 Sunday, April 26, 2009
10:30 am - 12:30 pm
329 CLINICAL IMPACT OF LEUKOCYTES IN CHRONIC ABACTERIAL PROSTATITIS David T. Duong*, Rodney U Anderson, Stanford, CA INTRODUCTION AND OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for up to 8% of male urology visits per year. NIH category III CP/CPPS includes painful nonbacterial prostatitis (IIIA, inflammatory) or prostatodynia (IIIB, non-inflammatory). Significant leukocytes from expressed prostatic secretion (EPS) or post-massage urine (VB3) implies inflammation. We evaluated the clinical relevance of leukocytes in refractory patients who failed multimodal therapy. METHODS: One hundred fourteen patients came to Stanford for a week-long intensive course of pelvic myofascial trigger point physiotherapy and cognitive relaxation training. Patients completed two validated questionnaires: NIH chronic prostatitis symptom index (CPSI) and Stanford pelvic pain symptom survey (PPSS). Patients with positive cultures were excluded. Prostate massage EPS specimens with leukocyte counts q5/hpf or 500/ul and q5/hpf or 250/ul for VB3 were classified as inflammatory. Age, disease duration, symptom severity, and treatment efficacy were compared for IIIA and IIIB patients. RESULTS: Median age 47 years; disease duration 8 years. Median pre-treatment CPSI and PPSS scores were 26 and 34, respectively. There were 44 category IIIA and 58 category IIIB patients. There was no significant difference between category IIIA and IIIB for either age (52 vs. 47 years; p=0.07) or disease duration (6 vs. 5 years; p=0.87). There was no significant difference between IIIA and IIIB in symptom severity for every domain of the CPSI (total score 26 vs. 26; p=0.36), except for quality of life (9 vs. 10; p=0.01). There was no significant difference between IIIA and IIIB in symptom severity for all domains of the PPSS (total score 34 vs. 34; p=0.87). Furthermore, there was no difference between IIIA and IIIB patients in symptomatic improvement after therapy: CPSI (-7 vs. -8; p=0.20) and PPSS (-10 vs. -10; p=0.68). CONCLUSIONS: Significant leukocytes in the EPS or VB3 of patients with refractory CPPS does not correlate with age, disease duration, or symptom severity. It also does not predict which patients will benefit from physiotherapy and cognitive behavior training. Determining the presence or absence of leukocytes from the prostate in uninfected CPPS patients does not appear to be clinically useful. Source of Funding: None
330 WEIDNER, W, MARCONI M, WAGENLEHNER F, DIEMER TH WHO CRITERIA OF MALE ACCESSORY GLAND INFECTION/ INFALMMATION (MAGI) IN INFERTILE MEN DO NOT CORRESPOND WITH NIH CLASSIFICATION FOR PROSTATITIS AND CP/CPPS. Marcelo Marconi, Florian Wagenlehner, Thorsten Diemer, Wolfgang Weidner*, Giessen, Germany INTRODUCTION AND OBJECTIVE: In infertile couples (12 months no pregnancy), MAGI is discussed as major cause in up to 20 percent of male partners. Major criteria of MAGI are defined by the WHO (manual 1993) with different parameters as a) typical history and physical signs b) evidence of bacteria and leukocytes in EPS c) altered ejaculate with bacteriospermia, leukocytospermia and inflammatory changes. A localisation of a possible inflammation and/or infection to the prostate is not addressed. The issue of the study was to identify NIH II prostatitis or NIH III a CP/CPPS as possible focus of the andrological infectious/
inflammatory diagnosis. METHODS: 258 infertile men (age 24-69 years) underwent an examination with ejaculate analysis according to WHO including counting of bacteria, Peroxidase Positive Leukocytes (PPL) and Elastase, a typical four-glass-test and a PCR for C.trachomatis of the 1. voided urine. The diagnostic management for prostatitis and CP/CPPS was done according to NIH criteria. For clinical diagnosis of CP/CPPS, the validated german version of the NIH-CPSI was used. Typically, >106 PPL/ ml and/or elastase levels > 250 ng/ml were considered to be indicative for inflammation in the ejaculate. Diagnosis of MAGI required at least two signs of a, b, c of MAGI criteria or at least two inflammatory signs in the ejaculate (PPL, bacteriospermia, C. trachomatis). RESULTS: Using MAGI criteria none of 26 men with NIH II prostatitis and 24 of 36 men with CP/CPPS II were classified as inflammatory or infectious disease resulting in a figure of 24 men classified as prostatis-related meaning 9% of all infertile men. Using NIH criteria, the prostatitis related figure increased to 62 males meaning a percentage of 24%. All patients with chronic epididymitis (n25) and chronic urethritis (n14) were classified with both classification techniques in a similar manner. 157 men with symptomatic CP/CPPS (diagnosed by NIH/CPSI) could not be identified by MAGI criteria. CONCLUSIONS: Looking for infectious/inflammatory changes of the prostate as one potential cause for male infertility, the MAGI classifcation of the WHO underestimates the percentage of infectious and inflammatory prostatitis and CP/CPPS. Source of Funding: MIDEPLAN, Chile, Government
331 SKIN SURFACE ELECTROMYOGRAPHY IN CHRONIC PROSTATITIS TYPE III/ CHRONIC PELVIC PAIN SYNDROME. A CASE CONTROL STUDY. Carlos Perez Martinez*, Irma B Vargas Diaz, Delicias, Chihuahua., Mexico INTRODUCTION AND OBJECTIVE: Pelvic floor muscles (PFM) are hypertonic and unstable in men suffering Chronic Prostatitis type III/ Chronic Pelvic Pain Syndrome (CP/CPPS). Our objective is to compare the skin surface electromyography (SSEMG) in patients with CP/CPPS versus healthy volunteers. METHODS: SSEMG were performed with skin surface electrodes (3M® pediatric skin gel patch), positioned at 3 cm from anal sphincter in 14 healthy volunteers as Control Group (CG) and 28 men suffering CP/CPPS as Problem Group (PG). For SSEMG we used the Verymed Myoexerciser® device. Tests were performed by the same nurse. PG inclusion criteria were CP/CPPS with minimum 6 months with not pathological origin to explain pain. The exclusion criteria were urine or semen positive cultures, urinary calculi, genitourinary tuberculosis, genitourinary malignancy, history of pelvic radiation or surgery and congenital genitourinary diseases. Also participants suffering mental or psychological disorders were excluded. All participants signed an informed consent; the study was approved by the ethics committee. Using a Data Base Excel age, average of resting SSEMG (PAVRG) (PFM resting tonus), the AMPLITUDE of curve (PFM stability), also the Chronic Prostatitis Symptoms Index (NIHSCORE) were collected and analyzed using the software SPSS10.0. RESULTS: The mean age was 46.36yrs in CG and 44.04yrs in PG(p=0.768). The mean score for NIHSCORE was 7.64 points (SD+/3.93) in CG, and 24.96 points (SD+/-5.05) in PG (p=0.000). The logistic regression shown as more significant variable the PAVRG (p=0.000) ( seeTable 1). The mean PAVRG was 0.0785 microV (SD+/-0.0763) in CG and 0.4243 microV (SD+/-0.2387) in PG. The mean AMPLITUDE was 0.0714 microV (SD+/-0.0588) in CG and 0.4375 microV (SD+/-0.5496) in PG(p=0.018).
120
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
Infection/Inflammation of Genitourinary Tract: Prostate and Genitalia (II) Podium 10 Sunday, April 26, 2009
10:30 am - 12:30 pm
329 CLINICAL IMPACT OF LEUKOCYTES IN CHRONIC ABACTERIAL PROSTATITIS David T. Duong*, Rodney U Anderson, Stanford, CA INTRODUCTION AND OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for up to 8% of male urology visits per year. NIH category III CP/CPPS includes painful nonbacterial prostatitis (IIIA, inflammatory) or prostatodynia (IIIB, non-inflammatory). Significant leukocytes from expressed prostatic secretion (EPS) or post-massage urine (VB3) implies inflammation. We evaluated the clinical relevance of leukocytes in refractory patients who failed multimodal therapy. METHODS: One hundred fourteen patients came to Stanford for a week-long intensive course of pelvic myofascial trigger point physiotherapy and cognitive relaxation training. Patients completed two validated questionnaires: NIH chronic prostatitis symptom index (CPSI) and Stanford pelvic pain symptom survey (PPSS). Patients with positive cultures were excluded. Prostate massage EPS specimens with leukocyte counts q5/hpf or 500/ul and q5/hpf or 250/ul for VB3 were classified as inflammatory. Age, disease duration, symptom severity, and treatment efficacy were compared for IIIA and IIIB patients. RESULTS: Median age 47 years; disease duration 8 years. Median pre-treatment CPSI and PPSS scores were 26 and 34, respectively. There were 44 category IIIA and 58 category IIIB patients. There was no significant difference between category IIIA and IIIB for either age (52 vs. 47 years; p=0.07) or disease duration (6 vs. 5 years; p=0.87). There was no significant difference between IIIA and IIIB in symptom severity for every domain of the CPSI (total score 26 vs. 26; p=0.36), except for quality of life (9 vs. 10; p=0.01). There was no significant difference between IIIA and IIIB in symptom severity for all domains of the PPSS (total score 34 vs. 34; p=0.87). Furthermore, there was no difference between IIIA and IIIB patients in symptomatic improvement after therapy: CPSI (-7 vs. -8; p=0.20) and PPSS (-10 vs. -10; p=0.68). CONCLUSIONS: Significant leukocytes in the EPS or VB3 of patients with refractory CPPS does not correlate with age, disease duration, or symptom severity. It also does not predict which patients will benefit from physiotherapy and cognitive behavior training. Determining the presence or absence of leukocytes from the prostate in uninfected CPPS patients does not appear to be clinically useful. Source of Funding: None
330 WEIDNER, W, MARCONI M, WAGENLEHNER F, DIEMER TH WHO CRITERIA OF MALE ACCESSORY GLAND INFECTION/ INFALMMATION (MAGI) IN INFERTILE MEN DO NOT CORRESPOND WITH NIH CLASSIFICATION FOR PROSTATITIS AND CP/CPPS. Marcelo Marconi, Florian Wagenlehner, Thorsten Diemer, Wolfgang Weidner*, Giessen, Germany INTRODUCTION AND OBJECTIVE: In infertile couples (12 months no pregnancy), MAGI is discussed as major cause in up to 20 percent of male partners. Major criteria of MAGI are defined by the WHO (manual 1993) with different parameters as a) typical history and physical signs b) evidence of bacteria and leukocytes in EPS c) altered ejaculate with bacteriospermia, leukocytospermia and inflammatory changes. A localisation of a possible inflammation and/or infection to the prostate is not addressed. The issue of the study was to identify NIH II prostatitis or NIH III a CP/CPPS as possible focus of the andrological infectious/
inflammatory diagnosis. METHODS: 258 infertile men (age 24-69 years) underwent an examination with ejaculate analysis according to WHO including counting of bacteria, Peroxidase Positive Leukocytes (PPL) and Elastase, a typical four-glass-test and a PCR for C.trachomatis of the 1. voided urine. The diagnostic management for prostatitis and CP/CPPS was done according to NIH criteria. For clinical diagnosis of CP/CPPS, the validated german version of the NIH-CPSI was used. Typically, >106 PPL/ ml and/or elastase levels > 250 ng/ml were considered to be indicative for inflammation in the ejaculate. Diagnosis of MAGI required at least two signs of a, b, c of MAGI criteria or at least two inflammatory signs in the ejaculate (PPL, bacteriospermia, C. trachomatis). RESULTS: Using MAGI criteria none of 26 men with NIH II prostatitis and 24 of 36 men with CP/CPPS II were classified as inflammatory or infectious disease resulting in a figure of 24 men classified as prostatis-related meaning 9% of all infertile men. Using NIH criteria, the prostatitis related figure increased to 62 males meaning a percentage of 24%. All patients with chronic epididymitis (n25) and chronic urethritis (n14) were classified with both classification techniques in a similar manner. 157 men with symptomatic CP/CPPS (diagnosed by NIH/CPSI) could not be identified by MAGI criteria. CONCLUSIONS: Looking for infectious/inflammatory changes of the prostate as one potential cause for male infertility, the MAGI classifcation of the WHO underestimates the percentage of infectious and inflammatory prostatitis and CP/CPPS. Source of Funding: MIDEPLAN, Chile, Government
331 SKIN SURFACE ELECTROMYOGRAPHY IN CHRONIC PROSTATITIS TYPE III/ CHRONIC PELVIC PAIN SYNDROME. A CASE CONTROL STUDY. Carlos Perez Martinez*, Irma B Vargas Diaz, Delicias, Chihuahua., Mexico INTRODUCTION AND OBJECTIVE: Pelvic floor muscles (PFM) are hypertonic and unstable in men suffering Chronic Prostatitis type III/ Chronic Pelvic Pain Syndrome (CP/CPPS). Our objective is to compare the skin surface electromyography (SSEMG) in patients with CP/CPPS versus healthy volunteers. METHODS: SSEMG were performed with skin surface electrodes (3M® pediatric skin gel patch), positioned at 3 cm from anal sphincter in 14 healthy volunteers as Control Group (CG) and 28 men suffering CP/CPPS as Problem Group (PG). For SSEMG we used the Verymed Myoexerciser® device. Tests were performed by the same nurse. PG inclusion criteria were CP/CPPS with minimum 6 months with not pathological origin to explain pain. The exclusion criteria were urine or semen positive cultures, urinary calculi, genitourinary tuberculosis, genitourinary malignancy, history of pelvic radiation or surgery and congenital genitourinary diseases. Also participants suffering mental or psychological disorders were excluded. All participants signed an informed consent; the study was approved by the ethics committee. Using a Data Base Excel age, average of resting SSEMG (PAVRG) (PFM resting tonus), the AMPLITUDE of curve (PFM stability), also the Chronic Prostatitis Symptoms Index (NIHSCORE) were collected and analyzed using the software SPSS10.0. RESULTS: The mean age was 46.36yrs in CG and 44.04yrs in PG(p=0.768). The mean score for NIHSCORE was 7.64 points (SD+/3.93) in CG, and 24.96 points (SD+/-5.05) in PG (p=0.000). The logistic regression shown as more significant variable the PAVRG (p=0.000) ( seeTable 1). The mean PAVRG was 0.0785 microV (SD+/-0.0763) in CG and 0.4243 microV (SD+/-0.2387) in PG. The mean AMPLITUDE was 0.0714 microV (SD+/-0.0588) in CG and 0.4375 microV (SD+/-0.5496) in PG(p=0.018).