- Email: [email protected]
SIGNIFICANCE OF PYURIA IN PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME
O12 PROSTATITIS AND PROSTATODYNIA Friday, 7 April, 14.00-15.30, Room Blue / Level 2 901 HEAT/BURNING SENSATION INDUCED BY TOPICAL APPLICATION OF CAPSAICIN ON THE PERINEAL CUTANEOUS AREA: A NEW APPROACH IN THE DIAGNOSIS AND TREATMENT OF CHRONIC PROSTATITICS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS)? Turini D.1, Lazzeri M.1, Beneforti P.1, Spinelli M.2, Malaguti S.2 University, Urology, Florence, Italy, 2Hospital, Spinal Unit, Milan, Italy
1
INTRODUCTION & OBJECTIVES: To investigate the feasibility, the safety and the efficacy of perineal cutaneous application of capsaicin as a test for the diagnosis as well as potential therapeutic tool in patients with chronic prostatitis/ chronic pelvis pain syndrome (CP/CPPS). MATERIAL & METHODS: The study recruited 22 patients (mean age 34.5 yrs, range 19 -56), who had received the diagnosis of CP/CPPS according the NIH criteria and 6 healthy control subjects. Both the groups received a topical application of 5 ml of capsaicin at the concentration of 10-5M in the perineal body skin by sponge kept in situ by patient digital compression for 5 min. The same procedure was repeated in other three sites of the body: right hypochondrium, precordial area and hypogastric area. The patients were asked to mark in a Visual Analogic Scale (VAS) the intensity of heat or burning sensation; 0 no sensation, 10 the maximum heat/burning sensation experienced. All the patients completed a NIH- Chronic prostatitis symptom index (NIH-CPSI) before and one week the test. The scores of the two groups were compared using the Mann-Whitney-U test. RESULTS: The patients belonged to CP/CPPS reported an intensity of heat/ burning sensation statistically higher that the healthy controls (7.5 vs. 4.3 p<0.001) and a shorter time of the heat sensation onset and maximal intensity respectively: 1.5 min. vs. 3.4 min (p<0.001) and 2.5 vs. 7 (p<0.001). No heat/burning sensation was reported in both the groups when capsaicin was applied in other parts of the body. 16 over 22 patients reported an improvement of symptoms after seven days and the mean NIH-CPSI decreased from 27 to 16 (p < 0.01). CONCLUSIONS: We found a statistically significant difference in pain VAS scale and time interval between the topical application and the heat/burning sensation onset between patients with CP/CPPS and healthy controls. Our cutaneous test seem to able to identify patients with CP/CPPS from healthy subjects and offer a clinical improvement, but our small sample size strongly suggest further wider and more controlled studies.
902 SIGNIFICANCE OF PYURIA IN PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME Moon W.C.1, Kim T.H.1, Oh M.R.1, Noh C.H.2, Cho J.h.3 1 Chung-Ang University Hospital, Urology, Seoul, South Korea, 2Inje University Sang-Gye Peak Hospital, Urology, Seoul, South Korea, 3Goldman Urologic Clinic, Urology, Seoul, South Korea
INTRODUCTION & OBJECTIVES: The significance of increase of number of white blood cells in sample of post-prostatic massage urine (VB3) or expressed prostatic secretion in patients with chronic pelvic pain syndrome (CPPS, NIH Category III) remains ill defined. It remains also unclear whether classification of CPPS IIIA versus CPPS IIIB is necessary for the proper clinical management of CPPS. Recently molecular genetic study is used to accurately identify the presence and genotype of bacteria in patients with CPPS. We herein have carried out a bacterial genetic study in patients with CPPS to identify whether pyuria in VB3 sample suggests the presence of infection and the need for administration of antibacterial drugs. MATERIAL & METHODS: Genomic DNA were isolated from samples of VB3 from 559 patients with CPPS (age 26-55 years) and polymerase chain reaction (PCR) were carried out for gene of 16S rRNA by using consensus primer common to all the genotypes of the bacteria and specific primer for coliform bacteria, N. gonorrhoea, C. trachomatis, U. urealyticum and M. genitalium. The PCR products were further analysed by using oligonucleotide microarray (GG Combo DNA Chip) and DNA sequencing to identify the genotype of bacteria. The patients with pyuria in VB3 (CPPS IIIA, N=181) and those without pyuria (CPPS IIIB, N=378) were comparatively analysed for the prevalence of bacterial prostatitis as defined by finding of gram negative enterobacteriaceae (uropathogens) by genetic test. RESULTS: Overall, molecular genetic evidence of bacterial prostatitis was found in VB3 samples of 147 patients (26.3%) with CPPS. Bacterial infection was found in significantly higher frequency in VB3 samples of patients with CPPS IIIA (54.8%) as compared with those with CPPS IIIB (12.7%, p<0.001). CONCLUSIONS: Pyuria in post-prostatic massage urine samples of patients with CPPS strongly suggests the presence of bacterial prostatitis, in which cases we may have to consider administration of antibacterial drug. Separate classification of CPPS IIIA from CPPS IIIB may be useful and necessary for the proper management of CPPS. Molecular bacteriological tests using PCR-DNA chip may be worthwhile to identify the presence of bacterial prostatitis in patients with CPPS III, especially IIIA.
903
904
MNSOD AND IL-10 POLYMORPHISMS IN CHRONIC PELVIC PAIN SYNDROME PATIENTS
CHANGES IN SOME COMPONENTS OF THE KALLIKREIN-KININ SYSTEM IN THE EJACULATE OF PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME
Arisan S.1, Buyuktuncer E.D.2, Kiremit M.C.1, Caskurlu T.1, Palavan Unsal N.1, Ergenekon E.1 Sisli Etfal Research and Training Hospital, 1st Urology, Istanbul, Turkey, 2Halic University, Molecular Biology and Genetics, Istanbul, Turkey
Kogan M., Shangichev A., Mikashinovich Z., Chernogubova E., Belousov I., Afoko A.
INTRODUCTION & OBJECTIVES: Although chronic pelvic pain syndrome (CPPS) is a common illness, its aetiology is still investigated. We investigate the relationship of polymorphisms at amino acid sequence 16 [Valine/Alanine] of antioxidant scavenger enzyme, manganese superoxide dismutase (MnSOD) and at region 1082 (G/A), 819 (T/C) and 592 (A/C) anti-inflammation cytokine interleukin 10 (IL-10) in CPPS patients. In some studies showed that second exon of MnSOD which targets mitochondrial transcription regions cause mitochondrial damage and dysfunction of some signal protein when Ala-9-Val (GCT/GTT) polymorphism is occurred. It is well reported that some cytokines such as IL-10 and IL-8 had a very important role in aetiology of CPPS,. Inter-individual variations in IL-10 production were genetically contributed to polymorphisms within IL-10 promoter region. It has been shown that adenine (A) at the site –1082 in the promoter region of the IL-10 gene is associated with low and guanine (G) with high production of IL-10. In this study, we characterized the relationship between IL-10 and MnSOD genetics variants which is still an unknown point for CPPS patients.
INTRODUCTION & OBJECTIVES: In various diseases of male reproductive system, especially, inflammatory process of the prostate, changes in the concentration of proteins and in the activity of proteolytic enzymes of the ejaculate are observed. This leads to a change in the viscosity of the ejaculate, which is one of its main quality parameters. The unique biochemical composition of ejaculate that maintains the functional activity of spermatozoa has been studied in detail, however, the role of the majority of the chemical compounds are not yet completely understood. The purpose of our research was to study some parameters of kallikrein- kinin system, the main proteolytic system in the ejaculate, in chronic pelvic pain syndrome (CPPS).
1
MATERIAL & METHODS: The genotyping of MnSOD and IL-10 were done by polymerase chain reaction-restriction fragment length polymorphism with a restriction enzyme (Bsaw 1, Mnl1, Mae3, Rsa1) in 72 Turkish CPPS (30 were 3a and 42 were 3b) patients and 40 healthy subjects with suitable primers. The genotype distribution of CPPS and healthy subjects was then compared, and the association of genotype with NIH classification was evaluated in the CPPS patients. All DNA samples were extracted from blood (Qiagen, DNA mini blood kit). Sperm motility and characteristics, Endtz test were investigated for each donor. Chi-square and student t-test were used for significance analysis. RESULTS: The GTC (MnSOD), GCC (IL-10) type showed a significantly higher frequency in the CPPS than control group (Table 1). In control group, GCC/GCC (20/40) was higher than GCC/GTC (12/40) and GTC/GTC (8/40) genotypes. IL-10 GCC genotype was higher in 3a prostatitis patients than other groups (p<0.005). When we compare the IL-10 polymorphic status at different regions, the most different allele was at 1082 position G to C exchange. Single nucleotide position at position 819 and 592 were not statistically different than control groups. When we compare the 3a and 3b patients for genotype distribution, there was significant difference at regions 1089 and 592 for IL-10 and Ala/Val polymorphism in MnSOD. CONCLUSIONS: Accordingly, the Val (16) Ala polymorphism of MnSOD and 1082 G to A exchange may be responsible one of the mechanism aetiology of type 3a and type 3b CPPS. Oxidative stress and cytokine effect on CPPS should be investigated more detail. However this study may be explanation of enhanced different type of IL secretions and impaired antioxidant enzyme activity.
Eur Urol Suppl 2006;5(2):248
Rostov State Medical University, Department of Urology, Rostov on Don, Russia
MATERIAL & METHODS: We determined the activity of kallikrein, the level of prekallikrein, arginine – esterase activity, the activity of a1-proteinase inhibitor and a2- macroglobulin in the ejaculate of 28 patients with inflammatory (IIIA) and 25 patients with non-inflammatory (IIIB) forms of CPPS. The control group consisted of 10 healthy males. RESULTS: The results of the investigation showed that in the inflammatory form of CPPS, proteolysis in the ejaculate had increased by 101.9% (p < 0,001) compared to the control levels of the summed activity of trypson-like proteinases and an increase in activity of a1- proteinase inhibitor and a2- macroglobulin in the ejaculate by 75.0% (p <0.001) and 63.68% (p <0.001) respectively. The activity and the level of kallikrein remained at the control values. In the noninflammatory form of CPPS the activity of kallikrein and arginine – esterase in comparison with control group increased by 3.3 (p<0.001) and 3.1 (p <0.001) times respectively. The activity of a1-proteinase inhibitor decreased by 52.2% (p <0.001) in comparison with the control group. The activity of a2- macroglobulin increased by 75.0% (p <0.001). CONCLUSIONS: In the inflammatory form of CPPS, the increase in the activity of proteinase is accompanied by an increase in the activity of a1-proteinase inhibitor and a2- macroglobulin. The imbalance of proteolysis in ejaculate in the non-inflammatory form of CPPS is expressed as a sharp increase in the activity of kallikrein and arginine –esterase in comparison with the control group. Depression of antiproteolytic systems of the ejaculate in the non-inflammatory form of CPPS is reduced in comparison with the control levels of a1-proteinase inhibitor activity. The increase in activity of a2- macroglobulin revealed in both forms of CPPS testifies the disorder of permeability of the hemo-testicular barrier, because of which high molecular weight proteins in ejaculate is increased. A dysbalance of kallikrein-kinin system in CPPS is observed in only the non-inflammatory form. The state of proteolysis in ejaculate can play a role in the differentiation of the two forms of CPPS.
1
INTRODUCTION & OBJECTIVES: To investigate the feasibility, the safety and the efficacy of perineal cutaneous application of capsaicin as a test for the diagnosis as well as potential therapeutic tool in patients with chronic prostatitis/ chronic pelvis pain syndrome (CP/CPPS). MATERIAL & METHODS: The study recruited 22 patients (mean age 34.5 yrs, range 19 -56), who had received the diagnosis of CP/CPPS according the NIH criteria and 6 healthy control subjects. Both the groups received a topical application of 5 ml of capsaicin at the concentration of 10-5M in the perineal body skin by sponge kept in situ by patient digital compression for 5 min. The same procedure was repeated in other three sites of the body: right hypochondrium, precordial area and hypogastric area. The patients were asked to mark in a Visual Analogic Scale (VAS) the intensity of heat or burning sensation; 0 no sensation, 10 the maximum heat/burning sensation experienced. All the patients completed a NIH- Chronic prostatitis symptom index (NIH-CPSI) before and one week the test. The scores of the two groups were compared using the Mann-Whitney-U test. RESULTS: The patients belonged to CP/CPPS reported an intensity of heat/ burning sensation statistically higher that the healthy controls (7.5 vs. 4.3 p<0.001) and a shorter time of the heat sensation onset and maximal intensity respectively: 1.5 min. vs. 3.4 min (p<0.001) and 2.5 vs. 7 (p<0.001). No heat/burning sensation was reported in both the groups when capsaicin was applied in other parts of the body. 16 over 22 patients reported an improvement of symptoms after seven days and the mean NIH-CPSI decreased from 27 to 16 (p < 0.01). CONCLUSIONS: We found a statistically significant difference in pain VAS scale and time interval between the topical application and the heat/burning sensation onset between patients with CP/CPPS and healthy controls. Our cutaneous test seem to able to identify patients with CP/CPPS from healthy subjects and offer a clinical improvement, but our small sample size strongly suggest further wider and more controlled studies.
902 SIGNIFICANCE OF PYURIA IN PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME Moon W.C.1, Kim T.H.1, Oh M.R.1, Noh C.H.2, Cho J.h.3 1 Chung-Ang University Hospital, Urology, Seoul, South Korea, 2Inje University Sang-Gye Peak Hospital, Urology, Seoul, South Korea, 3Goldman Urologic Clinic, Urology, Seoul, South Korea
INTRODUCTION & OBJECTIVES: The significance of increase of number of white blood cells in sample of post-prostatic massage urine (VB3) or expressed prostatic secretion in patients with chronic pelvic pain syndrome (CPPS, NIH Category III) remains ill defined. It remains also unclear whether classification of CPPS IIIA versus CPPS IIIB is necessary for the proper clinical management of CPPS. Recently molecular genetic study is used to accurately identify the presence and genotype of bacteria in patients with CPPS. We herein have carried out a bacterial genetic study in patients with CPPS to identify whether pyuria in VB3 sample suggests the presence of infection and the need for administration of antibacterial drugs. MATERIAL & METHODS: Genomic DNA were isolated from samples of VB3 from 559 patients with CPPS (age 26-55 years) and polymerase chain reaction (PCR) were carried out for gene of 16S rRNA by using consensus primer common to all the genotypes of the bacteria and specific primer for coliform bacteria, N. gonorrhoea, C. trachomatis, U. urealyticum and M. genitalium. The PCR products were further analysed by using oligonucleotide microarray (GG Combo DNA Chip) and DNA sequencing to identify the genotype of bacteria. The patients with pyuria in VB3 (CPPS IIIA, N=181) and those without pyuria (CPPS IIIB, N=378) were comparatively analysed for the prevalence of bacterial prostatitis as defined by finding of gram negative enterobacteriaceae (uropathogens) by genetic test. RESULTS: Overall, molecular genetic evidence of bacterial prostatitis was found in VB3 samples of 147 patients (26.3%) with CPPS. Bacterial infection was found in significantly higher frequency in VB3 samples of patients with CPPS IIIA (54.8%) as compared with those with CPPS IIIB (12.7%, p<0.001). CONCLUSIONS: Pyuria in post-prostatic massage urine samples of patients with CPPS strongly suggests the presence of bacterial prostatitis, in which cases we may have to consider administration of antibacterial drug. Separate classification of CPPS IIIA from CPPS IIIB may be useful and necessary for the proper management of CPPS. Molecular bacteriological tests using PCR-DNA chip may be worthwhile to identify the presence of bacterial prostatitis in patients with CPPS III, especially IIIA.
903
904
MNSOD AND IL-10 POLYMORPHISMS IN CHRONIC PELVIC PAIN SYNDROME PATIENTS
CHANGES IN SOME COMPONENTS OF THE KALLIKREIN-KININ SYSTEM IN THE EJACULATE OF PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME
Arisan S.1, Buyuktuncer E.D.2, Kiremit M.C.1, Caskurlu T.1, Palavan Unsal N.1, Ergenekon E.1 Sisli Etfal Research and Training Hospital, 1st Urology, Istanbul, Turkey, 2Halic University, Molecular Biology and Genetics, Istanbul, Turkey
Kogan M., Shangichev A., Mikashinovich Z., Chernogubova E., Belousov I., Afoko A.
INTRODUCTION & OBJECTIVES: Although chronic pelvic pain syndrome (CPPS) is a common illness, its aetiology is still investigated. We investigate the relationship of polymorphisms at amino acid sequence 16 [Valine/Alanine] of antioxidant scavenger enzyme, manganese superoxide dismutase (MnSOD) and at region 1082 (G/A), 819 (T/C) and 592 (A/C) anti-inflammation cytokine interleukin 10 (IL-10) in CPPS patients. In some studies showed that second exon of MnSOD which targets mitochondrial transcription regions cause mitochondrial damage and dysfunction of some signal protein when Ala-9-Val (GCT/GTT) polymorphism is occurred. It is well reported that some cytokines such as IL-10 and IL-8 had a very important role in aetiology of CPPS,. Inter-individual variations in IL-10 production were genetically contributed to polymorphisms within IL-10 promoter region. It has been shown that adenine (A) at the site –1082 in the promoter region of the IL-10 gene is associated with low and guanine (G) with high production of IL-10. In this study, we characterized the relationship between IL-10 and MnSOD genetics variants which is still an unknown point for CPPS patients.
INTRODUCTION & OBJECTIVES: In various diseases of male reproductive system, especially, inflammatory process of the prostate, changes in the concentration of proteins and in the activity of proteolytic enzymes of the ejaculate are observed. This leads to a change in the viscosity of the ejaculate, which is one of its main quality parameters. The unique biochemical composition of ejaculate that maintains the functional activity of spermatozoa has been studied in detail, however, the role of the majority of the chemical compounds are not yet completely understood. The purpose of our research was to study some parameters of kallikrein- kinin system, the main proteolytic system in the ejaculate, in chronic pelvic pain syndrome (CPPS).
1
MATERIAL & METHODS: The genotyping of MnSOD and IL-10 were done by polymerase chain reaction-restriction fragment length polymorphism with a restriction enzyme (Bsaw 1, Mnl1, Mae3, Rsa1) in 72 Turkish CPPS (30 were 3a and 42 were 3b) patients and 40 healthy subjects with suitable primers. The genotype distribution of CPPS and healthy subjects was then compared, and the association of genotype with NIH classification was evaluated in the CPPS patients. All DNA samples were extracted from blood (Qiagen, DNA mini blood kit). Sperm motility and characteristics, Endtz test were investigated for each donor. Chi-square and student t-test were used for significance analysis. RESULTS: The GTC (MnSOD), GCC (IL-10) type showed a significantly higher frequency in the CPPS than control group (Table 1). In control group, GCC/GCC (20/40) was higher than GCC/GTC (12/40) and GTC/GTC (8/40) genotypes. IL-10 GCC genotype was higher in 3a prostatitis patients than other groups (p<0.005). When we compare the IL-10 polymorphic status at different regions, the most different allele was at 1082 position G to C exchange. Single nucleotide position at position 819 and 592 were not statistically different than control groups. When we compare the 3a and 3b patients for genotype distribution, there was significant difference at regions 1089 and 592 for IL-10 and Ala/Val polymorphism in MnSOD. CONCLUSIONS: Accordingly, the Val (16) Ala polymorphism of MnSOD and 1082 G to A exchange may be responsible one of the mechanism aetiology of type 3a and type 3b CPPS. Oxidative stress and cytokine effect on CPPS should be investigated more detail. However this study may be explanation of enhanced different type of IL secretions and impaired antioxidant enzyme activity.
Eur Urol Suppl 2006;5(2):248
Rostov State Medical University, Department of Urology, Rostov on Don, Russia
MATERIAL & METHODS: We determined the activity of kallikrein, the level of prekallikrein, arginine – esterase activity, the activity of a1-proteinase inhibitor and a2- macroglobulin in the ejaculate of 28 patients with inflammatory (IIIA) and 25 patients with non-inflammatory (IIIB) forms of CPPS. The control group consisted of 10 healthy males. RESULTS: The results of the investigation showed that in the inflammatory form of CPPS, proteolysis in the ejaculate had increased by 101.9% (p < 0,001) compared to the control levels of the summed activity of trypson-like proteinases and an increase in activity of a1- proteinase inhibitor and a2- macroglobulin in the ejaculate by 75.0% (p <0.001) and 63.68% (p <0.001) respectively. The activity and the level of kallikrein remained at the control values. In the noninflammatory form of CPPS the activity of kallikrein and arginine – esterase in comparison with control group increased by 3.3 (p<0.001) and 3.1 (p <0.001) times respectively. The activity of a1-proteinase inhibitor decreased by 52.2% (p <0.001) in comparison with the control group. The activity of a2- macroglobulin increased by 75.0% (p <0.001). CONCLUSIONS: In the inflammatory form of CPPS, the increase in the activity of proteinase is accompanied by an increase in the activity of a1-proteinase inhibitor and a2- macroglobulin. The imbalance of proteolysis in ejaculate in the non-inflammatory form of CPPS is expressed as a sharp increase in the activity of kallikrein and arginine –esterase in comparison with the control group. Depression of antiproteolytic systems of the ejaculate in the non-inflammatory form of CPPS is reduced in comparison with the control levels of a1-proteinase inhibitor activity. The increase in activity of a2- macroglobulin revealed in both forms of CPPS testifies the disorder of permeability of the hemo-testicular barrier, because of which high molecular weight proteins in ejaculate is increased. A dysbalance of kallikrein-kinin system in CPPS is observed in only the non-inflammatory form. The state of proteolysis in ejaculate can play a role in the differentiation of the two forms of CPPS.