The 2001 Giessen Cohort Study on patients with prostatitis syndrome - an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis

Abstract

During the last years tremendous changes have occurred in the epidemiologic knowledge and the diagnostic process of the prostatitis syndrome. A new worldwide-accepted classification system has become the gold standard in contemporary literature. The aim of this study was to compare the inflammatory and infectious status of men with prostatitis syndrome with results from our study cohort from 1992. A total of 168 symptomatic men (mean age 43.2 years; range 18-79) attending the Giessen prostatitis outpatient department were included. All men underwent a standard four-glass-test including leucocyte analysis in all specimens. A routine search for Ureaplasma urealyticum and Chlamydia trachomatis was performed. Ejaculate analysis following World Health Organization (WHO) criteria has been performed including the evaluation of increased number of peroxidase-positive leucocytes (PPL). Men were classified according to the National Institutes of Health (NIH) prostatitis classification. The distribution of patients according to NIH criteria is as follows: NIH II (4.2%), NIH IIIA (31.5%), NIH IIIB (50.0%) and urethroprostatitis (14.3%). Chlamydial infection was present in one man (0.6%). Only two men with increased leucocytes in prostatic secretions demonstrated > or =106 million ml-1 PPL in semen. As compared with our cohort study 10 years ago, the proportion of the different subtypes of the prostatitis syndrome have remained stable. The aetiological spectrum of chronic bacterial prostatitis has not changed whereas, in contrast, the prevalence of C. trachomatis now is found to be strikingly reduced. Using the WHO cutpoints for leucocytospermia the inclusion of seminal leucocytes to the diagnostic process has not influenced the distribution between inflammatory (type NIH IIIA) and noninflammatory (type NIH IIIB) chronic pelvic pain syndrome.

Male infertility: Pathogenesis and clinical diagnosis

“…The most common pathogens causing infections of the urogenital tract are Ureaplasma urealyticum, Enterococcus faecalis, Escherichia Coli and are usually associated with typical irritative urinary tract symptoms and prostatodynia. 9,10 The presence of micro organisms and/or leucocytes in the seminal fluid may affect sperm motility and the fertilizing capacity of spermatozoa due to the production of reactive oxygen radicals by activated leucocytes. 11 An autoimmune reaction against the spermatozoa as an isolated abnormality is seen in <5% of infertile males.…”

Chronic prostatitis/chronic pelvic pain syndrome is associated with previous colonoscopy

“…Thus, the dataset used in this study did not allow us to differentiate CP/CPPS from chronic bacterial prostatitis, which accounts for only 4.2% of men with prostatitis syndrome. 2 All of these may have influenced the pathogenesis or mechanism of CP/ CPPS. Third, the CP/CPPS diagnoses in this study is based on claims data and ICD-9CM code.…”

“…1,2 Characteristics of patients with CP/CPPS include a high prevalence, frequent recurrences, and a substantially impaired quality of life; [3][4][5][6] however, the etiology, pathogenesis, and optimal treatment of CP/CPPS remain unknown. Previous reports suggested that trigger factors of the chronic pelvic pain process could be infections, chemical irritation, trauma, genetics, and psychological stress that result in subsequent neurological changes, such as brain microstructural changes, central sensitization, and pelvic floor spasms.…”

The Diagnostic Approach to Patients with Prostatitis-Like Symptoms: What Do We Have to Do?

“…If the clinical signs suggest a systemic or even accompanying bloodstream infection, a blood culture is suggested [ 1 , 10 ]. Enterobacteria (in primis Escherichia coli ) followed by enterococci and less frequently Pseudomonas aeruginosa are the most common pathogenic agents [ 11 ].…”