The NIH consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia

Abstract

The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.

Clinical Significance of National Institutes of Health Classification in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

“…CP/CPPS is a common disorder that is typically accompanied by pain with ejaculation or discomfort in the pelvic or perineal region with prominent lower urinary tract symptoms [6,7,8]. Although prostatic inflammation has been identified in many patients with this syndrome, the etiology and pathophysiology of CP/CPPS remain unknown [4,5,6,7].…”

“…The NIH consensus group identifies CP/CPPS on the basis of WBCs in the EPS, VB3, or semen without any evidence of uropathogenic bacteria detected by standard microbiological methodology [7,8]. The Meares-Stamey 4-glass test or simpler 2-glass test has been used to diagnosis CP [7].…”

“…The Meares-Stamey 4-glass test or simpler 2-glass test has been used to diagnosis CP [7]. Since Mobley reported the usefulness of a semen culture in combination with urine culture, the new NIH consensus classification is broader than the traditional approach, which was limited to the examination of EPS [6,7,8,9]. Krieger et al [8] reported an increase in inflammation from 52% to 93% when the diagnosis was based on the addition VB3 and seminal fluid analysis (SFA) to EPS.…”

The Effect of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) on Semen Parameters in Human Males: A Systematic Review and Meta-Analysis

“…Compared with the traditional EPS-based classification, NIH IIIA encompasses a larger range of patients than nonbacterial prostatitis due to its broader criteria for inflammation. In other words, patients diagnosed with prostatodynia may be categorized into the NIH IIIB or NIH IIIA subgroup [10], [11].…”

Prostatitis and male factor infertility: A review of the literature

“…Among the four categories of the recent National Institutes of Health (NIH) classification of prostatitis [5], we will focus on the nonbacterial category III (chronic pelvic pain syndrome [CPPS]), which is the form that affects most patients [6]. In contrast to category I (acute bacterial prostatitis) and category II (chronic bacterial prostatitis), with their clear infectious etiology and thus treatment options, the pathogenesis of category-III CPPS remains unresolved and the biochemical and cellular changes accompanying this condition are without any doubt incompletely described.…”