Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome.

OBJECTIVE: The aim of this study was to assess the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: A group of 399 patients with symptoms suggesting prostatitis without urethral discharge attending an outpatient Prostatitis Clinic was considered. All were evaluated by the same urologist according to a protocol comprising medical history, physical and transrectal ultrasound examination. Patients had a urethral swab, a four-specimen study and culture of the seminal fluid. Patients were classified according to NIDDK/NIH on the basis of the results of the microbiologic and microscopic four-specimen study and of the culture of the seminal fluid. Subjective symptoms were scored by CPSI questionnaire and by non validated general assessment questions inquiring loss of libido, quality of erection, premature loss of erection, pain on ejaculation, hemo-spermia, pyo-spermia, premature ejaculation, and presence of semen abnormalities. RESULTS: Of all the patients evaluated, 138 (34%) had erectile and 220 ejaculatory dysfunctions (55%). Loss of libido, premature ejaculation and presence of semen abnormalities were more frequent in subjects younger than 50 years. Rates of impaired erection and of semen abnormalities were significantly higher in patients with bacterial chronic prostatitis with respect to patients with chronic pelvic pain syndrome. Premature ejaculation was more frequent (p = 0.02) in patients with 10-30 leukocytes (36%) or > 30 leukocytes (32%) in VB3 urine than in those with 10 or less leukocytes (22%). Painful ejaculation was significantly associated to the sonographic demonstration of enlargement (p = 0.000), asymmetry (p = 0.001) or inflammatory changes (p = 0.038) of the seminal vesicles, whereas hemo-spermia was significantly associated to asymmetry (p = 0.000) or inflammatory changes (p = 0.013, respectively) of the seminal vesicles. Men with erectile (p = 0.001) and ejaculation dysfunction (p = 0.001) had more severe CPSI scores than men without such complaints. The presence of erectile and ejaculation dysfunction was related to significantly higher scores for domains of pain and quality of life. CONCLUSIONS: Although mental distress and impaired quality of life related to illness could contribute to sexual dysfunction observed in patients with CP/CPPS, the presence of erectile and ejaculatory disorders is more frequently related to symptoms and imaging suggestive of a more severe inflammatory condition.

Microscopic and microbiological findings for evaluation of chronic prostatitis.

OBJECTIVE: The aim of this study was to assess the significance of different diagnostic methods for detecting prostatic inflammation/infection. MATERIALS AND METHODS: A group of 233 with symptoms suggesting prostatitis without urethral discharge attending an outpatient Prostatitis Clinic was considered. All were evaluated by the same urologist according to a protocol comprising medical history, physical and transrectal ultrasound examination. Patients had a urethral swab for bacterial culture and additional swabs for identification of C. trachomatis, T. vaginalis, U. urealyticum, M. hominis and Candida spp. Patients also underwent a four-specimen study according to Meares and Stamey (first voided urine VB1, midstream urine VB2, expressed prostatic secretion EPS and urine after prostatic massage VB3) and culture of the seminal fluid. RESULTS: Of 233 patients evaluated, 47% had a positive urethral culture, 35% a positive culture of the seminal fluid and only 13% a positive culture of one or more samples of the four-specimen localization test. A positive culture of VB1 or VB2 was very rarely associated with a negative swab culture respectively in 1% and 0.9%; on the contrary, a positive swab culture was frequently associated with negative VB1 and VB2 culture respectively in 90% and 91%. Of the patients with positive urethral culture only 8% and 2% had more than 10 leukocytes respectively in VB1 and VB2. A positive seminal culture was associated with negative EPS and VB3 culture respectively in 89% and 83% cases; on the contrary, a positive culture of EPS or VB3 was associated with a negative seminal fluid culture respectively in 67% and 27% cases. In 49% patients with positive culture of the seminal fluid, more than 10 leukocytes in VB3 were observed. Only in 9 of the 47 patients with positive culture of the seminal fluid EPS can be obtained and 3 of them (33%) had more than 10 leukocytes in EPS. CONCLUSIONS: Culture and determination of leukocytes in first voided and midstream urine showed a low sensitivity in detection of urethral infection/inflammation compared to urethral swab culture. On the contrary, microscopic examination of urine after prostatic massage was confirmed as a useful indirect indicator in the diagnosis of prostatic inflammation and showed to be more feasible compared with the analysis of expressed prostatic secretion. In conclusion, urethral swab culture and post-massage urine culture and microscopic examination could be proposed as an alternative standard protocol in order to simplify the evaluation of prostatitis-like syndrome in the clinical practice.