Korean J Urol.  2014 Apr;55(4):276-280. 10.4111/kju.2014.55.4.276.

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

• Sung YH
• Jung JH
• Ryang SH
• Kim SJ
• Kim KJ

• KMID: 1885610
• DOI: http://doi.org/10.4111/kju.2014.55.4.276

Abstract

PURPOSE
We determined the effects of alpha-blockers and quinolone in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) classified by National Institute of Health (NIH) consensus group.
MATERIALS AND METHODS
Data from a total of 111 patients who were diagnosed with CP/CPPS between June 2010 and June 2012 were analyzed retrospectively. The patients were classified into group 1 (category IIIA, n=40) and group 2 (category IIIB, n=71). Treatment using alfuzosin and levofloxacin was given to both groups for 6 weeks. International Prostate Symptom Score (IPSS) and NIH Chronic Prostatitis Symptom Index were measured before and after therapy.
RESULTS
Group 1 had a significant decrease in total IPSS score, CPSI pain score, CPSI quality of life (QoL) score, and total CPSI score (p=0.043, p=0.006, p=0.015, and p=0.006, respectively). Group 2 had a significant decrease in IPSS voiding symptom score, IPSS storage symptom score, total IPSS, CPSI pain score, CPSI voiding score, CPSI QoL score, and total CPSI score (p=0.002, p=0.004, p=0.001, p=0.001, p=0.006, p=0.001, and p=0.001, respectively). The CPSI score was reduced by 6 points or more in 50.0% of patients (n=18) in group 1 and in 51.6% of patients (n=32) in group 2. However, there was no statistically significant difference between the changes in IPSS and CPSI scores across the 2 groups.
CONCLUSIONS
Although combination treatment reduced the CPSI score in both groups, there was no significant difference between the groups after combination treatment. We suggest that factors other than inflammation also contribute to symptoms associated with CP/CPPS.

Keyword

Adrenergic alpha-antagonist; Anti-bacterial agents; Leukocytes; Prostatitis

MeSH Terms

Anti-Bacterial Agents
Classification*
Consensus
Humans
Inflammation
Leukocytes
Levofloxacin
National Institutes of Health (U.S.)*
Pelvic Pain*
Prostate
Prostatitis
Quality of Life
Retrospective Studies
Anti-Bacterial Agents

Reference

1. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998; 159:1224–1228.

2. Nickel JC, Downey J, Johnston B, Clark J. Canadian Prostatitis Research Group. Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol. 2001; 165:1539–1544.

3. Kim TH, Lee KS, Kim JH, Jee JY, Seo YE, Choi DW, et al. Tamsulosin monotherapy versus combination therapy with antibiotics or anti-inflammatory agents in the treatment of chronic pelvic pain syndrome. Int Neurourol J. 2011; 15:92–96.

4. Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2010; 57:35–48.

5. Nickel JC. The three as of chronic prostatitis therapy: antibiotics, alpha-blockers and anti-inflammatories. What is the evidence? BJU Int. 2004; 94:1230–1233.

6. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999; 282:236–237.

7. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006; 355:1690–1698.

8. Krieger JN, Ross SO, Deutsch L, Riley DE. The NIH Consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia. Curr Urol Rep. 2002; 3:301–306.

9. Mobley DF. Semen cultures in the diagnosis of bacterial prostatitis. J Urol. 1975; 114:83–85.

10. Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, Propert KJ, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. 2003; 170:818–822.

11. Nickel JC. Classification and diagnosis of prostatitis: a gold standard? Andrologia. 2003; 35:160–167.

12. McNaughton Collins M, Fowler FJ Jr, Elliott DB, Albertsen PC, Barry MJ. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? Urology. 2000; 55:403–407.

13. Bjerklund Johansen TE, Gruneberg RN, Guibert J, Hofstetter A, Lobel B, Naber KG, et al. The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol. 1998; 34:457–466.

14. Jeong CW, Lim DJ, Son H, Lee SE, Jeong H. Treatment for chronic prostatitis/chronic pelvic pain syndrome: levofloxacin, doxazosin and their combination. Urol Int. 2008; 80:157–161.

15. Youn CW, Son KC, Choi HS, Kwon DD, Park K, Ryu SB. Comparison of the efficacy of antibiotic monotherapy and antibiotic plus alpha-blocker combination therapy for patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome. Korean J Urol. 2008; 49:72–76.

16. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol. 2002; 168:1048–1053.

17. Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP, et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med. 2004; 141:581–589.

18. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012; 110:1014–1022.

19. Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009; 12:177–183.

20. Magri V, Wagenlehner F, Perletti G, Schneider S, Marras E, Naber KG, et al. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 2010; 184:2339–2345.

21. Shoskes DA, Nickel JC, Dolinga R, Prots D. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology. 2009; 73:538–542.

22. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010; 75:1249–1253.