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Sacco E, Totaro A, Marangi F, Pinto F, Racioppi M, Gulino G, Volpe A, Gardi M, Bassi P. Prostatitis Syndromes and Sporting Activities. Urologia 2018. [DOI: 10.1177/039156031007700209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Prostatitis-like syndromes are high prevalent health problems and frequently considered by patients and physicians as strictly correlated to sports causing perineal compression. These syndromes and their relationships with sporting activities have been discussed in this report. Methods We reviewed peer-reviewed scientific articles published by May 2009 and searched according to the following term selection: prostatitis, pudendal nerve, sport, cycling. Results Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major healthcare burden heavily affecting patients’ Quality of Life. No clear evidence of any direct etiologic relationship has been found in literature between prostatitis, either bacterial or non-bacterial, and sports activities. On the other hand, some types of sport causing perineal compression, such as cycling, can exacerbate symptoms of acute and chronic prostatitis; a temporary sport discontinuation is justified in these patients. CP/CPPS may be often caused by pudendal nerve entrapment (PNE). Prostatitis-like urogenital neuropathic pain together with voiding and sexual dysfunctions are the hallmark of PNE. A common feature is that flexion activities of the hip, such as climbing, squatting, cycling provoke or worsen urogenital pain or pelvic pain. Many of the patients with PNE are cyclists, played American football, lifted weights, or wrestled as teenagers and young adults. PNE represents the most common bicycling associated urogenital problems. Conclusions Overall, studies show that no causal relationship has been demonstrated between prostatitis and sporting activities. Conversely, urologists should be aware that sports involving vigorous hip flexion activities or prolonged perineal compression are a potential and not an infrequent cause of uroand rological symptoms caused by pudendal nerve entrapment.
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Affiliation(s)
- E. Sacco
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Totaro
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - F. Marangi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - F. Pinto
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - M. Racioppi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - G. Gulino
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Volpe
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - M. Gardi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - P.F. Bassi
- Clinica Urologica, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
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Quallich SA, Arslanian-Engoren C. Chronic unexplained orchialgia: a concept analysis. J Adv Nurs 2014; 70:1717-26. [PMID: 24372508 DOI: 10.1111/jan.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2013] [Indexed: 11/27/2022]
Abstract
AIMS To conduct an analysis of the concept of chronic unexplained orchialgia. BACKGROUND Chronic unexplained orchialgia is a concept unique to men's health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. DESIGN Walker and Avant's framework was used to guide this concept analysis. DATA SOURCES Literature sources included bibliographic databases. REVIEW METHODS Literature published in English from January 1970 to December 31, 2012 was reviewed. Thematic analysis identified critical attributes, antecedents and consequences of the concept. RESULTS Based on the analysis, a contemporary definition for chronic unexplained orchialgia is proposed, rooted in the concept of chronic pain. This definition is based on the concept analysis and the defining attributes that were identified in the literature. Chronic unexplained orchialgia is a subjective negative experience of adult men, perceived as intermittent or continuous pain of variable intensity, present at least three months, localizing to the testis(es) in the absence of objective organic findings and that interferes with quality of life. CONCLUSION This analysis provides a precise definition for chronic unexplained orchialgia and distinguishes it from other similar terms. This concept analysis provides conceptual clarity that can guide understanding and development of a conceptual framework, middle range theory, or situation-specific theory. Further exploration of this concept is recommended to uncover the influence of social, sexual and cultural factors.
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Affiliation(s)
- Susanne A Quallich
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA; Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Quallich SA, Arslanian-Engoren C. Chronic testicular pain in adult men: an integrative literature review. Am J Mens Health 2013; 7:402-13. [PMID: 23403775 DOI: 10.1177/1557988313476732] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men's health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. This integrative literature review provides a summary of the current state of the science of chronic testicular pain in men, identifies the gaps in our knowledge, and provides recommendations to address this knowledge gap.
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Marx S, Cimniak U, Beckert R, Schwerla F, Resch KL. [Chronic prostatitis/chronic pelvic pain syndrome. Influence of osteopathic treatment - a randomized controlled study]. Urologe A 2010; 48:1339-45. [PMID: 19705093 DOI: 10.1007/s00120-009-2088-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prostatitis is the most common urological disease in males under [corrected] the age of 50 years old. As bacteria are detected in only <5% of cases the disease can mostly be classified as chronic nonbacterial prostatitis. The symptoms of this problem complex, often described as chronic prostatitis and chronic pelvic pain syndrome (CP-CPPS), seem to be multifactorial so that an improvement can only rarely be achieved with conventional forms of therapy. MATERIALS AND METHODS The aim of this study was to investigate whether osteopathic treatment can influence the symptoms of CP-CPPS (randomized controlled study, 5 sessions, follow-up after 6 weeks and 1.5 years without treatment). The study was carried out in a practice for osteopathy. Patients were recruited by referral from urologists, newspaper articles and lectures on the topic. A total of 35 males with medically diagnosed CP-CPPS aged 29-70 years old took part in the study. Of the patients 20 were allocated to the treatment group and 15 to the placebo group whereby 2 patients had to retire from the study prematurely. Patients in the treatment group received 5 osteopathic treatment sessions separated by 1 week at the beginning and by up to 3 weeks at the end (total period 8 weeks). The osteopathic dysfunctions of the patients were treated according to the principles of osteopathy. The placebo treatment in the control group consisted of a training program with simple gymnastic and physiotherapeutic exercises. Improvements of the complaints by urination (LUTS), chronic pelvic pain (CPPS) and quality of life (QOL) were measured using the questionnaires for international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life index (QOL). RESULTS Comparison of the results from the osteopathy and placebo groups revealed statistically significant differences in favor of the osteopathy group (p<0.0005). During the study period the average IPSS in the osteopathy group improved from 19.7 to 10.3 points (48%, p<0.0005), the NIH from 26.0 to 12.0 (54%; p<0.0005) and the QOL from 4.4 to 1.9 points (58%, p<0.0005). In contrast the corresponding values in the placebo group remained relatively constant. At the follow-up 6 weeks after the last session the improvements in the osteopathy group were found to be stabile and remained so at least up to the second follow-up after 1.5 years. CONCLUSIONS The positive results of this study indicate that osteopathic treatment can be considered a genuine alternative to the conventional treatment of CP-CPPS and a closer cooperation between urologists/internists and osteopaths would be desirable. Further studies with larger numbers of patients should be carried out to substantiate these results.
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Affiliation(s)
- S Marx
- Praxis Osteopathie und Naturheilkunde, Alte Talstrasse, Esslingen, Deutschland.
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Abstract
PURPOSE Chronic prostatitis (CP) is a common condition. It causes significant suffering to the patients and constitutes a sizeable workload for the urologists. The purpose of this review is to describe the currently accepted concepts regarding the aspects of CP. MATERIALS AND METHODS Relevant papers on the epidemiology, etiology, diagnosis, evaluation and management of CP were identified through a search of MEDLINE using text terms "prostatitis", "chronic prostatitis" and "chronic pelvic pain syndrome". The list of articles thus obtained was supplemented by manual search of bibliographies of the identified articles and also by exploring the MEDLINE option "Related Articles". RESULTS The salient points of the relevant articles on each aspect of CP have been summarized in the form of a non-systematic narrative review. CONCLUSION Chronic prostatitis is caused by a variety of infective and non-infective factors and is characterized by a rather long remitting and relapsing clinical course. The diagnosis is based on symptoms comprising pain and nonspecific urinary and/or ejaculatory disturbances and microbiological tests to localize bacteria and/or leucocytes in segmented urinary tract specimens. The contemporary classification was proposed by the National Institutes of Health/National Institute of Diabetes Digestive Kidney Diseases (NIH/NIDDK). National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) is the patient evaluation tool used extensively in clinical practice and research. Management should be individualized, multimodal and of an appropriate duration.
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Abstract
Prostatitis syndrome is a multifactorial disease with a largely unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification, pathogens can be cultured only in acute and chronic bacterial prostatitis. A long-term antimicrobial therapy, mainly with fluoroquinolones, is then recommended. Most patients suffer from chronic pelvic pain syndrome (CP/CPPS) which can be subdivided into inflammatory and non-inflammatory types. Whether the inflammatory CP/CPPS is an infectious disease remains uncertain. The effect of an antibiotic therapy therefore remains debatable. In case of proven or suspected functional infravesical obstruction, treatment with a-receptor blockers is recommended. Accompanying symptomatic therapy is also recommended. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic limitations.
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Ford APDW, Gever JR, Nunn PA, Zhong Y, Cefalu JS, Dillon MP, Cockayne DA. Purinoceptors as therapeutic targets for lower urinary tract dysfunction. Br J Pharmacol 2006; 147 Suppl 2:S132-43. [PMID: 16465177 PMCID: PMC1751490 DOI: 10.1038/sj.bjp.0706637] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are present in many common urological syndromes. However, their current suboptimal management by muscarinic and alpha(1)-adrenoceptor antagonists leaves a significant opportunity for the discovery and development of superior medicines. As potential targets for such therapeutics, purinoceptors have emerged over the last two decades from investigations that have established a prominent role for ATP in the regulation of urinary bladder function under normal and pathophysiological conditions. In particular, evidence suggests that ATP signaling via P2X(1) receptors participates in the efferent control of detrusor smooth muscle excitability, and that this function may be heightened in disease and aging. ATP also appears to be involved in bladder sensation, via activation of P2X(3) and P2X(2/3) receptors on sensory afferent neurons, both within the bladder itself and possibly at central synapses. Such findings are based on results from classical pharmacological and localization studies in non-human and human tissues, knockout mice, and studies using recently identified pharmacological antagonists--some of which possess attributes that offer the potential for optimization into candidate drug molecules. Based on recent advances in this field, it is clearly possible that the development of selective antagonists for these receptors will occur that could lead to therapies offering better relief of sensory and motor symptoms for patients, while minimizing the systemic side effects that limit current medicines.
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Affiliation(s)
- Anthony P D W Ford
- Department of Biochemical Pharmacology, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
- Department of Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Joel R Gever
- Department of Biochemical Pharmacology, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Philip A Nunn
- Department of Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Yu Zhong
- Department of Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Joseph S Cefalu
- Department of Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Michael P Dillon
- Department of Medicinal Chemistry, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
| | - Debra A Cockayne
- Department of Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A
- Neuroscience, Roche Palo Alto, 3431 Hillview Avenue, Palo Alto, CA 94304, U.S.A. E-mail:
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Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O'Leary MP, Pontari MA, Fowler JE, Nyberg LM, Kusek JW. Catastrophizing and Pain-Contingent Rest Predict Patient Adjustment in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. THE JOURNAL OF PAIN 2006; 7:697-708. [PMID: 17018330 DOI: 10.1016/j.jpain.2006.03.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 03/14/2006] [Accepted: 03/21/2006] [Indexed: 11/23/2022]
Abstract
UNLABELLED Cognitive/behavioral and environmental variables are significant predictors of patient adjustment in chronic pain. Using a biopsychosocial template and selecting several pain-relevant constructs from physical, cognitive/behavioral, and environmental predictors, outcomes of pain and disability in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were explored. Men (n = 253) from a North American multi-institutional NIH-funded Chronic Prostatitis Cohort Study in 6 US and 1 Canadian centers participated in a survey examining pain and disability. Measures included demographics, urinary symptoms, depression, pain, disability, catastrophizing, control over pain, pain-contingent rest, social support, and solicitous responses from a significant other. Regressions showed that urinary symptoms (beta = .20), depression (beta = .24), and helplessness catastrophizing (beta = .29) predicted overall pain. Further, affective pain was predicted by depression (beta = .39) and helplessness catastrophizing (beta = .44), whereas sensory pain was predicted by urinary symptoms (beta = .25) and helplessness catastrophizing (beta = .37). With regard to disability, urinary symptoms (beta = .17), pain (beta = .21), and pain-contingent rest (beta = .33) were the predictors. These results suggest cognitive/behavioral variables (ie, catastrophizing, pain-contingent rest) may have significant impact on patient adjustment in CP/CPPS. Findings support the need for greater research of such pain-related variables in CP/CPPS. PERSPECTIVE This article explores predictors of patient adjustment in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Cognitive/behavioral variables of catastrophizing and pain-contingent rest respectively predicted greater pain and disability. Catastrophic helplessness was a prominent pain predictor. These findings inform clinicians and researchers on several new variables in CP/CPPS outcomes and suggest future research.
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Affiliation(s)
- Dean A Tripp
- Department of Psychology, Anesthesiology and Urology, Queen's University, Kingston, Ontario, Canada.
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Chen Y, Song B, Jin XY, Xiong EQ, Zhang JH. Possible mechanism of referred pain in the perineum and pelvis associated with the prostate in rats. J Urol 2006; 174:2405-8. [PMID: 16280857 DOI: 10.1097/01.ju.0000180421.90260.65] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Since persistent pain in the perineum and pelvic floor associated with chronic prostatitis /chronic pelvic pain syndrome has been hypothesized to be referred pain, it might also be explained by neural mechanisms. MATERIALS AND METHODS Dual retrograde fluorescent labeling and immunohistochemistry were identified as methods with which to investigate the neurogenic aspect of this status. The dual distribution of dorsal root ganglia (DRG) cells was determined after double retrograde fluorescent staining of the prostate and pelvic floor, and the prostate and perineum somatic nerves. Calcitonin gene-related peptide (CGRP) and substance P (SP) in dual labeled cells were determined by immunohistochemistry, giving possible insight into the cause of pelvic pain. RESULTS Fluorescent double labeled cells were found in the lumbar and sacral DRG, while double labeled cells were distributed predominantly in L6 to S1 and L1 to L2 segment DRG in groups 1 and 2, respectively. On immunohistochemistry some of them were confirmed to contain CGRP and SP. Thus, there are crossover pathways between the prostate and pelvic floor. CONCLUSIONS The findings that we present confirm that the peripheral process of DRG cells dichotomizes to the prostate, sphincter and somatic parties simultaneously. Some of these cells contain CGRP and SP, which indicate that referred pain in the perineum and pelvic floor may be caused by an axon reflex in the peripheral process of DRG neurons.
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Affiliation(s)
- Yong Chen
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China 40008
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Macaluso MP. Re: Chronic Bacterial Prostatitis: An Evolving Clinical Enigma. Eur Urol 2006. [DOI: 10.1016/j.eururo.2006.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Turner JA, Ciol MA, Von Korff M, Liu YW, Berger R. Men With Pelvic Pain: Perceived Helpfulness of Medical and Self-Management Strategies. Clin J Pain 2006; 22:19-24. [PMID: 16340589 DOI: 10.1097/01.ajp.0000148630.15369.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the frequency of use of different treatments and pain management strategies and their perceived helpfulness in male patients with pelvic pain. METHODS Approximately 1 month after a health maintenance organization visit for pelvic pain, 286 men (mean age 46.7 years) completed telephone interviews about their symptoms and treatments and pain management strategies used in the past year. Participants rated the helpfulness of each treatment and strategy used on 0 to 10 scales. RESULTS Even though men with identified bacterial etiology were excluded from the study, antibiotic medication was the most commonly reported treatment (67% of patients) and rated as the second most helpful treatment [mean (SD)=6.3 (3.6)]. Opiates were rated as the most helpful treatment on average [mean (SD)=7.9 (2.1)], but were used by only 12% of patients. Substantial minorities of patients reported several behaviors as helpful, including urinating (reported as helpful by 26%), taking warm baths (23%), and drinking water (23%), although patterns of effects differed for men with versus without urinary symptoms. Activities most commonly reported as worsening symptoms were sitting (42%), walking/jogging (27%), and sexual activity (25%). DISCUSSION Patients with male pelvic pain syndrome are commonly prescribed antibiotics, which they perceive as moderately helpful, despite the lack of scientific evidence of efficacy. Clinicians may find it useful to support patient use of safe, inexpensive, self-management approaches, especially warm baths, increased water intake, and avoidance of prolonged sitting.
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Affiliation(s)
- Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Ku JH, Kim SW, Paick JS. Quality of life and psychological factors in chronic prostatitis/chronic pelvic pain syndrome. Urology 2005; 66:693-701. [PMID: 16230119 DOI: 10.1016/j.urology.2005.04.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 04/02/2005] [Accepted: 04/21/2005] [Indexed: 11/20/2022]
Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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Tripp DA, Curtis Nickel J, Landis JR, Wang YL, Knauss JS. Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study. BJU Int 2005; 94:1279-82. [PMID: 15610105 DOI: 10.1111/j.1464-410x.2004.05157.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the cross-sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS In all, 463 men enrolled in the National Institutes of Health (NIH) Chronic Prostatitis Cohort Study from seven clinical centres (six in the USA and one in Canada) reported baseline screening symptoms using the NIH Chronic Prostatitis Symptom Index (CPSI). The CPSI provides scores for pain, urinary symptoms and QoL. In addition, a demographic profile, including age and partner (living with another) status, and a depressive symptom score were obtained. Regression modelling of QoL, adjusting for between-centre variability, examined the unique effects of age, partner status, urological symptoms, depressive symptoms and pain. RESULTS Urinary scores, depressive symptoms and pain intensity scores significantly predicted QoL for patients with CP/CPPS (higher CPSI QoL scores indicated more impairment; median 8.0, range 0-12). On average, for every 1-point increase in urinary scores, there was a corresponding increase in QoL score of 0.118 points (P = 0.001); for every 1-point increase in pain intensity score, there was a corresponding increase in QoL score of 0.722 points (P < 0.001); and for every 1-point decrease in depressive symptoms (lower scores equal poorer mood), the QoL score increased (poorer quality of life) by 0.381 points (P < 0.001). Age and partner status did not significantly contribute to poorer QoL. Urinary scores and depressive symptoms were significant predictors (P < 0.001) of pain in patients with CP/CPPS. CONCLUSIONS These data show that depressive symptoms and pain intensity significantly predict a poorer QoL in patients with CP/CPPS, and that these effects are independent of partner status, age and urinary status. In particular, pain intensity was the most robust predictor of a poorer QoL. Further data relating pain and psychological factors to CP/CPPS are highly recommended, to aid in determining specific factors for pain and its impact on QoL. These data are essential if empirically guided efforts to manage pain are to progress.
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Affiliation(s)
- Dean A Tripp
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.
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Affiliation(s)
- Gary B Rollman
- Department of Psychology, University of Western Ontario, London, Ontario, Canada.
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Hochreiter WW, Hruz P, Danuser H, Weidner W, Studer UE. [Evaluation of symptoms in men with chronic pelvic pain]. Urologe A 2003; 42:38-40. [PMID: 12574882 DOI: 10.1007/s00120-002-0264-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
According to the National Institutes of Health classification system, chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is subdivided into an inflammatory (category IIIa) and a non-inflammatory (category IIIb) form. The difference is based on the presence or absence of white blood cells in expressed prostatic secretions, urine after prostatic massage, or semen. This is the only criterion which allows a differentiation between the IIIa and IIIb forms. The symptoms, i.e. pain and urinary complaints of various degrees, are thought to be similar in both forms. These symptoms can be assessed with the Chronic Prostatitis Symptom Index (CPSI) and the International Prostate Symptom Score (IPSS), which are both available in a validated German translation. One hundred and six patients with CPPS were evaluated with CPSI and IPSS. Urinary symptoms troubled all patients. Men with category IIIa had significantly more urinary symptoms when compared to men with category IIIb. There was no difference between the two groups regarding pain and impact on the quality of life. Although pain is thought to be the hallmark of CPPS, the contribution of urinary troubles to the symptoms must not be underestimated.
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Affiliation(s)
- W W Hochreiter
- Urologische Universitätsklinik, Inselspital, Bern, Switzerland.
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Propert KJ, Alexander RB, Nickel JC, Kusek JW, Litwin MS, Landis JR, Nyberg LM, Schaeffer AJ. Design of a multicenter randomized clinical trial for chronic prostatitis/chronic pelvic pain syndrome. Urology 2002; 59:870-6. [PMID: 12031372 DOI: 10.1016/s0090-4295(02)01601-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the study design and rationale for the first placebo-controlled, randomized clinical trial to be conducted by the Chronic Prostatitis Collaborative Research Network sponsored by the National Institutes of Health. METHODS The clinical trial will use a 2 by 2 factorial design to evaluate four treatments: placebo, tamsulosin hydrochloride alone, ciprofloxacin alone, and tamsulosin hydrochloride and ciprofloxacin combined. The primary objectives are to compare the efficacy and safety endpoints in patients with chronic prostatitis/chronic pelvic pain syndrome. The study population consists of men with symptoms of discomfort or pain in the pelvic region for at least a 3-month period. One hundred eighty-four participants will be treated for 6 weeks and followed up for an additional 6 weeks. The primary endpoint is the change in the overall National Institutes of Health Chronic Prostatitis Symptom Index from baseline to 6 weeks. Secondary endpoints include a patient-reported global assessment of response and white blood cell counts and cultures in urine, expressed prostatic secretions, and semen. The evaluation of changes from 6 to 12 weeks will be used to assess the durability of the response. RESULTS This trial was opened to enrollment in July 2001. The study is expected to require 14 months of accrual and follow-up. CONCLUSIONS The issues considered in the design of this clinical trial may provide guidelines for future clinical trials in chronic prostatitis/chronic pelvic pain syndrome.
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Affiliation(s)
- Kathleen J Propert
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA
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Primary Care And Urology Patients With The Male Pelvic Pain Syndrome: Symptoms And Quality Of Life. J Urol 2002. [DOI: 10.1097/00005392-200204000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Turner JA, Hauge S, Von Korff M, Saunders K, Lowe M, Berger R. Primary Care And Urology Patients With The Male Pelvic Pain Syndrome: Symptoms And Quality Of Life. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65196-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Judith A. Turner
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
| | - Stephanie Hauge
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
| | - Michael Von Korff
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
| | - Kathleen Saunders
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
| | - Marc Lowe
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
| | - Richard Berger
- From the Departments of Psychiatry, Behavioral Sciences and Rehabilitation Medicine, and Urology, University of Washington School of Medicine, Center for Health Studies and Department of Urology, Group Health Cooperative of Puget Sound, Seattle, Washington
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Abstract
Very few epidemiologic studies of interstitial cystitis (IC) have been published over the past 5 years. One population-based study focused only on women and suggested that the prevalence of the IC symptom complex in the United States is much higher than previously reported. Future epidemiologic studies of IC must overcome major obstacles to obtain more accurate population-based estimates. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) criteria used to assist in identifying patients with IC have proven to be cumbersome and too restrictive. Other obstacles include (1) the relative infrequency of the condition; (2) the long duration between development of symptoms and diagnosis; and (3) the perception that the disorder occurs predominantly in white women. Evidence suggests men with the IC symptom complex are often misdiagnosed by physicians and identified as having chronic prostatitis (also called the chronic pelvic pain syndrome) or benign prostatic hyperplasia. Children who present with the IC symptom complex are often thought to have voiding dysfunction. We propose that the more inclusive, less restrictive term chronic pelvic pain of the bladder (CPPB) be used in future epidemiologic studies of persons with the characteristic IC symptoms of urinary frequency, urgency, and pain. Early studies of chronic pelvic pain in general suggest that it is most common in women, of unknown etiology, and, in many patients, is associated with urinary bladder symptoms. It is necessary to develop case definitions for CPPB to accurately identify those patients with symptoms currently identified as IC.
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Affiliation(s)
- J W Kusek
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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COLLINS MARYM, MEIGS JAMESB, BARRY MICHAELJ, CORKERY ELIZABETHWALKER, GIOVANNUCCI EDWARD, KAWACHI ICHIRO. PREVALENCE AND CORRELATES OF PROSTATITIS IN THE HEALTH PROFESSIONALS FOLLOW-UP STUDY COHORT. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65301-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- MARY McNAUGHTON COLLINS
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - JAMES B. MEIGS
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - MICHAEL J. BARRY
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - ELIZABETH WALKER CORKERY
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - EDWARD GIOVANNUCCI
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - ICHIRO KAWACHI
- From the General Medicine Division, Medical Services, Massachusetts General Hospital, Department of Health and Social Behavior, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Riley DE, Krieger JN. X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis. BIOCHIMICA ET BIOPHYSICA ACTA 2002; 1586:99-107. [PMID: 11781154 DOI: 10.1016/s0925-4439(01)00090-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes substantial morbidity afflicting approximately 10% of adult males. Treatment is often empirical and ineffective since the etiology is unknown. Other prostate and genitourinary diseases have genetic components suggesting that CP/CPPS may also be influenced by genetic predisposition. We recently reported a highly polymorphic short tandem repeat (STR) locus near the phosphoglycerate kinase gene within Xq11-13. Because this STR is in a region known to predispose towards other prostate diseases, we compared STR polymorphisms in 120 CP/CPPS patients and 300 control blood donors. Nine distinct allele sizes were detected, ranging from 8 to 15 repeats of the tetrameric STR plus a mutant allele (9.5) with a six base deletion in the flanking DNA sequence. The overall allele size distribution in the CP/CPPS patients differed from controls (Chi-square=19.252, df=8, P=0.0231). Frequencies of two specific alleles, 9.5 and 15, differed significantly in CP/CPPS vs. control subjects and allele 10 differed with marginal significance. Alleles 9.5 and 10 were both more common in CP/CPPS patients than controls while allele 15 was less common. These observations suggest that Xq11-13 may contain one or more genetic loci that predispose toward CP/CPPS. Further investigations involving family studies, larger patient populations, and other control groups may help elucidate this potential genetic predisposition in CP/CPPS.
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Affiliation(s)
- Donald E Riley
- Department of Urology, School of Medicine, University of Washington, Seattle, WA 98195, USA.
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25
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McNaughton Collins M, Pontari MA, O'Leary MP, Calhoun EA, Santanna J, Landis JR, Kusek JW, Litwin MS. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med 2001; 16:656-62. [PMID: 11679032 PMCID: PMC1495276 DOI: 10.1111/j.1525-1497.2001.01223.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQOL) impairment may be a central component of chronic prostatitis for men afflicted with this condition. Our objective was to examine HRQOL, and factors associated with HRQOL, using both general and condition-specific instruments. DESIGN Chronic Prostatitis Cohort (CPC) study. SETTING Six clinical research centers across the United States and Canada. PARTICIPANTS Two hundred seventy-eight men with chronic prostatitis. MEASUREMENTS AND MAIN RESULTS The Short Form 12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) were measures used. CPC subjects' MCS scores (44.0 +/- 9.8) were lower than those observed in the most severe subgroups of patients with congestive heart failure and diabetes mellitus, and PCS scores (46.4+/-9.5) were worse than those among the general U.S. male population. Decreasing scores were seen in both domains with worsening symptom severity (P < .01). History of psychiatric disease and younger age were strongly associated with worse MCS scores, whereas history of rheumatologic disease was associated with worse PCS scores. Predictors of more severe NIH-CPSI scores included lower educational level and lower income; history of rheumatic disease was associated with higher scores. CONCLUSIONS Men with chronic prostatitis experience impairment in the mental and physical domains of general HRQOL, as well as condition-specific HRQOL. To optimize the care of men with this condition, clinicians should consider administering HRQOL instruments to their patients to better understand the impact of the condition on patients' lives.
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Affiliation(s)
- M McNaughton Collins
- General Medicine Unit, Medical Services, Massachusetts General Hospital, Boston, MA 02114, USA.
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Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 2001; 88:35-8. [PMID: 11446842 DOI: 10.1046/j.1464-410x.2001.02259.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the occurrence of mental distress related to prostatitis in Finnish men. SUBJECTS AND METHODS A population-based cross-sectional survey was conducted of 2500 men aged 20--59 years living in the two northernmost provinces of Finland (Oulu and Lapland). The final response rate was 75% (1832 men). RESULTS The fear of undetected prostate cancer was reported by 17% of the men in the population who had had prostatitis, a value significantly higher (P < 0.001) than in healthy men. Fears of having a sexually transmitted disease and suicidal thinking were also slightly more common. The men who had had prostatitis preferred to be alone in a public toilet during voiding (58% vs 44%, P < 0.001). Erectile dysfunction was reported by 43% of the men with symptomatic prostatitis and decreased libido by 24%. Self-assessment of personality, adjusted for age, showed that the men with prostatitis were more often busy and nervous than the healthy controls (P < 0.001), and that they had a more meticulous attitude to life and its problems. Marital difficulties were reported by 17% of the men who had had prostatitis at some point in their lives, and 4% were convinced that their illness had caused their divorce. Socio-economic status and social well-being had no apparent influence on the occurrence of prostatitis. CONCLUSIONS This survey showed that psychological stress is common in men with prostatitis. Urologists and general practitioners should consider that a consultation with a psychiatrist may be appropriate for selected men with prostatitis.
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Affiliation(s)
- A Mehik
- Division of Urology, Department of Surgery, Oulu University Hospital, Finland.
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SIMILARITY OF DISTRIBUTIONS OF SPINAL C-FOS AND PLASMA EXTRAVASATION AFTER ACUTE CHEMICAL IRRITATION OF THE BLADDER AND THE PROSTATE. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67101-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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SIMILARITY OF DISTRIBUTIONS OF SPINAL C-FOS AND PLASMA EXTRAVASATION AFTER ACUTE CHEMICAL IRRITATION OF THE BLADDER AND THE PROSTATE. J Urol 2000. [DOI: 10.1097/00005392-200011000-00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Computed Tomography-Guided Pudendal Nerve Block. A New Diagnostic Approach to Long-term Anoperineal Pain. Reg Anesth Pain Med 2000. [DOI: 10.1097/00115550-200007000-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Concepts regarding the etiology, diagnosis, and management of prostatitis have changed more in the last 3 years than they have in the last 3 decades. Urologists (and all physicians) no longer need to avoid patients with this disease. It is hoped that the new management strategies that are evolving will eventually benefit the majority of patients sustaining prostatitis.
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Affiliation(s)
- J C Nickel
- Department of Urology, Queen's University, Kingston, Canada
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Collins MM, O'Leary MP, Barry MJ. Prevalence of bothersome genitourinary symptoms and diagnoses in younger men on routine primary care visits. Urology 1998; 52:422-7. [PMID: 9730454 DOI: 10.1016/s0090-4295(98)00172-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To assess the prevalence of bothersome genitourinary (GU) symptoms in younger men on routine primary care physician visits. METHODS One hundred six men aged 18 to 50 years were approached to complete a brief, self-administered survey that included the American Urological Association Symptom Index, a benign prostatic hyperplasia (BPH) Impact Index, and additional questions about GU pain and sexual dysfunction and about a history of GU diseases. Men with GU symptoms had their outpatient records reviewed. RESULTS Of the 101 respondents (mean age 36 years), 50% reported GU symptoms. Of these men, 25% were bothered by their symptoms and 17% wanted to talk about them with their physicians; 22% were worried that their GU symptoms might be due to prostate cancer; 27% of all men reported a history of at least one GU disease and 17% had more than one; 16% of all men had been to a urologist. Chart review for the 51 men with symptoms revealed physician documentation of GU symptoms in only 24% of cases and an abnormal GU examination in 8%. One third of reviewed charts documented a GU problem that visit. A broad spectrum of GU diagnoses was documented; no one cause predominated. Ninety percent of all men reported that primary care physicians should routinely ask younger men GU questions as part of their general healthcare. CONCLUSIONS The high prevalence of bothersome GU symptoms and diagnoses in younger men suggests that information about the clinical, functional, and quality of life implications of these symptoms needs to be collected in this population.
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Affiliation(s)
- M M Collins
- General Medicine Division, Medical Services, Massachusetts General Hospital, Boston 02114, USA
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Abstract
Although there has been a recent surge of interest in chronic prostatitis, which hopefully will translate into advances in our understanding of the distribution and determinants of this condition, at present there is a scarcity of published epidemiologic research on chronic prostatitis. However, from the currently available epidemiologic studies, it appears that chronic prostatitis is common. In addition, studies of several determinants (i.e. age, race, region, infectious agents, uric acid, sexual activity, autoimmunity, prostate-specific antigen and prostate biopsy) may provide clues to the etiology of chronic prostatitis.
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Affiliation(s)
- M McNaughton Collins
- General Medicine Division, Medical Services, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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