Granulomatous prostatitis after bacille Calmette-Guérin instillation resembles prostate carcinoma:A case report and review of the literature

BACKGROUND Bacille Calmette-Guérin(BCG)instillation is recommended in patients with nonmuscle-invasive bladder cancer who have intermediate-risk and high-risk tumors.However,granulomatous prostatitis is a rare complication induced by BCG instillation,which can easily be misdiagnosed as prostate cancer.Here,we report a case of granulomatous prostatitis that resembled prostate cancer.CASE SUMMARY A 64-year-old Chinese man with bladder cancer received BCG instillation.Three days later,he stopped BCG instillation and received anti-infective therapy due to the urinary tract infection.Three months after BCG restart,he had rising total prostate-specific antigen(PSA)(9.14 ng/mL)and decreasing free PSA/total PSA(0.09).T2-weighted images of magnetic resonance imaging(MRI)showed a 28 mm×20 mm diffuse low signal abnormality in the right peripheral zone,which was markedly hyperintense on high b-value diffusion-weighted MRI and hypointense on apparent diffusion coefficient map images.Considering Prostate Imaging Reporting and Data System score of 5 and possibility of prostate cancer,a prostate biopsy was conducted.Histopathology showed typical features of granulomatous prostatitis.The nucleic acid test for tuberculosis was positive.He was finally diagnosed with BCG-induced granulomatous prostatitis.Thereafter,he stopped BCG instillation and received anti-tuberculosis treatment.During 10 mo follow-up,he had no evidence of tumor recurrence or symptoms of tuberculosis.CONCLUSION Temporarily elevated PSA and high followed by low signal abnormality on diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.

Research progress of miRNA and chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis(CNP),also the typeⅢprostatitis account for more than 90%of all patients with prostatitis.It has a long course of disease,easy to repeat,unknown pathogenesis and poor clinical efficacy.At present,some scholars at home and abroad have found that there is differential expression of microRNA(miRNA)in prostatic fluid of CNP patients or prostate tissue of CNP rat model.Intervention of miRNA expression can alleviate the symptoms and pharmacodynamics of CNP to a certain extent,which opens up a new way and direction for the pathogenesis and diagnosis and treatment of CNP.Therefore,this paper reviews the research progress of miRNA and CNP in recent years.

A comparative study of two methods for establishing a chronic non‑bacterial prostatitis model in rats‑

Objective:To compare the biological characteristics and stability of the chronic non-bacterial prostatitis(CNP)model in rats induced by the depot combined with estrogen induction method and the autoimmune response induction method.Methods:The CNP rat model was prepared using the depot combined with 17β-estradiol induction method in the depot hormone group and three concentrations of prostate protein homogenate at 40 mg/mL,20 mg/mL and 10 mg/mL in the autoimmune group,respectively.The degree of prostate tissue damage was evaluated by pathology(HE staining),and the immunoturbidimetric method was used to evaluate the contents of immunoglobulins IgA,IgM and IgG.ELISA was used to evaluate interleukin-1β(IL-1β),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and high-sensitivity-C-reactive protein(hs-CRP),and electrochemiluminescence was used to evaluate the expression level of testosterone(T),and the two model methods were compared.Results:Compared with the sham-operated group,the body mass of rats in both models was significantly lower in the depot hormone group and autoimmune group before extraction(P<0.01,P<0.01),and histopathology of the prostate in both models showed destruction of glandular structure and a significant increase in inflammatory cells.Compared with the depot hormone group and the autoimmune group,the histopathological changes and inflammatory pathological scores of prostate and the contents of immune indexes IgA,IgM and IgG were significantly different in the depot hormone group(P<0.05,P<0.05,P<0.05),and the levels of IL-1β,IL-10,TNF-α,hs-CRP and T were significantly changed in the autoimmune group(P<0.01).The comparison between the high,medium and low dose groups of the autoimmune group,in which the pathological changes in the medium dose of the autoimmune group were slightly better than the other two groups between the groups,but the changes in IL-1β,IL-10,TNF-α,hs-CRP,and T in the low dose of the autoimmune group were the most significant(P<0.05).Conclusion:The pathological tissues of the chronic non-bacterial prostatitis model established by the depot combined with estrogen induction method and the autoimmune response induction method both showed significant changes,and the comprehensive indexes indicated that the depot combined with estrogen induction method was a more appropriate modeling choice.

Clinical Study on Treatment of Chronic Prostatitis with Lingze Tablets Combined with TCM Herbal Acupoint Plasters

Objective:To study the therapeutic effect of Lingze tablets combined with traditional Chinese medicine herbal acupoint plasters on chronic prostatitis.Methods:A total of 64 patients with chronic prostatitis who were admitted to the Andrology Clinic of Shuyang County Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were randomly divided into a treatment group and a control group,with 32 cases in each group.The control group took Lingze tablets orally,4 tablets/time,3 times/d;the treatment group took the same medication along with traditional Chinese medicine acupoint herbal plasters.The two groups of patients were treated continuously for 6 weeks,and the differences in the relevant indexes of the curative effect were observed.Results:The NIH-Chronic Prostatitis Symptom Index(NIH-CPSI)scores of the two groups significantly reduced after treatment(P<0.05),and the scores of the patients in the treatment group were lower than those in the control group(P<0.05).The treatment received in the treatment group achieved and efficacy of 96.88%,which was significantly higher than that of the group,which was 81.25%(P<0.05).The maximum flow rate(MFR),average flow rate AFR,and urine output of the patients of both groups improved significantly after treatment(P<0.05).However,the experimental group showed better improvements in these indicators(P<0.05).Conclusion:Lingze tablets combined with traditional Chinese medicine acupoint herbal plasters can significantly improve the symptoms and urodynamic function of patients with chronic prostatitis.

Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis： retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg day^- 1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen （PSA） were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction （ED） at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men： a preliminary investigation

The expressed prostatic secretions （EPSs） of men with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）, infertile men and normal men were subjected to microbiological study. EPSs were collected from the subjects, which included 26 normal men, 11 infertile patients and 51 CP/CPPS patients. DNA was extracted from each specimen, and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers. The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men, but without any difference among the three patient groups. The denaturing gradient gel electrophoresis （DGGE） method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues. Principal component analysis （PCA） and partial least squares （PLS） analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups. Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients （P〈O.05）. Two bands were identified as priority factors in the discrepancy of category IliA and category IIIB prostatitis patients （P〈O.05）. According to this research, the ecological balance of the prostate and low urethra tract, when considered as a microenvironment, might play an important role in the maintenance of a healthy male reproductive tract.

Treatment of chronic prostatitis in Chinese men

The aim of this study is to assess the status of treatment of chronic prostatitis(CP)in Chinese men.A population-based cross-sectional survey was performed,in which 15000 men aged between 15 and 60 years were randomly selected to receive a questionnaire designed to assess National Institutes of Health Chronic Prostatitis Symptoms Index(NIH-CPSI)status,therapeutic efficacy and 28 other items.A total of 12743 men(84.95%)completed the questionnaire,of whom 1071(8.4%)were identified as having prostatitis-like symptoms and 517(4.5%)were diagnosed with CP according to NIH-CPSI criteria and prostatitis-like symptomatology.Of the CP patients,372(65%)underwent long-term routine treatment 12 times per year.Additionally,217(72.8%)patients received antibiotic therapy and 215(79.3%)men showed therapeutic effects.The treatment cost USD 1151(8059 yuan)per person per year on average.Most CP patients received routine treatment,in most cases with antibiotics.Treatment was costly and most CP patients were not satisfied with its effectiveness.Antibacterial treatment might have been effective primarily in patients with bacterial disease.

Increased oxidative stress and oxidative damage associated with chronic bacterial prostatitis

Aim： To investigate whether chronic bacterial prostatitis might increase oxidative stress and oxidative damage in chronic bacterial prostatitis patients （CBPP）, and to explore its possible mechanism. Methods： Enrolled in a casecontrol study were 70 randomly sampled CBPP and 70 randomly sampled healthy adult volunteers （HAV）, on whom plasma nitric oxide （NO）, vitamin C （VC）, vitamin E （VE） and β-carotene （β-CAR） level, erythrocyte malondialdehyde （MDA） level, as well as erythrocyte superoxide dismutase （SOD）, catalase （CAT） and glutathione peroxidase （GPX） activities were determined by spectrophotometry. Results： Compared with the HAV group, values of plasma NO and erythrocyte MDA in the CBPP group were significantly increased （P 〈 0.001）; those of plasma VC, VE and β-CAR as well as erythrocyte SOD, CAT and GPX activities in the CBPP group were significantly decreased （P 〈 0.001）. Findings from partial correlation for the 70 CBPP showed that with prolonged course of disease, values of NO and MDA were gradually increased （P 〈 0.001）, and those of VC, VE, β-CAR, SOD, CAT and GPX were gradually decreased （P 〈 0.05- 0.001）. The findings from stepwise regression for the 70 CBPP suggested that the model was Y= -13.2077 ＋ 0.1894MDA ＋ 0.0415NO - 0.1999GPX, F = 18.2047, P 〈 0.001, r = 0.6729, P 〈 0.001. Conclusion： The findings suggest that there exist increased oxidative stress and oxidative damage induced by chronic bacterial prostatitis in the patients, and such phenomenon was closely related to the course of disease.

Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection

Aim: To assess the efficacy and safety of anal submucosal injection (ASI) of amikacin in chronic bacterial prostatitis (CBP). Methods: Fifty male outpatients with CBP were randomly divided into two groups. Thirty cases of ASI group were given amikacin 400 mg daily by ASI for ten times and the other twenty cases of intramuscular injection (IM) group were given the same drug dally by IM. All patients were evaluated with NIH-Chronic prostatitis symptom index (NIH-CPSI), the bacteria culture of the expressed prostate secretion (EPS), proctoscopic examination, rectal biopsy and the clinical manifestation were checked at pretreatment and on day 7 and 90 after cessation of therapy. Results: The cure rate, apparent effective rate and effective rate of ASI group and IM group were 33.3% vs 5% (P<0.05), 43.3% vs 10% (P<0.05) and 16.7% vs 20% (P>0.05), respectively. The score of NIH-CPSI in both of ASI group and IM group decreased significantly 7 days after cessation of therapy, both ASI and IM of amikacin could relieve symptoms within a short time. However, 3 months after cessation of therapy the score of NIH-CPSI in ASI group continued down in spite of no significant differences compared with 7 days after cessation of therapy, but the score of IM group was rebound nearly closed to level of pretreatment at 23.8±8.5 and significantly higher than that of ASI group. The amount of white blood cell (WBC) of EPS in ASI group increased slightly at 7 days after cessation of therapy without significant difference with pretreatment (P>0.05), but it significantly decreased at 3 months after cessation of therapy, the amount of WBC of EPS in ASI group was lower than that of IM group at 3 months after cessation of therapy (P<0.05). Proctoscopic examination of anal canal were normal after ASI therapy and the rectum biopsy showed no obvious histopathologic abnormality at the site of injection except mild focal submucosal infiltration of lymphocytes and plasma cells at 7 days after cessation of therapy which disappeared on 3 months after cessation of therapy. All patients had no evident complications. Conclusion: ASI could be recommended as a new safe, effective, painless method of antibiotics administration in the treatment of CBP.

Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients

Levofloxacin is a synthetic fluoroquinolone that is usually used to treat chronic bacterial prostatitis. We investigated the safety and efficacy of levofloxacin compared with ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. This was a multicenter, open-label, randomized controlled non-inferiority trial. Four hundred and seventy-one patients with clinical symptoms/ signs were enrolled into the study, and 408 patients were microbiologically confirmed chronic bacterial prostatitis, who were randomized to either oral levofloxacin （500 mg q,d.） or ciprofloxacin （500 mg b.i^d.） for 4 weeks. Bacterial clearance rate, clinical symptoms/signs, adverse reactions and disease recurrence were assessed. The clinical symptoms and signs （including dysuria, perineal discomfort or pain） and bacteria cultures in 209 patients treated with levofloxacin and 199 patients treated with ciprofloxacin were similar. The most common bacteria were Escherichia cofiand Staphylococcus aureus. One to four weeks after the end of 4 weeks treatment, the bacterial clearance rate （86.06% vs. 60.03%; P〈O.05） and the clinical efficacy （including clinical cure and clinical improvement（93.30% vs. 71.86%; P〈0.05）） were significantly higher in the levofloxacin-treated group than in the ciprofloxacin-treated group. The microbiological recurrence rate was significantly lower in the levofloxacin-treated group than in the ciprofloxacin-treated group （4.00% vs. 19.25%; P〈0.05）. Rates of adverse events and treatment-related adverse events were slightly lower in the levofloxacin-treated group than in ciprofloxacin-treated group. Levofloxacin showed some advantages over ciprofloxacin in terms of clinical efficacy and disease recurrence, with a low rate of adverse events, for the treatment of chronic bacterial prostatitis in Chinese patients.

Chronic prostatitis in Korea:a nationwide postal survey of practicing urologists in 2004

Aim： To examine the diagnosis and treatment of chronic prostatitis by means of a nationwide postal survey of practicing urologists in 2004. Methods： A random sample of 850 Korean urologists from the Korean Urological Association Registry of Physicians were asked to complete a questionnaire that explored practicing characteristics, attitudes and diagnostic and treatment strategies in the management of chronic prostatitis. Results： Of the 850 questionnaires sent, 302 were returned （response rate 35.5 %） and 275 were induced in the final analysis. More than 50 % believed in a multifactorial etiology for chronic prostatitis and 52 % considered chronic abacterial prostatitis to be bacterial in nature. For routine diagnostic assessment, the most commonly used tests were reported to be urinalysis （95.3 %）, analysis of expressed prostatic secretions （89.5 %） and digital rectal examination （81.1%）. Only a few urologists use specific lower urinary tract cultures. Symptom assessment according to the National Institute of Health-Chronic Prostatitis Symptom Index was less frequently used （12.7 %）. First choices for therapy included antibiotics （96.4 %）, alpha-blockers （71.6 %） and sitz baths （70.5 %）. If unsuccessful, urologists frequently continued to prescribe a second course of either alpha-blockers （69.5 %） or antibiotics （57.8 %）. Conclusion： These data provide a picture of current practice regarding the management of chronic prostatitis in Korea. The diagnostic and treatment practices for prostatitis do not follow standard textbook algorithms. Further studies are needed to elucidate the etiology and pathogenesis of chronic prostatitis and to establish guidelines for its diagnosis and treatment.

Phenotypic differences between coryneform bacteria isolated from seminal fluid of healthy men and men with chronic prostatitis syndrome

We compared the potential phenotypic properties of coryneform bacteria associated with chronic prostatitis syndrome （CPS）, such as secretory inhibitor of lysozyme （SIL） and secretory inhibitor of platelet microbicidal protein （SIPMP）. A total of 110 clinical isolates of coryneform bacteria isolated from the seminal fluid of healthy men and men with CPS were tested. SIPMP production was tested by inhibiting platelet microbicidal protein （PMP） bioactivity against Bacillus subtilis, and was expressed as percentage of inhibition of PMP bactericidal activity. SIL production was tested by inhibiting lysozyme activity against Micrococcus lysodeikticus and was expressed in microgram per millilitre of inactivated lysozyme. A significantly higher proportion of CPS strains （58.7% vs. 19.2 %） was SIPMP-positive compared with non-CPS strains （P 〈 0.01）. Of the CPS strains tested, 77.8% were SIL-positive compared with 34% of the non- CPS isolates （P 〈 0.05）. These results suggest that the diagnosis of CPS should not rely solely on classical parameters, for example, the identification and counting of microorganisms, but the functional significance of these parameters must be estimated, possibly by the concentration of different bacterial substrains, detection of opportunistic microorganisms with pathogenic properties, such as pronounced resistance to the cationic antimicrobial peptides, and/or the ability to inhibit the antimicrobial host defence factors.

The influence of asymptomatic inflammatory prostatitis on the onset and progression of lower urinary tract symptoms in men with histologic benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,the incidence of which has been reported to reach approximately 80% in men in their 70s.In clinical practice,approximately 25% of men with histologic BPH are assumed to experience lower urinary tract symptoms(LUTS)and receive some kind of treatment.In other words,there are some men with histologic BPH who do not exhibit LUTS.For that reason,many factors,such as the change in hormonal environment,the immune or autoimmune response,the alteration of gene expression,and so on,are thought to affect the onset and progression of LUTS in men with histologic BPH.One such factor that has long drawn attention is the presence of asymptomatic histological inflammation,which very often accompanies symptomatic BPH.Recent studies have suggested that asymptomatic histological inflammation causes repeated destruction,healing,and regeneration of the prostate tissue,leading to the enlargement of prostatic nodules,while at the same time causing stromal tissuepredominant remodeling of the prostate tissue,which can increase urination resistance and result in the condition changing from asymptomatic BPH to symptomatic BPH.In future,the biomolecular clarification of the significance of asymptomatic histological inflammation in the prostate tissue could help develop new treatment strategies for BPH accompanied by LUTS.

Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis （CBP） patients with or without prostatic calculi. This study included 101 patients （21-62 years old） who met the consensus criteria for CBP （National Institutes of Health category II）. According to the results of transrectal ultrasonography （TRUS）, all patients were divided into two groups： Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months （range： 3-8 months）. In addition to expressed prostatic secretions （EPS） and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） and the subjective global assessment （SGA）. The microbiological eradication rate at the end of treatment were 32/39 （82.1%） and 54/62 （87.1%）, while the rates for continued eradication at the end of study were 17/39 （43.6%） and 45/62 （72.6%） in Group I and Group 2 （P〈0.01）, respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group I and from 24 to 11 in Group 2. The pain subscore （P〈0.01）, urinary sunscore （P〈0.05） and quality of life （QoL; P〈0.05） as well as the total NIH-CPSI score （P〈0.01） were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NI H-CPSI total score by at least 50%, was seen in Group I versusGroup 2 in 38.5% and 58.1% （P〈0.01）, respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP, There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

Increased Oxidative Stress and Damage in Patients With Chronic Bacterial Prostatitis

Objective To investigate whether chronic bacterial prostatitis （CBP） increases oxidative stress and damage in patients with CBP, and to explore its possible mechanism. Methods Eighty patients with CBP and 80 healthy adults as controls were enrolled in a case-control study, in which levels of nitric oxide （NO）, vitamin C （VC）, and vitamin E （VE） in plasma, as well as malondialdehyde （MDA）, activities of superoxide dismutase （SOD）, and eatalase （CAT） in erythrocytes were determined by spectrophotometry. Results Compared with the average values of NO, VC, VE, MDA, SOD, and CAT in the healthy control group, those of plasma N O and erythrocyte MDA in the CBP group were significantly increased （P〈0.00 1）, and those of plasma VC and VE as well as erythrocyte SOD and CAT in the CBP group were significantly decreased （P〈0.001）. Findings from partial correlation analysis for course of the disease and NO, VC, VE, MDA, SOD, and CAT in 80 patients with CBP, adjusted for age, suggested that with prolonged course of the disease, values of NO and MDA were gradually increased （P〈0.001）, and those of VC, VE, SOD, and CAT were gradually decreased （P〈0.05-0.001）. The findings from stepwise regression analysis for course of the disease and NO, VC, VE, MDA, SOD, and CAT in CBP group suggested that the model of stepwise regression was Y = -19.1160 ＋0.3112MDA ＋ 0.0337NO, F = 22.1734, P〈0.001, r = 0.6045, P〈0.001. The findings from the reliability analysis for VC, VE, SOD, CAT, NO, and MDA in the CBP group showed that the reliability coefficients＇ alpha （6 items） was 0.7195, P〈0.0001, and the standardized item alpha was 0.9307, P〈0.0001. Conclusion There exist increased oxidative stress and damage induced by chronic bacterial prostatitis in patients, and such a phenomenon is closely related to the course of disease.

Ambulatory urodynamic monitoring of external urethral sphincter behavior in chronic prostatitis patients

Aim: To study the behavior of external urethral sphincter in chronic prostatitis (CP) patient under natural filling.Methods: Twenty-one CP patients and 17 normal volunteers were involved in the study. Both the patients andvolunteers underwent ambulatory urodynamic monitoring (AM) and conventional medium filling cystometry (CMG).Urodec 500 was used for AM and Menuet for CMG. AM findings from CP patients were compared with those fromnormal volunteers, and the results from AM were compared with those from CMG. Results: In AM, the restingand voiding external urethral sphincter (EUS) pressures and maximum urethral closure pressures (MUCP) weresignificantly higher in CP patients [ ( 121.5 ±10.3) and (85.6±3.5) cm water, respectively ] than in normalvolunteers [ (77.6±11.4) and (10.3±1.6) cm water, respectively)]. Conclusion: The behavioral changes ofEUS in CP patients included spasm and instability of EUS, which were demonstrated using AM under natural filling;the findings were also in accord with the results of CMG. (Asian J Androl 1999 Dec; 1: 215 -217)

Factors influencing the diagnosis and treatment of chronic prostatitis among urologists in China

Aim. To identify the factors influencing diagnosis and treatment of chronic prostatitis （CP） among Chinese urologists. Methods： A sample of 656 urologists from 29 provinces of China were asked to complete a questionnaire that explored attitudes towards CP as well as diagnosis and treatment patterns in the management of CP. Both univariate and multivariate logistic regression analysis schemes were used to determine the factors that influence the diagnosis and treatment of CP. Results： A total of 656 questionnaires were given out. All were returned and 410 of those were included in the final univariate and multivariate analysis. Multivariate logistic regression analysis indicated that belief of bacterial infection in the etiology of CP （odds ratio [OR], 2.544; 95% confidence interval [CI], 1.650-3.923; P 〈 0.001） was the most significant factor influencing the routine performance of bacterial culture test. Using the same model, the type of hospital （OR, 2.799; 95% CI, 1.719-4.559; P 〈 0.001） and the routine use of the 4- or the 2-glass test （OR, 3.194; 95% CI, 2.069-4.931; P 〈 0.001） were determined to be significant factors influencing the use of the National Institutes of Health （NIH） new classification system. According to the same model, belief of bacterial infection in the etiology of CP （OR, 3.415; 95% CI, 2.024-5.762; P 〈 0.001） and the routine use of bacterial culture test （OR, 2.261; 95% CI, 1.364-3.749; P 〈 0.01） were important factors influencing the routine prescription of antibiotics. Conclusion： Our findings suggest that attitudes towards CP, and the characteristics of individual urologists＇ practices may influence the diagnosis and treatment of CP among Chinese urologists.

Endotoxins in the prostatic secretions of chronic prostatitis patients

Aim: To evaluate the clinical significance of the quantitative determinations of endotoxins in the expressed prostatic secretions (EPS) of chronic prostatitis (CP) patients. Methods: The EPS of 45 patients with CP and 15 normal volunteers were obtained for microscopic examination, bacterial culture and endotoxin determination. The level of endotoxins was determined by the Limulus-amebocyte-lysate test with chromogenic substrate. Results: Patients with CP had higher mean levels of endotoxins in EPS than normal volunteers [52.06 ± 32.83 EU.L^(-1) vs. 4.77 ± 4.14 EU'L^(-1) (P < 0.05)]. The levels of endotoxins in CP type Ⅱ, type Ⅲa and type Ⅲb were 68.62 ± 34.78 EU.L^(-1), 45.30± 23.33 EU.L^(-1) and 15.83 ± 5.31 EU·L^(-1), respectively [type Ⅱ vs. type Ⅲa (P > 0.05), type Ⅲb vs. normal controls (P > 0.05), type Ⅱ/type Ⅲa vs. normal controls P < 0.05)]. Conclusion: CP patients have elevated levels of endotoxins in the EPS, which suggests that inflammation is a feature of this disease. EPS endotoxin determination is not only helpful in diagnostic confirmation, but also in evaluating the response to treatment in CP patients.

Clinical classification of chronic prostatitis:a preliminary investigation

Aim: To propose a practical clinical classification for the chronic prostatitis (CP). Methods: The clinical fea-tures and the findings in the expressed prostatic secretion (EPS) in 804 cases of CP patients were retrospectively ana-lyzed. Results: Four types of CP were identified based on the clinical manifestations and the amounts of whiteblood cells (WBC) and lecithin in EPS. They were the latent type (85 cases; 10.6%), the common type (423 cases;52.6%), the persisting type (104 cases; 12.9%), and the active type (192 cases, 23.9%). The therapeutic efficacyfor these 4 subtypes were 40.4%, 76.8%, 30.8% and 37%, respectively; a statistical difference was noticed be-tween the common type and the persisting type (P < 0.01 ). Conclusion: The method of classification proposed bythe authors may help clinicians in the diagnosis and predicting the prognosis of CP. (Asian J Androl 2000 Dec; 2:311-313)