| Part I:Psychometric profiles in chronic prostatitis/chronic pelvic pain syndrome patients complicated by lower urinary tract symptoms and erectile dysfunctionObjective:To investigate the severity of voiding and erectile dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and to detect the correlations among voiding syndrome, erectile function and psychometric profiles.Methods:We randomly recruited 1209 CP/CPPS patients,469 erectile dysfunction (ED) patients and 176 controls. Questionnaires including general condition, the National Institutes of Health-Chronic Prostatitis Symptom index (NIH-CPSI), the International Index of Erectile Function (IIEF-5), International prostate symptom score (IPSS) and completed psychometric self-report questionnaires including the Type A personality test (TAPT), Perceived Stress Scale (PSS), Beck Anxiety Inventory (BAI) and the Symptom Checklist-90 (SCL-90). We compared the correlations among symptoms and divided all subjects into 4 groups according to the IIEF-5 and IPSS questionnaires.Results:The mean age of CP/CPPS patients was 33.5±7.4. The duration of CP/CPPS was 3-117 months. CP/CPPS patients complaint lower urinary tract symptoms (LUTS) but no pain (IPSS>8) accounted for 85.4%, CP/CPPS patients complaint LUTS and ED (IIEF-5<12) accounted for 12.9%. The mean IPSS was 11.1±7.2, positively correlated with NIH-CPSI (r=0.680, P<0.01), BAI (r=0.340, P<0.01), PSS(r=0.176, P=0.002) and SCL-90 (r=0.201, P=0.001). The mean IIEF-5 was 17.1±5.4, negatively correlated with quality of life in NIH-CPSI (r=-0.196, P<0.01), BAI (r=-0.246, P<0.01), PSS (r=-0.285, P<0.01) and SCL-90(r=-0.310, P<0.01). IIEF-5 was not correlated with total NIH-CPSI, pain and voiding syndrome. Compared with controls, the BAI (P=0.001; P<0.001; P=0.002), PSS (P<0.001; P=0.007; P=0.027) and SCL-90 (P<0.001; P<0.001; P=0.005) in group 1,2 and 3 were significantly increased. Compared with group 2, the PSS, SCL-90 and ratio of TAPT in group 1 was significantly increased (P=0.004; P=0.027; P=0.0131).Conclusion:The voiding function, erectile function and psychometric profiles were interacted with each other in men with CP/CPPS. However, they were hardly correlated with the TAPT. ED secondary to CP/CPPS might be related to the stress induced anxiety, depression, fear and so on. PartⅡ:Hypothalamic-pituitary-adrenal axis activity and autonomic nervous system changes in patients with chronic prostatitis/chronic pelvic pain syndrome complicated by lower urinary tract symptoms and erectile dysfunctionObjective:The hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) have been known to be reactive to psychological factors such as stress. Growing data suggest that stress conditions could be associated with the development or aggravation of prostatic disease. The present study aims to investigate the characters of ANS and HPA axis in Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) concomitant with and erectile dysfunction (ED).Methods:We recruited 25 CP/CPPS men with ED (group 1),25 CP/CPPS men with voiding symptom only (group 2),25 men with ED no CP/CPPS (group 3) and 25 age-matched, asymptomatic controls (group 4). Saliva samples were collected on 2 consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol, reflecting secretory activity of the HPA axis. We quantified cortisol variations as the 2-day average slope of the awakening cortisol response and the subsequent diurnal levels. Heart rate variability (HRV) analysis was performed using the 24 hour Holter monitorisation.Results:One-way ANOVA showed that the time-domain calculated parameters of HRV in patients from the four groups are similar (P>0.05). Compared with group 4, the frequency-domain parameters HF was significantly decreased in group 1,2 and 3 (P=0.029, P=0.021, P=0.008), the mean LF was significantly decreased in group 3 (P=0.022), and the mean ratio of LF/HF in groups 1 was significantly increased (P=0.035). However, HPA axis measures were not changed significantly (P>0.05).Conclusion:The HRV changes suggest altered autonomic nervous system responses in men with CP/CPPS and ED. Predominance of sympathetic nervous system activity is possibly associated with comitant CP/CPPS and ED, whereas HPA axis activity is not. Observations suggest opportunities for neurophysiological study of relationships of stress, ED and CP/CPPS. PartⅢ:Autoantibody-mediated functional alteration of sympathetic neurons in men with chronic prostatitis/chronic pelvic pain syndrome complicated by lower urinary tract symptoms and erectile dysfunctionObjective:To identify the antibodies directed against sympathetic neurons and the impact of norepinephrine transporter (NET) expression on the function of sympathetic neurons in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) complicated by lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).Methods:10ml sera were obtained from all subjects in the 4 groups. After cocultures of sympathetic neurons and purified serum IgQ we measured the supernatant noradrenaline with enzyme-linked immunosorbent assay, and detected the levels of NET mRNA and protein expression with real-time PCR and Western blotting, respectively.Results:The supernatant noradrenaline was similar in 4 groups after cocultures (P>0.05). However, the real-time PCR indicated that NET mRNA level in group 1 and 2 was significantly higher than that in group 3 and 4 (P<0.05). The western blotting showed that the level of NET protein expression in group 1 was much higher than the other 3 groups (P<0.05).Conclusions:Our findings indicate that in CP/CPPS complicated by LUTS and ED, circulating antibodies directed against sympathetic neurons may contribute to altered autonomic nervous system responses and predominance of sympathetic nervous system activity.
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