| Background: Chronic prostatitis (CP), one of the most common and puzzlingdiseases seen in the daily practice of urology, is characterized by high prevalence, lowcure rate, frequent recurrence and severe impairment of quality of life.To date therehave been few epidemiological studies on the prevalence of prostatitis-like symptoms inChina. The NIH-CPSI has been accepted by the international prostatitis researchcommunity as an accepted outcome measure. We developed a Chinese version of theNIH-CPSI (CHI-NIH-CPSI) by translating it into Chinese，and conifrmed its validityand applicability to Chinese patients with CP.The aim of this study is to assess theprevalence of prostatitis and identiifed their associated risk factors in a population basedChinese sample and the status of treatment of chronic prostatitis in Chinese men, also,to assess the prevalence of erectile dysfunction (ED) and premature ejaculation (PE) inChinese men with chronic pelvic pain syndrome and studied its correlation to chronicprostatitis.Methods: A population based cross-sectional survey of the prevalence of prostatitisand sexual dysfunction in men15to60years old (age range chosen to allowcomparison to census data) was performed in Beijing’，Anhui, Xian, Guangzhou andGansu cities or provinces representative of the North, Mideast, Middle，South and Westin China. In each city or province3rural villages and3communities were chosenrandomly. The questionnaire consisted of sociodemographics (weight, height, age, marital status, education level and smoking,drinking), current stress and health raitngs,lifestyle, edical history, EPS evaluation, NIH-CPSI score and International Index ofErectile Function-5. Descriptive statistics were used. The data were processed withSPSS? version10.01for Windows. The t test, Mann-Whitney test, Pearson test andchi-square test were used for power analysis and p less than0.05was consideredsigniifcant in single factor correlation.Results: Of15,000selected individuals12,743subjects responded to thequestionnaire survey, giving a response rate of84.95%. Information on12,743(84.95%)men was collected. Of these men1,071(8.4%) reported prostatitis-like symptoms. Thepercent of chronic prostatitis was4.5%(571) among the symptoms group according topast urological history and expressed prostatic secretion evaluation. The peak age ofmen with symptoms ranged from31to40years old (12.0%). The percent of symptomswas less than10.0%in groups younger than30years, but it was more than10.0%ingroups older than30years.The syndrome is closely related to alcohol consumption, cigarette smoking，frequentintercourse, as well as fatigue, pressure and too little sleep. A total of12743men(84.95%) completed the questionnaire, of whom1071(8.4%) were identified as havingprostatitis-like symptoms and517(4.5%) were diagnosed with CP according toNIH-CPSI criteria and prostatitis-like symptomatology. Of the CP patients,372(65.1%)underwent long-term routine treatment12times per year. Additionally,217(72.8%)patients received antibiotic therapy and215(79.3%) men showed therapeutic effects.The treatment cost USD1151(8059yuan) per person per year on average. Among7372eligible men，5028(68.2%，mean age37.2士10.19)，1740(23.6%，mean age40.1土12.94) and602(8.2%, mean age48.6土10.80) individuals were experiencing normalsexual function, decreased sexual functionand decreased libido，respectively.ED prevalence as assessed by self-report and IIEF-5score was12.0%and17.1%，respectively. Among771men with prostatitis-like symptoms, ED prevalence asassessed by self-report and IIEF-5score was39.3%and30.1%，respectively. Among370men suffering from chronic prostatitis, ED prevalence as assessed by self-reportand IIEF-5score was40.5%and35.1%，respectively. The prevalence of self-reportedand IIEF-5score-assessed ED had high correlation with increasing age among alleligible men，men with prostatitis-like symptoms, and men with chronic prostatitis. EDprevalence as assessed by both self-report and IIEF-5score was higher in men withprostatitis-like symptoms and with chronic prostatitis than in the general group. Theprevalence of ED was higher in the prostatitis population than in the general populationwith either self-reported or IIEF-5score assessment. The prevalence was higher withself-reported than with IIEF-5assessment in men with prostatitis. Among the7372eligible men，1127(15.3%) self-reported PE. The mean ages for PE group and non-PEgroup were34.9士10.5and35.3士14.2，respectively. Participants with PE had worseNIH-CPSI total scores (mean37.2士4.6) than men without PE (meanl8.2±5.6). Theparticipants with PE also had higher NIH-CPSI pain sub-scores (mean12.5士5.1) thanthose without PE (mean7.2士4.6)，and the PE group had worse urinary sub-scores(mean5.9士3.0) than the non-PE group (mean4.0士2.7).Eligible men suffering from thePE had higher QOL sub-scores (mean9.7土2.1) than men without PE (mean6.9土3.0).The IIEF-5score was16.7士3.2in the PE group and22.6土2.9in the non-PE group. Theprevalence of PE was64.1%and36.9%in the prostatitis-like symptom and chronicprostatitis group, respectively, which was signiifcantly higher than in the whole eligiblepopulation (15.3%).Conclusion: Prostatitis-like symptoms are a multifactorial problem affecting men ofall ages (15to60years) and demographics, and the prevalence is high in China. Thesyndrome is closely related to alcohol consumption, cigarette smoking，frequent intercourse, as well as fatigue, pressure and too little sleep. These findings suggest thatrisk factors for this condition are largely modiifable and highlight potential targets forfuture prevention. Most CP patients received routine treatment, in most cases withantibiotics. Treatment was costly and most CP patients were not satisifed with itseffectiveness. Antibacterial treatment might have been effective primarily in patientswith bacterial disease. Also, our ifndings showed a high prevalence of ED in patientswith CP/CPPS that increased with age. These ifndings suggest that more prospectiveresearch is needed to further characterize the pathogenesis of ED and its correlation toprostatitis, and to elucidate the role of inlfammation and infection of the prostate glandin sexual dysfunction in men. More importantly, our study also demonstrates thatself-reported ED prevalence is higher than the prevalence of ED reported by IIEF-5score among men with CP/CPPS. Assessments of ED prevalence among those reliant onself-reporting alone are likely to overestimate the true burden of ED within the greaterpopulation. Further more，these ifndings showed a high prevalence of prematureejaculation in patients with CP/CPPS. Examination of the prostate, physically andmicrobiologically，should be considered during assessment of patients with prematureejaculation. Importantly, these ifndings suggest that more prospective research isneeded to further characterize the etiology of prostatitis and its correlation to PE，and toelucidate the role of inflammation and infection of prostatic gland in sexual dysfunctionin men. Objective: To evaluate the symptoms of prostatitis patients on the basis of the majorand minor symptoms, and then discuss the accuracy and eiffcacy of prostatitis diagnosisbased on the major symptoms. Furthermore, to identiyf the judging criteria of thetherapeutic efficacy.Methods: We distributed the questionnaires for chronic prostatitis to1500out-patients and200healthy people in several hospitals at Anhui, Beijing，Shanxi，Guangzhou, Sichuan, Shanghai et al. The contents of the questionnaire includedemographic information, the related symptom characteristics of prostatitis, theself-assessment of the patient, the treatment state, NIH-CPSI， major symptoms,minor symptoms and other20questions. Under the assistance of the medical registrars,we completed the questionnaires and then evaluated, diagnosed, classified andgraduated the patients or subjects. After collecting the questionnaires, we analyzedthe data by using SPSS16.0software. The new judging criteria of prostatitis weredeifned as follows: whose symptom was consistent with one of the major symptoms thatcan not be relieved by self-modulation, regardless of the minor symptoms, can bedeifned as a prostatitis patient.Results: We have received1313valid questionnaires, which consisted of93healthypeople and1220out-patients. In the1220out-patients with chronic prostatitis, theearliest symptom of453(34.5%) patients was pain, the earliest symptom of329(24.6%) patients was urination, and339(25.8%) patients presented both of the earliestsymptoms of pain and urination. In this group of patients with chronic prostatitis,977(80.1%) of whom suffered pain,841(68.9%) of whom suffered urination. In the1220out-patients with chronic prostatitis, the score of the pain symptom was7.53±4.47，thescore of the urination symptom was3.77±2.91，the score of QOL influence was7.83土2.40， the score of CPSI was19.13±6.24. To introduce the new method to evaluate thepatients with chronic prostatitis above, the score of major symptom was14.17土6.07,the score of major symptom was2.41土2.10，and the total score of the new method was16.58±6.69. We then carried out the concordance test between the traditional andnew diagnostic method in the1313valid questionnaires. To deifne the traditionaldiagnostic method as the authoritative standard, the sensitivity of the new method todiagnose chronic prostatitis was95.9%, the specificity was90.3%, the accuracy-indexwas0.86，the false negative rate was4.1%，the false positive rate was9.7%, thepositive prediction value was99.2%, the negative prediction value was62.7%. Todiagnose by using the new method,50of the1220out-patients with chronic prostatitiswere not patients, the characteristics of the symptoms were as follows: the score of thepain symptom was0.48土1.84，the score of the urination symptom was1.14±2.16，thescore of QOL influence was6.24土2.67， the score of CPSI was7.86土4.40. Amongthem,26people suffered the psychology symptom,28people suffered the sexualdisturbance,18people suffered the dysgenesia,19people suffered the other symptomssuch as urinary white drop. By using different diagnostic methods to analyze theminor symptoms of the chronic prostatitis patients, we found that672(55.1%)of themsuffered the psychology symptom,564(46.2%) of them suffered the sexual disturbance,188(15.4%) of them suffered the dysgenesia,351(28.8%) suffered the othersymptoms such as urinary white drop. In the doctors’ diagnostic methods,184of thechronic prostatitis patients were diagnosed via the NIH-CPSI,843of them werediagnosed via the clinical experience,39of them were diagnosed via both of the NIH-CPSI and clinical experience,150of them were diagnosed via both of the EPS andclinical experience. Based on the major symptoms, prostatitis can be classiifed as fourtypes: no symptom, pain symptom, urination symptom and both of the pain andurination symptom, the percent was4.1%，27.0%,15.8%and53.1%, respectively.Conclusion: At present, there are a great quantity of patients with chronic prostatitis inclinical out-patient service. The methods to diagnose and classiyf prostatitis weremainly in experience, to diagnose prostatitis based on the major symptoms has thecharacteristics of high sensitivity and lower speciifcity, which reason is caused by thefalse positive diagnosis of the patients who suffer the sexual disturbance anddysgenesia. The play a deifnite role in diagnosis and classiifcation, the patients whosuffer various kinds of minor symptoms are probably the midrange and severe chronicprostatitis patients. Suiffcient cases are necessary for evaluating the judging methodsand criteria of the therapeutic eiffcacy. |
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