Inflammation in bacterial prostatitis is characterized by the "presence of polymorphonuclear leukocytes and macrophages in the glandular ducts, epithelium and/or adjacent stroma" around the acini or ducts. Stromal involvement depends on intraluminal inflammation (1, 2). Other findings are: abnormal glandular ducts, epithelial atrophy, metaplasia and dysplasia, and hyperchromasia ("with polymorphism of the epithelial cell nuclei and cytoplasmic basophilia"). Changes that may be misinterpreted as cancerous. If palpated the prostate is often enlarged and "soft" in bacterial prostatitis while never in CPPS.
In CP/CPPS "glandular atrophy with stromal fibrosis, accompanied by a mild residual inflammatory reaction" is commonly observed(3). But only 5% of biopsies show significant inflammation(4). Although variation between studies is high up to 100% (5) prevalence has been found. The variation is obviously due to the varying (read: poor!) selection criteria of the studies. There is minimal correlation between histopathology and visible/clinical symptoms, but histological findings increase with age and are more commin in infertile men.
It is unclear whether some minimal inflammation of the prostate is normal or not, so if this is of any clinical use remains to be seen.
The recent REDUCE trial involving 5597 subjects has shown that no "clinically meaningful" difference is present between healthy subjects and CP/CPPS sufferers.(6) PSA levels are insignificantly elevated in CPPS (NIH III) and slightly to highly elevated in NIH IV. CPPS sufferers with elevated levels should be screened for cancer and BPH.(7)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, prostata
________________
(1) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(2) Dellabella M, Milanese G, Sigala S, d’Anzeo G, Arrighi N, Bodei S, Muzzonigro G. The role of prostatic stroma in CP/CPPS. Inflamm Res. 2009 Sep 11 Epub ahead of print.
(3) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(4) True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and CP/CPPS: a prospective biopsy study. J Urol 162:2014-2018, 1999.
(5) PHF Schatteman, L Hoekx, J J Wyndaele, W Jeuris, E van Marck. Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis. Eur Urol 37:404-412, 2000
(6) Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. Examination of the Relationship Between Symptoms of Prostatitis and Histological Inflammation: Baseline Data From the REDUCE Chemoprevention Trial. J Urol. Jul 13 2007.
(7) Nadler RB, McNaughton Collins M, Propert KJ, Mikolajczyk SD, Knauss JS, Landis JR, Fowler JE jr, Schaeffer AJ, Alexander RB. PSA test in diagnostic evaluation of CP/CPPS. Urology 67:337-342, 2006.
Wednesday, September 30, 2009
Friday, September 25, 2009
Post-ejaculatory pain
Regarding sexual activity advice goes both ways. It stands to reason that if you have pain during or after intercourse it may not be so smart to proceed with it. But some men’s symptoms (pain, epidydimitis) get relieved by ejaculation (see Treatment below). (Local application of anti-inflammatory and pain relieving medications may help. But check with your doctor first.)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
CPPS and ejaculation
Premature ejaculation / “failed” / “unexpected” ejaculation
Both anecdotal evidence and some research show that ejaculation is un-coordinated in men with CPPS. Problems vary but common problems is ejaculation before climax ("premature ejaculation, PE), no climax and ejaculation (anejaculation/anorgasmia), painful (often sort of “stumbling”) ejaculation and “weak” ejaculation. An Italian study has shown that about 50% of patients with ejaculatory problems had chronic bacterial prostatitis .(1)
A Turkish study showed that over 75% of patients with CP/CPPS had ejaculatory problems .(2) In both cases no other pathology could be found, but in hyperthyroid patients with premature ejaculation ejaculation normalizes after euthyroidism (thyroid hormones within normal range) is attained(3-4). An interesting finding as there seems to be little research on this in CPPS. Could some CPPS patients have undiagnosed thyroid disorder?
Research on ejaculation is, in my opinion, in some regards plain stupid as any ejaculation within two minutes is regarded as premature/abnormal, regardless of how it is experienced or if foreskin is normal or removed. It is also very focussed on "end" results and not the underlying (reflex) dyssynergia.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
____________
(1) Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Prevalence of chronic prostatitis in men with premature ejaculation. Urology. 58(2):198-202, 2001.
(2) Gonen M, Kalkan M, Cenker A, Ozkardes H. Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome. J Androl. 26(5):601-603, 2005.
(3) Krassas GE, Tziomalos K, Papadopoulou F, Pontikides N, Perros P. Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? J Clin Endocrinol Metab 93(5):1815-9, 2008.
(4) Cihan A, Demir O, Demir T, Aslan G, Comlekci A, Esen A. The relationship between premature ejaculation and hyperthyroidism. J Urol 181(3):1273-1280, 2009.
Both anecdotal evidence and some research show that ejaculation is un-coordinated in men with CPPS. Problems vary but common problems is ejaculation before climax ("premature ejaculation, PE), no climax and ejaculation (anejaculation/anorgasmia), painful (often sort of “stumbling”) ejaculation and “weak” ejaculation. An Italian study has shown that about 50% of patients with ejaculatory problems had chronic bacterial prostatitis .(1)
A Turkish study showed that over 75% of patients with CP/CPPS had ejaculatory problems .(2) In both cases no other pathology could be found, but in hyperthyroid patients with premature ejaculation ejaculation normalizes after euthyroidism (thyroid hormones within normal range) is attained(3-4). An interesting finding as there seems to be little research on this in CPPS. Could some CPPS patients have undiagnosed thyroid disorder?
Research on ejaculation is, in my opinion, in some regards plain stupid as any ejaculation within two minutes is regarded as premature/abnormal, regardless of how it is experienced or if foreskin is normal or removed. It is also very focussed on "end" results and not the underlying (reflex) dyssynergia.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
____________
(1) Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Prevalence of chronic prostatitis in men with premature ejaculation. Urology. 58(2):198-202, 2001.
(2) Gonen M, Kalkan M, Cenker A, Ozkardes H. Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome. J Androl. 26(5):601-603, 2005.
(3) Krassas GE, Tziomalos K, Papadopoulou F, Pontikides N, Perros P. Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? J Clin Endocrinol Metab 93(5):1815-9, 2008.
(4) Cihan A, Demir O, Demir T, Aslan G, Comlekci A, Esen A. The relationship between premature ejaculation and hyperthyroidism. J Urol 181(3):1273-1280, 2009.
Physiology of ejaculation
Ejaculation requires exquisite coordination and timing of various muscles and glands. Thus minimal differences in timing cause disruption. Also non-neurological disturbances caused by enlarged prostate (constricting the urether and ejaculatory ducts) and constipation (generalized pressure on the lower abdominopelvic cavity) affect ejaculation.
Ejaculation is divided in two phases: emission and ejaculation proper.
Emission is under control of the sympathetic nervous system, while the ejaculatory phase is under control of a spinal reflex. Emission begins with sperm travelling along the vas deferens (spermatic cord a 30 centimeter long structure that loops over the pelvic bone ! one of these evolutionary trade-offs we carry) and entering the ejaculatory ducts and being mixed with fluids from the seminal vesicles, prostate and bulbourethral glands. The resulting fluid is called semen.
Ejaculation proper consists of approximately 5-15 rhythmic contractions of the bulbospongiosus muscle ejecting the semen through the urethra and out. Total duration of the process is about 15 seconds. (Females differ slightly as they have up to 20-30 contractions and shorter refractory period, i.e. time before next attempt can be made. Women having Skene’s glands may experience orgasm by indirect stimulation of the gland,(1) the so called G-spot. )
N.B. ejaculation is not necessarily concomitant with orgasm or vice versa.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
_________________
Wolters JP, Hellstrom WJG. Current Concepts in Ejaculatory Dysfunction. Rev Urol 8(Suppl 4):S18-S25, 2006.
(1) Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. J Sex Med. 2008 5(3):610-8.
Ejaculation is divided in two phases: emission and ejaculation proper.
Emission is under control of the sympathetic nervous system, while the ejaculatory phase is under control of a spinal reflex. Emission begins with sperm travelling along the vas deferens (spermatic cord a 30 centimeter long structure that loops over the pelvic bone ! one of these evolutionary trade-offs we carry) and entering the ejaculatory ducts and being mixed with fluids from the seminal vesicles, prostate and bulbourethral glands. The resulting fluid is called semen.
Ejaculation proper consists of approximately 5-15 rhythmic contractions of the bulbospongiosus muscle ejecting the semen through the urethra and out. Total duration of the process is about 15 seconds. (Females differ slightly as they have up to 20-30 contractions and shorter refractory period, i.e. time before next attempt can be made. Women having Skene’s glands may experience orgasm by indirect stimulation of the gland,(1) the so called G-spot. )
N.B. ejaculation is not necessarily concomitant with orgasm or vice versa.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, ejakulation
_________________
Wolters JP, Hellstrom WJG. Current Concepts in Ejaculatory Dysfunction. Rev Urol 8(Suppl 4):S18-S25, 2006.
(1) Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. J Sex Med. 2008 5(3):610-8.
Sunday, September 6, 2009
Patient reported frequency and severity of urological symptoms
Presenting symptoms (described by patients and recorded by urologists) in 1074 patients with prostatitis.(1)
_____________
(1) Rizzo M, Marchetti F, Travaglini F, Trinchieri A, Nickel JC. Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study. BJU Int 92(9):955-959, 2003.
| Symptom | N (%) |
|---|---|
| Frequency | 689 (64.2) |
| Obstructive voiding | 675 (62.8) |
| Perineal pain or discomfort | 630 (58.7) |
| Suprapubic pain or discomfort | 492 (45.8) |
| Penile pain or discomfort | 360 (33.5) |
| Premature ejaculation | 305 (28.4) |
| Malaise | 229 (21.3) |
| Urethral discharge | 220 (20.5) |
| Inguinal pain or discomfort | 216 (20.1) |
| Erectile dysfunction | 205 (19.1) |
| Haematospermia | 169 (15.7) |
| Voiding difficulties | 162 (15.1) |
| Fever | 159 (14.8) |
| Purulent urine | 150 (14.0) |
| Abnormal seminal fluid | 97 (9.0) |
| Myalgia | 64 (6.0) |
| Abnormal urine (mucus) | 61 (5.7) |
| Haematuria | 46 (4.3) |
| Mean (sd) score | |||
|---|---|---|---|
| frequency | severity | ||
| Penile pain or discomfort | 55.2 (386/699) | 1.3 (1.4) | 3.1 (2.7) |
| Perineal pain or discomfort | 81.6 (666/816) | 2.2 (1.3) | 4.5 (2.5) |
| Suprapubic pain or discomfort | 74.6 (561/779) | 2.0 (1.4) | 4.3 (2.5) |
| Ejaculatory pain or discomfort | 63.9 (461/721) | 1.4 (1.3) | 3.3 (2.4) |
| Testicular pain or discomfort | 43.9 (302/688) | 0.9 (1.2) | 2.5 (2.5) |
| Lumbar/inguinal/thigh pain | 35.4 (240/678) | 0.8 (1.3) | 2.3 (2.8) |
| or discomfort | |||
| Incomplete bladder emptying | 72.8 (541/743) | 1.8 (1.4) | 3.7 (2.7) |
| Burning during micturition | 81.7 (652/798) | 2.0 (1.3) | 4.2 (2.5) |
| Urgency | 72.4 (514/710) | 1.7 (1.4) | 3.9 (2.8) |
| Urinary frequency | 86.4 (717/830) | 2.4 (1.4) | 5.0 (2.7) |
_____________
(1) Rizzo M, Marchetti F, Travaglini F, Trinchieri A, Nickel JC. Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study. BJU Int 92(9):955-959, 2003.
Saturday, September 5, 2009
Genetic findings
Not much research has been done. There is a study showing an association between a "highly polymorphic short tandem repeat (STR) locus near the phosphoglycerate kinase gene within Xq11-13" (1) and another indicating low TNF-alpha (NIH-IIIa) or low IL-10 expression (NIH-III).(2) A newer study showed differences in manganese superoxide dismutase and gluthathione polymorphisms versus controls.(3)
A general discussion on genetic research in CPPS and IC is given by Dimitrakov and Guthrie.(4)
___________
(1) Riley DE, Krieger JN. X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis. Biochim Biophys Acta 1586(1):99-107, 2002.
(2) Shoskes DA, Albakri Q, Thomas K, Cook D. Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol. 168(1):331-335, 2002.
(3) Arisan ED, Arisan S, Kiremit MC, Tiğli H, Caşkurlu T, Palavan-Unsal N, Ergenekon E. Manganese superoxide dismutase polymorphism in chronic pelvic pain syndrome patients. Prostate Cancer Prostatic Dis. 9(4):426-431, 2006.
(4) Dimitrakov J, Guthrie D. Genetics and phenotyping of urological chronic pelvic pain syndrome. J Urol 181(4):1550-1557, 2009.
A general discussion on genetic research in CPPS and IC is given by Dimitrakov and Guthrie.(4)
___________
(1) Riley DE, Krieger JN. X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis. Biochim Biophys Acta 1586(1):99-107, 2002.
(2) Shoskes DA, Albakri Q, Thomas K, Cook D. Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol. 168(1):331-335, 2002.
(3) Arisan ED, Arisan S, Kiremit MC, Tiğli H, Caşkurlu T, Palavan-Unsal N, Ergenekon E. Manganese superoxide dismutase polymorphism in chronic pelvic pain syndrome patients. Prostate Cancer Prostatic Dis. 9(4):426-431, 2006.
(4) Dimitrakov J, Guthrie D. Genetics and phenotyping of urological chronic pelvic pain syndrome. J Urol 181(4):1550-1557, 2009.
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