Greater endothelial dysfunction and arterial stiffness in men with chronic prostatitis/chronic pelvic pain syndrome--a possible link to cardiovascular disease.

PURPOSE: Men with chronic prostatitis/chronic pelvic pain syndrome have higher self-reported rates of cardiac disease than controls. Peripheral arterial tone abnormalities correlate with cardiac disease and mortality. We studied vascular dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome and controls. MATERIALS AND METHODS: A total of 21 men with chronic prostatitis/chronic pelvic pain syndrome and 14 asymptomatic controls were tested with an Endo-PAT®2000 machine which assessed the augmentation index, a measure of arterial stiffness, and reactive hyperemia index, a measure of endothelial vasodilation. Symptoms were measured with the National Institutes of Health Chronic Prostatitis Symptom Index and patient phenotype was characterized by the UPOINT (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles) system. Statistical significance was set at p<0.05. RESULTS: Age was similar in the chronic prostatitis/chronic pelvic pain syndrome group (range 22 to 63 years, median 40) and controls (range 19 to 57, median 40). Patients had median symptom duration of 24 months (range 3 to 440), a mean Chronic Prostatitis Symptom Index score of 24.7±5.1 and mean UPOINT domains of 2.9±1.1 (range 1 to 5). The augmentation index was significantly higher (greater arterial stiffness) in patients with chronic pelvic pain syndrome vs controls (5.0%±2.3 vs -6.0%±3.0, p=0.006). The reactive hyperemia index was significantly lower (more endothelial dysfunction) in patients with chronic pelvic pain syndrome (1.76±1.2 vs 2.21±1.7, p=0.03). There was no correlation between symptom duration, severity or phenotype (number or type of UPOINT domains) and reactive hyperemia index or augmentation index. CONCLUSIONS: Men with chronic prostatitis/chronic pelvic pain syndrome have evidence of increased arterial stiffness and vascular endothelial dysfunction. This is the first mechanistic correlation found that links the higher incidence of self-reported cardiac disease in these patients. Noninvasive Endo-PAT testing may allow stratification of cases of chronic prostatitis/chronic pelvic pain syndrome by vascular dysfunction, which may require specific treatment or at least further assessment of cardiac risk.

Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity.

OBJECTIVES: To propose a clinical phenotype system (urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness [UPOINT]) to classify patients with urologic pelvic pain to help understand the etiology and guide therapy. We wished to validate this system in men with chronic pelvic pain syndrome (CPPS). CPPS is a heterogeneous syndrome with a variable treatment response. METHODS: A total of 90 men with CPPS were retrospectively classified in each domain of our UPOINT system and the symptoms were measured using the Chronic Prostatitis Symptom Index. RESULTS: The percentage of patients positive for each domain was 52%, 34%, 61%, 16%, 37%, and 53% for the urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness domains, respectively. Of the 90 patients, 22% were positive for only 1 domain, and a significant stepwise increase was found in the total Chronic Prostatitis Symptom Index score as the number of positive domains increased. A symptom duration of >2 years was associated with an increase in positive domains (2.9 +/- 0.21 vs 2.3 +/- 0.14, P = .01). Comparing the total Chronic Prostatitis Symptom Index score with the presence of each domain revealed significantly increased symptoms in patients positive for the urinary, psychosocial, organ specific, and neurologic/systemic domains. When this analysis was repeated for the pain subscore, the psychosocial, neurologic/systemic, and tenderness domains had significantly greater scores. Only the psychosocial and neurologic domains influenced the patients' quality of life. CONCLUSIONS: Applying the UPOINT system to patients with CPPS can discriminate clinical phenotypes, allowing for hypothesis testing for etiology and therapy. The number of positive domains correlated with symptom severity and a longer duration of symptoms increased the number of positive domains. Because each domain has specific targeted therapies, we propose that multimodal therapy might best be guided by the UPOINT phenotype.