Current Urology Reports

, Volume 3, Issue 4, pp 301–306 | Cite as

The NIH consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia

  • John N. Krieger
  • Susan O. Ross
  • Leslie Deutsch
  • Donald E. Riley


The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.


Prostatitis Chronic Prostatitis Pelvic Pain Syndrome Chronic Bacterial Prostatitis Prostatic Secretion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Collins MM, Stafford RS, O’Leary MP, et al.: How common is prostatitis? A national survey of physician visits. J Urol 1998, 159:1224–1228. This article demonstrates the widespread incidence of genitourinary symptoms among men in the United States.PubMedCrossRefGoogle Scholar
  2. 2.
    Drach GW, Meares EM, Jr, Fair WR, et al.: Classification of benign disease associated with prostatic pain: prostatitis or prostatodynia? J Urol 1978, 120:266.PubMedGoogle Scholar
  3. 3.
    Meares EM, Jr, Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968, 5:492–518.PubMedGoogle Scholar
  4. 4.
    Stamey T: Urinary infections in males. In Pathogenesis and Treatment of Urinary Tract Infections. Baltimore: Williams and Wilkins; 1980:342–429.Google Scholar
  5. 5.
    Krieger J, Nyberg L, Jr, Nickel J, et al.: NIH consensus definition and classification of prostatitis. JAMA 1999, 282:236–237.PubMedCrossRefGoogle Scholar
  6. 6.
    Krieger JN, Jacobs RR, Ross SO: Does the chronic prostatitis/ pelvic pain syndrome differ from nonbacterial prostatitis and prostatodynia? J Urol 2000, 164:1554–1558. In this article, the authors compare the number of patients diagnosed with CP/CPPS by the NIH classification system with the number of patients diagnosed by traditional evaluation methods.PubMedCrossRefGoogle Scholar
  7. 7.
    Krieger J, Egan K, Ross S, et al.: Chronic pelvic pains represent the most prominent urogenital symptoms of “chronic prostatitis.” Urology 1996, 48:715–721.PubMedCrossRefGoogle Scholar
  8. 8.
    Krieger J, Jacobs R, Ross S: Detecting urethral and prostatic inflammation in patients with chronic prostatitis. Urology 2000, 55:186–191.PubMedCrossRefGoogle Scholar
  9. 9.
    Krieger J, McGonagle LA: Diagnostic considerations and interpretation of microbiological findings for evaluation of chronic prostatitis. J Clin Microbiol 1989, 27:2240–2244.PubMedGoogle Scholar
  10. 10.
    Krieger JN, Berger RE, Ross SO, et al.: Seminal fluid findings in men with nonbacterial prostatitis and prostatodynia. J Androl 1996, 17:310–318.PubMedGoogle Scholar
  11. 11.
    Yanushpolsky EH, Politch JA, Hill JA, et al.: Antibiotic therapy and leukocytospermia: a prospective, randomized, controlled study. Fertil Steril 1995, 63:142–147.PubMedGoogle Scholar
  12. 12.
    Branigan EF, Muller CH: Efficacy of treatment and recurrence rate of leukocytospermia in infertile men with prostatitis. Fertil Steril 1994, 62:580–584.PubMedGoogle Scholar
  13. 13.
    Comhaire FH, Rowe PJ, Farley TM: The effect of doxycycline in infertile couples with male accessory gland infection: a double blind prospective study. Int J Androl 1986, 9:91–98.PubMedGoogle Scholar
  14. 14.
    Aitken RJ, West K, Buckingham D: Leukocytic infiltration into the human ejaculate and its association with semen quality, oxidative stress, and sperm function. J Androl 1994, 15:343–352.PubMedGoogle Scholar
  15. 15.
    Anderson DJ: Cell-mediated immunity and inflammatory processes in male infertility. Arch Immunol Ther Exp (Warsz) 1990, 38:79–86.Google Scholar
  16. 16.
    Christiansen E, Tollefsrud A, Purvis K: Sperm quality in men with chronic abacterial prostatovesiculitis verified by rectal ultrasonography. Urology 1991, 38:545–549.PubMedCrossRefGoogle Scholar
  17. 17.
    El-Bayoumi MA, Hamada TA, El-Mokaddem HH: Male infertility: etiologic factors in 385 consecutive cases. Andrologia 1982, 14:333–339.PubMedCrossRefGoogle Scholar
  18. 18.
    Purvis K, Christiansen E: Infection in the male reproductive tract: impact, diagnosis and treatment in relation to male infertility. Int J Androl 1993, 16:1–13.PubMedGoogle Scholar
  19. 19.
    Politch JA, Wolff H, Hill JA, et al.: Comparison of methods to enumerate white blood cells in semen. Fertil Steril 1993, 60:372–375.PubMedGoogle Scholar
  20. 20.
    Couture M, Ulstein M, Leonard J, et al.: Improved staining method for differentiating immature sperm from white blood cells in human seminal fluid. Andrologia 1976, 8:61–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Stamm WE: Measurement of pyuria and its relation to bacteriuria. Am J Med 1983, 75:53–58.PubMedCrossRefGoogle Scholar
  22. 22.
    Ludwig M, Schroeder-Printzen I, Lubecke G, et al.: Comparison of expressed prostatic secretions with urine after prostatic massage: a means to diagnosis chronic prostatitis/inflammatory chronic pelvic pain syndrome. Urology 2000, 55:175–177.PubMedCrossRefGoogle Scholar
  23. 23.
    Krieger JN, Riley DE, Roberts MC, Berger RE: Prokaryotic DNA sequences in patients with chronic idiopathic prostatitis. J Clin Microbiol 1996, 34:3120–3128.PubMedGoogle Scholar
  24. 24.
    Tanner MA, Shoskes D, Shahed A, et al.: Prevalence of corynebacterial 16S rRNA sequences in patients with bacterial and “nonbacterial” prostatitis. J Clin Microbiol 1999, 37:1863–1870.PubMedGoogle Scholar
  25. 25.
    Berger RE, Krieger JN, Rothman I, et al.: Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J Urol 1997, 157:863–865.PubMedCrossRefGoogle Scholar
  26. 26.
    Alexander RB, Ponniah S, Hasday J, et al.: Elevated levels of proinflammatory cytokines in the semen of patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 1998, 52:744–749.PubMedCrossRefGoogle Scholar
  27. 27.
    Ludwig M, Kummel C, Schroeder-Printzen I, et al.: Evaluation of seminal plasma parameters in patients with chronic prostatitis or leukocytospermia. Andrologia 1998, 30:41–47.PubMedCrossRefGoogle Scholar
  28. 28.
    Vicari E: Seminal leukocyte concentration and related specific reactive oxygen species production in patients with male accessory gland infections. Hum Reprod 1999, 14:2025–2030.PubMedCrossRefGoogle Scholar
  29. 29.
    Nishimura T, Abe H, Ito H, et al.: IL-1ra versus IL-1 levels in prostatic fluid from prostatitis patients. Urol Int 1998, 60:92–96.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • John N. Krieger
    • 1
  • Susan O. Ross
    • 1
  • Leslie Deutsch
    • 1
  • Donald E. Riley
    • 1
  1. 1.Department of UrologyUniversity of Washington School of MedicineSeattleUSA

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