Asymptomatic Prostatitis: Clinical Significances and Management

In-Chang Cho; Seung Ki Min

doi:10.14777/kjutii.2013.8.1.13

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Cho and Min: Asymptomatic Prostatitis: Clinical Significances and Management

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Korean J Urogenit Tract Infect Inflamm 2013;8(1):13-19.

Published online: 17 April 2013

DOI: https://doi.org/10.14777/kjutii.2013.8.1.13

Asymptomatic Prostatitis: Clinical Significances and Management

In-Chang Cho, Seung Ki Min

Department of Urology, National Police Hospital, Seoul, Korea

Correspondence to: Seung Ki Min Department of Urology, National Police Hospital, 123, Songi-ro, Songpa-gu, Seoul 138-708, Korea Tel: +82-2-3400-1263, Fax: +82-2-431-3192 E-mail: drmsk@korea.com No potential conflict of interest relevant to this article was reported.

Received 25 March 2013 Accepted 8 April 2013 Revised 8 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Asymptomatic inflammatory prostatitis (National Institutes of Health, category IV) has been introduced as a separate clinical entity among other prostatitis syndromes. Asymptomatic inflammatory prostatitis is characterized by the presence of significant amount of leukocytes (white blood cells) in prostate-specific samples (post-prostatic massage urine, expressed prostatic secretion, semen, and prostate biopsy) but no subjective symptoms are found, and is therefore diagnosed solely in the laboratory. There have been many questions regarding the clinical role of asymptomatic inflammatory prostatitis and its impact on the management of prostate disease and sterility. This review presents the current definition of asymptomatic inflammatory prostatitis, summarizes the clinical evidence on the two important issues prostate specific antigen and pyospermia, and discusses the optimal approaches to reduce its confounding impact on prostate cancer screening and indiscriminate use of antibiotics.

Keywords: Prostatitis, Prostate-specific antigen, Infertility, Male

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Fig. 1.

The effect of white blood cells (WBCs) on spermatozoa activities. The scheme demonstrates the balancing mechanisms between pro- and anti-oxidants.

Table 1.

National Institutes of Health consensus classification of prostatitis

Type of syndrome	Description	WBC/HPF (400×)	Bacterial cultures
Type of syndrome	Description	WBC/HPF (400×)	VB1^a	VB2^b	EPS	VB3^c
I. Acute bacterial prostatitis	Acute infection of the prostate gland	>10	+	+	NR	+
II. Chronic bacterial prostatitis	Chronic infection of the prostate gland	>10	-	-	+	+
III. Chronic pelvic pain syndrome	Chronic pelvic pain in the absence of bacteria localized to the prostate
A. Inflammatory	Significant WBC count in the EPS, VB3, or semen	>10	-	-	-	-
B. Noninflammatory	Insignificant WBC count in the EPS, VB3, or semen	n <10	-	-	-	-
IV. Asymptomatic prostatitis	WBC count and/or bacteria in the EPS, VB3, semen or histologic specimens of prostate gland in asymptomatic patients	>10	-	-	-	-

WBC: white blood cell, HPF: high-power field, VB: voided bladder, +: positive culture, NR: not recommended, EPS: expressed prostatic secretions.

^a First 10 ml of voided urine (urethral specimen),

^b midstream urine specimen (bladder specimen)

^c first 10 ml of voided urine after EPS (prostatic secretion).

Table 2.

Summary of localization tests and EPS

Test	VB1^a	VB2^b	EPS^c	VB3^d	Semen analysis	Comment
Meares-Stamey 4-glass	○	○	○	○		Preferred test; lack of validating evidence
2-glass (pre and post-prostatic massage)		○		○		Good concordance with Meares-Stamey 4-glass test; reasonable alternative
Alternative (2 glasses)	○				○	Higher sensitivity than EPS for gram-negative organisms (97 vs. 84 percent) and higher sensitivity for gram-positive organisms (100 vs. 16 percent)
						Semen cultures recommended only if high index of suspicion for chronic bacterial infection despite negative urine cultures

EPS: expressed prostatic secretions, VB: voided bladder, WBC: white blood cell.

^a First 10 ml of voided urine (urethral specimen); culture if WBC count >10 per high-power field

^b midstream urine specimen (bladder specimen); culture if WBC count >10 per high-power field

^c EPS (prostatic specimen) contraindicated in acute bacterial prostatitis; WBC count and differential, Gram stain, and culture should be performed

^d first 10 mlof voided urine after EPS (prostatic secretion); always requires culture given the small colony counts.

Table 3.

Etiologies of pyospermia

Category
- Presence of defective sperm
- Varicocele
- Chronic prostatitis
- Smoking, drug abuse like marijuana (social causes), alcohol, exposure to irritants and toxins
- Use of vaginal products by partner during sexual activities
- Abstinence
- Vasovasostomy, urethroplasty
- Clomiphene citrate therapy
- Chlamydia trachomatis, Gardnerella vaginalis and Ureaplasma urealyticum in patient's sexual partners (genital infection)
- Lower CD4+ cell counts in HIV patients

HIV: human immunodeficiency virus.

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