Clinical Significance of National Institutes of Health-Chronic Prostatitis Symptom Index Pain Score in Patients with Benign Prostatic Hyperplasia

Chang Min Lee; Jae Mann Song; Kwang Jin Kim; Tae Wook Kang; Seung Hoon Ryang; Yun Byung Chae; Hyun Chul Chung; Jae Hung Jung

doi:10.14777/uti.2015.10.02.102

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Lee, Song, Kim, Kang, Ryang, Chae, Chung, and Jung: Clinical Significance of National Institutes of Health-Chronic Prostatitis Symptom Index Pain Score in Patients with Benign Prostatic Hyperplasia

Original Article

Urogenit Tract Infect 2015;10(2):102-107.

Published online: 19 October 2015

DOI: https://doi.org/10.14777/uti.2015.10.02.102

Clinical Significance of National Institutes of Health-Chronic Prostatitis Symptom Index Pain Score in Patients with Benign Prostatic Hyperplasia

Chang Min Lee, Jae Mann Song, Kwang Jin Kim, Tae Wook Kang, Seung Hoon Ryang, Yun Byung Chae¹, Hyun Chul Chung, Jae Hung Jung

Department of Urology, Yonsei University Wonju College of Medicine, Wonju

¹Department of Urology, Cheongju St. Mary's Hospital, Cheongju, Korea

Correspondence to: Jae Hung Jung http://orcid.org/0000-0002-4990-7098 Department of Urology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-0652, Fax: +82-33-748-3804 E-mail: geneuro95@yonsei.ac.kr

Received 6 June 2015 Revised 11 August 2015 Accepted 22 August 2015

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

Purpose:

Many benign prostatic hyperplasia (BPH) patients were accompanied by pelvic pain apart from urinary symptoms. Therefore, we evaluate the treatment outcomes of alpha-blockers via a change of international prostate symptom score (IPSS) according to pain score of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

Materials and Methods:

A total of 356 male patients with BPH from March 2011 to May 2014 were analyzed retrospectively. Prostate specific antigen, prostate volume, IPSS, NIH-CPSI, international index of erectile function (IIEF-5), and uroflowmetry were collected. Patients were categorized according to 2 groups based on the presence and severity of pain and baseline characteristics and treatment outcomes were analyzed.

Results:

Two hundred twenty-nine patients (64.3%) reported pain/discomfort on NIH-CPSI. Mean IPSS, mean voiding symptoms, mean storage symptoms on IPSS, and mean IIEF-5 showed a significant difference in groups 1A and 1B. Logistic regression analysis showed that NIH-CPSI pain score was a significant predictive factor for severe IPSS (odds ratio, 2.830; 95% confidence interval, 1.307-6.129). After treatment for 3 months, improvement of IPSS, voiding symptoms, storage symptoms, and quality of life was observed in all groups (p=0.001, p<0.001, p=0.026, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). Group 2B (pain score>5) showed greater improvement of symptoms and statistically significant difference compared with group 2A (pain score ≤5) (p=0.029, p=0.026).

Conclusions:

We suggest that the presence and severity of pain score are helpful for therapeutic efficacy in patients with BPH.

Keywords: Prostatic hyperplasia, Lower urinary tract symptoms, Prostatitis

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Fig. 1.

Changes of international prostate symptom score (IPSS) between 2 groups.

Fig. 2.

Changes of quality of life (QoL) between 2 groups.

Table 1.

Baseline characteristics (n=356)

Characteristic	Pain		p-value
Characteristic	No (n=127)	Yes (n=229)	p-value
Age (y)	65.89±7.19	66.55±8.18	0.450
Diabetes mellitus	100 (78.7)	178 (77.7)	0.375
Prostate volume (ml)	32.21±16.12	29.99±12.84	0.185
Prostate-specific antigen (ng/dl)	2.53±7.79	2.14±5.21	0.699
International prostate symptom score	15.13±7.96	17.66±7.90	0.004
Voiding	8.59±5.31	10.27±5.22	0.004
Storage	6.53±4.14	7.39±3.60	0.041
Quality of life	3.96±1.45	4.15±1.42	0.225
International index of erectile function score	11.20±7.24	9.19±7.01	0.023
Qmax (ml/s)	10.93±6.90	11.36±8.01	0.626

Values are presented as mean±standard deviation or number (%). Independent t-test.

Qmax: maximum flow rate on uroflowmetry.

Table 2.

Risk factor for National Institutes of Health-Chronic Prostatitis Symptom Index pain score

	Odds ratio (95% confidence interval)
Age (y)
≤60	-
＞60, ≤70	0.448 (0.246-0.815)
＞70	1.182 (0.580-2.410)
IPSS
Mild (IPSS≤7)	-
Moderate (8≤IPSS≤19)	1.604 (0.793-3.243)
Severe (IPSS≥20)	2.830 (1.307-6.129)
Diabetes mellitus	0.809 (0.459-1.424)

Logistic regression analysis.

IPSS: international prostate symptom score.

Table 3.

Comparison of treatment outcomes before and after treatment in each group

		Baseline	3 month later	p-value
Pain score≤5 (n=66)	IPSS	15.30±6.53	11.95±7.13	0.001
	Voiding	9.09±4.63	6.82±4.71	0.000
	Storage	6.21±3.64	5.12±3.32	0.026
	QoL	3.86±1.28	2.95±1.54	0.000
	Pain score	1.55±1.96	1.67±2.55	0.735
	IIEF-5 score	12.12±6.69	9.51±7.42	0.009
	Qmax (ml/s)	9.54±6.04	10.91±5.50	0.083
Pain score>5 (n=38)	IPSS	18.26±6.93	11.34±6.80	0.000
	Voiding	11.03±4.77	6.82±4.45	0.000
	Storage	7.24±3.41	4.53±3.00	0.000
	QoL	4.53±1.25	2.87±1.32	0.000
	Pain score	9.53±2.69	3.45±3.29	0.000
	IIEF-5 score	10.64±6.28	10.86±7.07	0.881
	Qmax (ml/s)	11.53±6.69	13.20±8.11	0.054

Values are presented as mean±standard deviation. Paired t-test.

IPSS: international prostate symptom score, QoL: quality of life, IIEF-5 score: international index of erectile function score, Qmax: maximum flow rate on uroflowmetry.

Table 4.

The changes of subjective and objective parameters between 2 groups

Changes of parameters	Pain score≤5 (n=66)	Pain score＞5 (n=38)	p-value
IPSS	-3.35±7.69	-6.92±8.34	0.029
Voiding	-2.27±4.80	-4.21±5.82	0.070
Storage	-1.09±3.89	-2.71±3.73	0.041
QoL	-0.91±1.62	-1.65±1.63	0.026
NIH-CPSI pain score	0.12±2.90	-6.08±3.79	0.000
IIEF-5 score	-2.60±6.28	0.22±7.04	0.104
Qmax (ml/s)	1.36±5.16	1.67±4.70	0.796

Values are presented as mean±standard deviation. Paired t-test.

IPSS: international prostate symptom score, QoL: quality of life, NIH-CPSI pain score: National Institutes of Health Chronic Prostatitis Symptom Index pain score, IIEF-5 score: international index of erectile function score, Qmax: maximum flow rate on uroflowmetry.

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