SYMPTOMS AND INFLAMMATION IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME JOHN N. KRIEGER, SUSAN O. ROSS, DAVID F. PENSON, AND DONALD E. RILEY ABSTRACT Objectives. To evaluate the possibility that patients with inflammatory and noninflammatory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) might present with different symptoms. Patients with CP/CPPS present with characteristic symptoms without bacteriuria. The new National Institutes of Health consensus suggests that CP/CPPS can be divided into inflammatory and noninflammatory categories. Methods. Standardized symptom surveys were completed by 130 subjects who met the criteria for CP/CPPS after clinical examination and urethral, urine, expressed prostatic secretion (EPS), and seminal fluid analysis evaluations. Results. When classified by either EPS or postprostatic massage urine (VB3) findings, subjects with and without inflammation had similar symptoms. However, when classified using the combination of EPS, VB3, and seminal fluid analysis, subjects with inflammatory CP/CPPS had more severe (P 0.02) and more frequent symptoms, in particular, difficulty reaching erection (P 0.01), weak urinary stream (P 0.01), urinary frequency (P = 0.03), and penile pain (P = 0.04). Conclusions. The increased severity and frequency of symptoms among patients with inflammatory CP/ CPPS provide empirical support for the new consensus classification on the basis of the combination of EPS, VB3, and seminal fluid analysis findings. UROLOGY 60: 959–963, 2002. © 2002, Elsevier Science Inc. T he traditional classification of prostatitis em- phasized the evaluation of expressed prostatic secretions (EPS) and postprostatic massage urine (VB3). 1,2 Patients with bacteriuria who had a 10- fold increase in the same uropathogens in EPS or VB3 were considered to have chronic bacterial prostatitis 3 and were treated with antimicrobial agents. 4 Patients without bacteriuria who had EPS leukocytes (WBCs) had nonbacterial prostatitis; those without WBCs had prostatodynia. 1 Nonbac- terial prostatitis was believed to reflect an organic abnormality, perhaps a cryptic infection, an immu- nologic disorder, or a voiding disturbance. 3 Pros- tatodynia was thought to reflect “disorders in sex- ual identification” or a “primary personality disturbance.” 3 After 30 years of investigation, no clinical difference was demonstrated between pa- tients with and without EPS inflammation. The new National Institutes of Health (NIH) classification recommends the evaluation of the seminal fluid analysis (SFA) in addition to EPS and VB3. 5 Patients without bacteriuria or urethritis are considered to have inflammatory CP/CPPS if they have WBCs in their EPS, VB3, or SFA. Patients without WBCs in any specimen had noninflamma- tory CP/CPPS. The question is whether this distinction is im- portant clinically. One possibility is that patients with inflammatory and noninflammatory CP/CPPS present with different symptoms. To examine this possibility, we used a broad approach in a carefully defined population. MATERIAL AND METHODS POPULATION AND CLINICAL EVALUATION The subjects were older than 18 years with symptoms for 3 months or longer. None had taken antimicrobial agents for 6 weeks or more and none had bacteriuria. After a standardized history and physical examination, urethral swabs were ob- tained for gram staining and cultures for Neisseria gonor- rhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, My- coplasma hominis, 6 and Trichomonas vaginalis. 7 Patients had microscopy and cultures of first-voided urine, mid-stream This study was partially supported by grant RO1 DK38955 from the National Institutes of Health. From the Department of Urology, School of Medicine and De- partment of Pathobiology, School of Public Health and Commu- nity Medicine, University of Washington, Seattle, Washington Reprint requests: John N. Krieger, M.D., Urology Section, 112- GU, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, University of Washington Campus Mail Box 358280, Seattle, WA 98108-1597 Submitted: April 12, 2002, accepted (with revisions): July 18, 2002 ADULT UROLOGY © 2002, ELSEVIER SCIENCE INC. 0090-4295/02/$22.00 ALL RIGHTS RESERVED PII S0090-4295(02)01963-5 959