Chronic prostatitis /chronic pelvic pain syndrome associated with endothelial dysfunction

Vienna, Austria-Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) appear to have a higher incidence of endothelial dysfunction and arterial stiffness, providing a possible link to cardiovascular disease in these patients, results of a recent study indicate.

A National Institutes of Health prostatitis cohort study showed that men with chronic CP/CPPS had a higher rate of self-reported cardiovascular disease than asymptomatic controls (J Urol 2002; 168:593-8). No link had ever been found before, and no mechanism has since been seen.

"We wished to test whether patients with CPPS were at risk for the development of cardiovascular disease using a noninvasive measurement of peripheral arterial tone," explained first author Daniel A. Shoskes, MD, attending urologist at the Glickman Urological and Kidney Institute at Cleveland Clinic.

"If confirmed, CPPS may emerge as an associated risk factor for cardiovascular disease and, much like in the young erectile dysfunction population, could prompt early referral to an internist for preventative cardiology measures," said Dr. Shoskes, who presented the findings at the 2011 European Association of Urology annual congress in Vienna, Austria.

The researchers used the EndoPAT device (Itamar Medical, Caesarea, Israel) to assess two measures of peripheral arterial tone: the augmentation index (AI), a measure of arterial stiffness, and the reactive hyperaemia index (RHI), which measures nitric oxide-mediated endothelial vasodilatation. Both elevated AI and diminished RHI suggest vascular and endothelial disease.

Twenty-one men with symptomatic, untreated CP/CPPS and 14 asymptomatic controls with no evidence of cardiovascular disease were tested with the EndoPAT. Symptom severity in patients was measured by the NIH Chronic Prostatitis Symptom Index (CPSI) and patient phenotype by the UPOINT (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles) system. UPOINT, developed by Dr. Shoskes, is designed to classify patients with CPPS according to these six domains.

Ages were similar in the CP/CPPS group and controls (median, 40 years). Patients had median symptom duration of 24 months (range, 3-440), mean CPSI score of 24.7±5.1 (range, 18-37), and mean UPOINT domains of 2.9±1.1 (range, 1-5).