Prostatitis

Genitourinary Pain Index (GUPI) This 9-item instrument was developed by modifying the original NIH-Chronic Prostatitis Symptom Index (CPSI) [38 (link)]. Several new items about bladder-specific pain were added, and male gender-specific items were replaced with female-gender specific items for women. The GUPI is applicable to men and women to assess pain symptoms, urinary symptoms, and quality of life as separate sub-scales, and overall as a total score [39 (link)].

GPs participating in the JGPN register a diagnosis for each consultation using International Classification of Primary Care (ICPC) codes. As a first step, medical record data were collected from all consultations of adult males with ICPC codes U01 (dysuria/painful urination), U02 (urinary frequency/urgency), U70 (pyelonephritis/pyelitis), U71 (cystitis), and Y73 (prostatitis) for which a UTI-related antibiotic (nitrofurantoin, trimethoprim, ciprofloxacin, amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, fosfomycin, or norfloxacin) was prescribed within 7 days before and after the start date. A UTI episode after a UTI consultation-free interval of 30 days was considered a new UTI episode. Second, UTI episodes were excluded if:

the patient had an indwelling urinary catheter;

no information on patient-reported symptoms and GP-assessed signs was available;

one UTI episode was associated with two prescriptions for different antibiotics on the same day;

the antibiotic prescription was for prophylactic or future use, and

the patient was anatomically female.

Next, medical records of all remaining UTI episodes were manually screened and scored for patient-reported symptoms and GP-assessed signs of a complicated UTI, namely fever reported by patients and/or assessed  by  GPs,  patient-reported  malaise  and/or cold shivers, and GP-assessed ‘clinically severely ill’, costovertebral angle tenderness, perineal pain, and/or signs of delirium.² A UTI was considered uncomplicated when all of these signs and symptoms were absent. If a sign or symptom was not recorded it was considered absent. Screening and scoring of 400 variables regarding signs and symptoms of complicated UTI was done in duplicate by two independent investigators with an agreement of 99% (kappa 0.94 [almost perfect agreement]).
The following data were extracted for each uncomplicated UTI episode: age, comorbidities (diabetes, cardiovascular, pulmonary, oncological, nephrological, urological, and neurological and immunocompromising conditions; see Supplementary Appendix S1), number and type of antibiotic prescriptions using Anatomical Therapeutic Chemical codes, and hospital referrals.
Treatment failure was defined as an antibiotic prescription for a different antibiotic >1 day after the initial prescription or an acute hospital referral to urology or internal medicine >1 day after the antibiotic prescription.
The Dutch UTI guideline recommends nitrofurantoin (first choice) or trimethoprim (second choice) for treatment of uncomplicated UTI in males.² GPs were therefore considered adherent to the guideline if they prescribed one of those antibiotics. If treatment failure had occurred in the year before the current UTI episode, ciprofloxacin, amoxicillin/clavulanic acid, and trimethoprim/sulfamethoxazole were considered adherent as well.
As data on UTI episodes from 2013 were not available, treatment failure in the year before 2014 could not be determined. The year 2014 was therefore excluded from the adherence analysis.

All experimental animals were randomly divided into five groups (N = 6 for each group): sham control group, 3% CAR-induced prostatitis group, 5% CAR-induced prostatitis group, and 5% CAR-induced prostatitis groups with LESW (100 or 300 pulses; 0.12 mJ/mm²; frequency of two pulses per second). The experimental animals were anesthetized with isoflurane (5% during induction and 2% during maintenance), and a small incision was made in the midline of the lower abdomen following a sterile technique. The bladder and the prostate were carefully exposed from the surrounding tissues. CAR (Sigma, MO, USA) was dissolved in 50 μL of sterile saline at concentrations of 3% or 5% and injected into the left and right ventral lobes of the prostate with a 30-gauge needle. The wound was closed in layers, and an antibacterial cream was applied to the wound. The sham control group received 50 μL of sterile saline injection.

The anti-inflammatory activity on a bacterial-induced inflammation in vitro model of prostate epithelium was assessed for the active principles described in Table 1, and their mix.