Metabolic Aspects of Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Authors: Nurimanov Kamil 
Published: December 2024

Symptoms of prostatitis, in particular, pain and urination disorders significantly affect the quality of life of patients. Metabolic mechanisms of the pathogenesis of prostatitis and the formation of prostate calcifications are of interest for modern research.
The objective: to determine the relationship between the concentration of uric acid, oxalates and pH in blood serum, urine and ejaculate with symptoms of prostatitis and ultrasound signs of prostate calcifications.
Materials and methods. 102 men aged 18 to 45 were included in the study. Group 1 (n=34) consisted of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Group 2 included patients with asymptomatic prostatitis (n=34). They had no complaints, but laboratory signs of prostatitis were observed (pyospermia, leukocytes more than 10 per high power field in the ejaculate). The material (urine, ejaculate) of 34 healthy men was used as a control (Group 3).
Prostatitis symptoms were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scale, and depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. All participants underwent ejaculate analysis. Interleukins (IL) 1β and IL-10 were determined by enzyme immunoassay in ejaculate. In all cases, daily diuresis, pH of urine, concentration of uric acid, oxalates in urine and ejaculate were determined by methods of analytical chemistry.
Patients of Group 1 received a course of extracorporeal shock wave therapy (ESWT) for 10 sessions, 2-3 times a week. Treatment success was defined as a reduction of 6 points or more on the NIH-CPSI total score. After receiving a course of ESWT, patients of Group 1 were recommended to follow a diet for 2 months (± 2 weeks), after which they were subject to re-examination. All other study participants (Group 2 and Group 3) followed the diet immediately after the initial examination. After 2 months (± 2 weeks), after which they were also subject to re-examination.
Results. Both high and low values of the studied indicators were found in all patients. The analysis of the obtained data on the concentration of uric acid and oxalates in the urine, blood serum and ejaculate of the study participants showed no statistically significant difference between the groups. The concentration of uric acid in blood serum was inversely correlated with its concentration in urine and ejaculate (r=–0.238, p=0.016; r=–0.267, p=0.007, respectively). In addition, it was inversely correlated with the concentration of oxalates in urine, ejaculate and their daily excretion (r=–0.301, p=0.02; r=–0.288, p=0.003; r=–0.212, p=0.032, respectively). The ejaculate pH was correlated with the concentration of uric acid in sperm and blood serum (r=0.297, p=0.002; r=–0.467, p=0.001, respectively), as well as with the presence of flickering artifact during ultrasonography of the prostate gland (r=–0.249, p=0.011). In turn, the urine pH level was positively correlated with the presence of a flickering artifact and the assessment of depression symptoms according to the PHQ-9 questionnaire (r=0.208, р=0.036; r=–0.199, р=0.045, respectively). Correlations between metabolic indicators and evaluation of prostatitis symptoms according to the NIH-CPSI scale were absent.
As a result of adherence to the diet for 2 months, there was no recurrence of the disease or deterioration of the condition of patients in Group 1, as well as the appearance of prostatitis symptoms in the participants of Groups 2 and 3. This may also have been facilitated by compliance with our general recommendations for maintaining a healthy lifestyle. Significant changes in the studied metabolic indicators were observed in all studied groups. In Group 1, the activity of prostatitis symptoms and depression decreased statistically significantly as a result of using the diet. The average difference in the total score of the NIH-CPSI questionnaire was 4.2±6.8, p<0.001; the total score of the PHQ-9 questionnaire was 4.1±2.9, p<0.001.
Conclusions. The results of the study show that the concentration of uric acid, oxalates in urine, semen, and blood serum, as well as the pH values of urine and ejaculate, most of which traditionally characterize stone formation in the urinary tract, significantly affect the condition of patients with chronic calculous prostatitis. Adherence to the diet allows patients to influence the indicators of salt transport, reduce the activity of symptoms and the likelihood of disease recurrence. Along with this, no significant relationship was found between the studied indicators and the activity of prostatitis symptoms and depression in such patients.