Patients who have received ciprofloxacin within 3 months of TRUSBxshould be considered for alternate prophylaxis or possibly a delay ofbiopsy beyond 3 months.

Source of Funding: Vancouver Coastal Health ResearchInstitute

1081TARGETED PROPHYLAXIS PRIOR TO TRANSRECTALPROSTATE BIOPSY: A COMPARISON OF BROTH ENRICHMENTTO DIRECT PLATING FOR THE EVALUATION OF RECTALCULTURES.

Michael Liss*, Kristen Nakamura, Ellena Peterson, Irvine, CA

INTRODUCTION AND OBJECTIVES: To compare broth en-hancement to direct plating of rectal swabs for the recovery of cipro-floxacin resistant organisms; information that can be used to tailorprophylactic antimicrobial therapy prior to transrectal prostate biopsy.

METHODS: Rectal swabs from 50 men undergoing a transrec-tal prostate biopsy were obtained from Long Beach VA Medical Centerover a 4 month period (7/2011-11/2011). Participant demographics andrectal specimens were obtained prior to transrectal prostate biopsy.Rectal swabs were placed directly into 5 ml of brain heart infusion brothcontaining either 1 �g/mL or 10 �g/mL of ciprofloxacin (Hardy Diag-nostics), incubated overnight at 35 °C and then subcultured to MacCo-nkey agar containing the corresponding concentration of ciprofloxacin.The third swab was plated directly to MacConkey agar without cipro-floxacin and to MacConkey agar containing 1 �g/mL or 10 �g/mLciprofloxacin. All enteric gram-negative bacilli were characterized onthe Vitek II, using GN and AST-GN30 cards for identification andsusceptibility testing, respectively.

RESULTS: Swabs were obtained from 50 patients. Samplesfrom eight of these patients yielded no growth (16%) and thus wereeliminated from further analysis. Of the remaining cultures from 42patients the following was recovered: 54.8% (23/42) grew normal floraonly from the MacConkey agar without added antibiotic; 21.4% (9/42)grew ciprofloxacin resistant enterics from all media used; 2 ciprofloxa-cin resistant organisms were recovered only from subcultures of the 1�g/mL broth. Seven of the samples resulted in false positive growth(ciprofloxacin susceptible) when subcultured from the 1 �g/mL cipro-floxacin containing broth in contrast to one false positive resulting fromthe 10 �g/mL containing broth. Direct plating using both plates with 1�g/mL and 10 �g/mL, yielded a sensitivity, specificity, positive andnegative predictive values (PPV and NPV) of 82%, 100%, 100%, and94%, respectively. Broth enhancement predictive values (sensitivity,specificity, PPV, NPV, respectively) were: 1�g broth, 100%, 77%, 61%and 100%; and 10ug broth, 82%, 97%, 90% and 94%.

CONCLUSIONS: While broth enhancement may increase theyield of FQ-R organisms it also increases the number of false positives.Direct plating of rectal swabs onto MacConkey agar containing 1 �g/mLor 10 �g/ mL ciprofloxacin gives the lowest false positives but may failto isolate a low number of resistant organisms.

Source of Funding: None

1082NATIONAL INSTITUTE OF HEALTH CHRONIC PROSTATITISSYMPTOM INDEX (CPSI) SYMPTOM EVALUATION IN PATIENTSWITH CHRONIC PROSTATITIS / CHRONIC PELVIC PAINSYNDROME – A MULTINATIONAL STUDY IN 1,563 PATIENTS.

Florian Wagenlehner*, Giessen, Germany; Olivier van Till,Leiderdorp, Netherlands; Vittorio Magri, Gianpaolo Perletti, Milano,Italy; Jos Houbiers, Leiderdorp, Netherlands; Wolfgang Weidner,Giessen, Germany; Curtis Nickel, Kingston, Canada

INTRODUCTION AND OBJECTIVES: The assessment of CP/CPPS patients in everyday practice and clinical studies rely on theCPSI scores for symptom appraisal, inclusion criteria for clinical trials,follow up and response evaluation. We investigated multiple data

bases of CP/CPPS patients to determine the prevalence and impact ofpain locations and types to improve our strategy of individualizedphenotypically guided treatment.

METHODS: Four major databases with CPSI scores for non-selected CP/CPPS clinic patients from Canada, Germany, Italy andUSA were included. The individual question scores, sub-total and totalscores of the CPSI are described and correlated with each other.

RESULTS: In this data base analysis, 1,563 CP/CPPS patientswere included. Perineal pain/discomfort was the most prevalent painsymptom (63%) followed by testicular pain/discomfort (58%). Pain/discomfort was reported less often in the pubic area (42%) and penis(32%) while reports during ejaculation and voiding were 45% and 43%respectively. Severity of pain correlated well with frequency of pain(r�0.650). No specific pain localization/type was associated with moresevere pain. Correlation of the pain subdomain with QoL (r�0.682) washigher than the urinary subdomain (r�0.336). QoL is considered thegold standard in a patient’s general condition and wellbeing. Individu-ally, pain frequency (r�0.589) and pain severity (r�0.633) correlatedbetter with QoL than pain localization (r�0.420). In order to definedisease severity categories ANOVA of different pain domain and totalCPSI cut-off levels and their impact on QoL was calculated resulting inoptimal cut-off levels: pain severity (0-10) – mild, 0 to 3; moderate, 4 to6; severe, 7 to 10; total CPSI (0-43) – mild, 0 to 14; moderate, 15 to 26;severe 27 to 43. European patients had a significantly higher number ofpain localizations and symptoms compared to North-American patients(p�0.0001).

CONCLUSIONS: Pain has more impact on QoL than urinarysymptoms. Pain severity and frequency are more important than painlocalization/type. Cut-off levels for disease severity categories havebeen identified which will prove valuable in symptom assessment anddevelopment of therapeutic strategies.

Source of Funding: None

1083CANNABIS (MARIJUANA) USE IN MEN WITH CHRONICPROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

Dean Tripp*, J. Curtis Nickel, Katz Laura, Jessica V. Ginting,Kingston, Canada; Ware Mark, Montreal, Canada; Darcy Santor,Ottawa, Canada

INTRODUCTION AND OBJECTIVES: To examine the preva-lence of cannabis use among men with CP/CPPS, to estimate the dosesize and frequency of cannabis use, and to describe the patientreported indications for its use in this population.

METHODS: Parallel online and clinic questionnaire surveyswere conducted to assess cannabis use among men with CP/CPPS.As a check on study generalizability, comparisons between the onlinedata (n�365) and clinic data (n�60) showed no clinically meaningfuldifferences in the outcome variables of quality of life (QoL), suicidalideation, pain and urinary symptoms were evident between thesegroups.

RESULTS: Forty nine percent of this sample reported cannabisuse (n�206). Of those reporting cannabis use, 29% (n�59) indicateduse for pain relief (pain users) and 71% (n�147) for recreation. Thepain users (mean age�38.26�13.78), were younger than recreationalusers (42.37�12.18) and individuals who reported never using canna-bis (45.29�13.73)(p�.001). More pain users reported cannabis was ofpain reduction benefit in comparison to recreational users(Chisq�3.83, p�.05). No differences were found between recreationaland pain users in degree of side effects (Chisq�4.43, p�.22), reasonsfor stopping (Chisq�4.84, p�.18), or use frequency (Chisq�5.48,p�.07). There were no differences in dose smoked between the painand recreational users (Chisq�5.80, p�.12), but a difference wasfound in dose eaten between these two groups with 20% of pain usersreporting consuming more than 1 gram per dose versus only 7% ofrecreational users reporting consuming this dosage. (Chisq�12.51,p�.002). Pain users reported more pain (F�4.04, p�.05), poorerCP/CPPS QoL/impact (F�8.61, p�.004), and more suicidal thoughts(F�6.59, p�.01) than recreational users.

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CONCLUSIONS: Cannabis use is prevalent in men reportingCP/CPPS (49%), but not necessarily used for CP/CPPS symptoms(used for pain in only 29% users). It is important that physiciansplanning a therapeutic strategy for patients with CP/CPPS know therelevance of this data and question their patients on their use (andeffect/impact on symptoms) of marijuana/cannabis. Although this studycannot qualify the benefit or hazard of cannabis use, this is the firststudy to document the prevalence and patterns of cannabis use in aCP/CPPS population.

Source of Funding: Valeant Canada Inc.

1084RELATIVE CONTRIBUTION OF UPOINT DOMAINS TO SYMPTOMSEVERITY AND PHENOTYPE CLUSTERING IN MEN WITHCHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

Daniel Shoskes*, Mary Samplaski, Jianbo Li, Cleveland, OH

INTRODUCTION AND OBJECTIVES: The UPOINT systemcharacterizes men with chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) according to 6 domains (Urinary, Psychosocial, OrganSpecific, Infection, Neurologic/Systemic and Tenderness of SkeletalMuscles) which can guide multimodal therapy. Some domains havemultiple possible criteria and the lumping of these criteria has neverbeen validated. Furthermore, patterns of domain and subdomain clus-tering may give clues as to etiology or temporal staging of the syn-drome. We examined the contribution and clustering patterns of UP-OINT domains and subdomains to symptom severity.

METHODS: Records were reviewed from CP/CPPS patientsincluding 120 men characterized by UPOINT alone and 100 character-ized by subdomains: U.V (voiding), U.V (storage), P.C (catastrophiz-ing), P.D (depression), O.B (bladder), O.P. (prostate), I.E (prostaticfluid bacteria), I.U (urethritis), N.N (neurologic), N.S (systemic). TheChronic Prostatitis Symptom Index (CPSI) measured symptom severity.

RESULTS: For U, P and I, subdomains had similar incidencesbut for N, N.Neurologic � N.Systemic (77% vs 11%) and O.Prostate �O.Bladder (51% vs 33%). By cluster analysis with multidimensionalscaling, the U, O.Prostate and T, domains clustered together and P, I,N, and O.Bladder clustered together. In the larger group without sub-domains, the groupings were O/U/T and P/I/N. Domains whose contri-bution to total CPSI was significant by multivariable analysis were U, Pand T and to the pain subscore of CPSI were P and T only. Only Pindependently contributed to the QOL subscore.

CONCLUSIONS: UPOINT domain criteria capture a homoge-neous group for each domain except for divergence between OrganSpecific Bladder vs Prostate. The clustering of domains specific to thepelvis (O/U/T) vs those that are systemic (P/N) suggests 2 patientpopulations who may differ in pathophysiology and treatment response.The primary drivers of pain in CPPS are pelvic floor tenderness andpsychologic depression and catastrophizing.

Source of Funding: None

1085COMBINATION THERAPY OF CYCLOOXYGENASE-2 INHIBITORAND �-BLOCKER PROVIDED A BETTER THERAPEUTICRESULT THAN �-BLOCKER ALONE FOR MEN WITH BENIGNPROSTATE HYPERPLASIA AND ELEVATED PROSTATICSPECIFIC ANTIGEN LEVELS: A PROSPECTIVE ANDRANDOMIZED CONTROL STUDY

Jia-Fong Jhang*, Hualien, Taiwan; Victor Chia-Hsiang Lin,Kaohsiung, Taiwan; Hann-Chorng Kuo, Hualien, Taiwan

INTRODUCTION AND OBJECTIVES: Chronic inflammationplays an important role in human benign prostatic hyperplasia (BPH).Treatment with cyclooxygenase-2 (COX-2) inhibitor had effects onlower urinary tract symptoms (LUTS) through anti-inflammatory effect.Patients with BPH and an elevated prostatic specific antigen (PSA)level could be due to adenocarcinoma or chronic inflammation. We

conducted a prospective study to investigate the therapeutic efficacy ofthe combination COX-2 inhibitor and �-adrenoceptor blocker (�-blocker) for men with BPH and LUTS and an elevated PSA.

METHODS: A total of 80 men with clinical BPH, LUTS(IPSS�8) and elevated PSA level (�4 ng/ml) for at least 6 months wererecruited into this study. Patients were randomly assigned to the studyand control group at 1:1 ratio. The study group received doxazosin 4mgQD plus celecoxib 200mg QD for 3 months while the control groupreceived doxazosin 4 mg QD alone for 3 months. Patients wereinvestigated for the changes of IPSS, total prostatic volume (TPV),maximum flow rate (Qmax), voided volume and serum PSA frombaseline to 3 months after treatment. Therapeutic results were com-pared between the study and control groups. Prostate biopsy was alsoperformed to investigate the presence of adenocarcinoma after 3month treatement.

RESULTS: The IPSS, Qmax, quality of life index and PSA in thestudy group all showed significant improvement after treatment(P�0.01). The improvement in IPSS-empty was significantly greater inthe study group than the control group (P�0.05) (Table). In the studygroup, patients with chronic inflammation in the prostate biopsy had asignificantly better therapeutic result than in patients with prostaticadenocarcinoma, typically in the changes of Qmax and voided volume(P�0.05).

CONCLUSIONS: Adding COX-2 inhibitor on �-blocker in-creased therapeutic effectiveness in LUTS secondary to BPH in theempty symptoms in patients with BPH and high PSA levels. Thechanges of Qmax and voided volume after combination treatment wassignificantly greater in patients with chronic inflammation, suggestingCOX-2 inhibitor provide an anti-inflammatory effect on BPH with highPSA level due to chronic inflammation.

Table. The mean changes of variables from baseline to 3 month aftertreatment

Celecoxib with Doxazosinn�40

Doxazosinn�40 P-value

IPSS-empty -4.75�5.21 -2.00�5.01 0.034

IPSS-storage -2.22�3.08 -2.90�3.40 0.395

IPSS-total -6.97�5.56 -4.94�7.16 0.201

Qmax 1.18�6.04 1.57�3.56 0.725

TPV -1.19�10.56 3.32�15.68 0.122

PSA -1.89�3.51 -2.70�7.76 0.545

IPSS: International Prostate Symptom Score. Qmax: maximum flow rate, ml/sec.TPV: total prostate volume, ml. PSA: serum prostate specific antigen, ng/ml.

Source of Funding: None

1086SIGNIFICANT MARKER FOR LOWER URINARY TRACTSYMPTOMS IN CHRONIC PROSTATITIS

Minori Matsumoto*, Katsumi Shigemura, Kazushi Tanaka,Yuzo Nakano, Soichi Arakawa, Masato Fujisawa, Kobe, Japan

INTRODUCTION AND OBJECTIVES: Chronic prostatitis (CP)has been traditionally characterized by inflammation and/or infection ofthe prostate gland but the treaments are often in failure. The purpose ofthis study is to investigate the significant marker relating to inflamma-tory and immune system for symptomatic CP.

METHODS: We retrospectively examined 123 CP patients cat-egorized in type type IIIA and IIIB and their treatments. In order todetect the significant marker for symptomatic CP, we investigated theprotein expressions of the makers (TGF-beta, Interleukin (IL)-6, CD3,decorating T-lymphocytes, and CD163, decorating macrophages) us-ing 10 patients� prostate biopsy specimens of which chronic prostaticinflammation was diagnosed by IHC staining and their correlation withLUTS symptom score using international prostate symptom score/quality of life (QOL) statistically. Statistical analyses were performedusing Spearman rank correlation coefficient.

RESULTS: We had 36/124 (29.0 %) of patients diagnosed asCP by the 2-glass test. Treatment details were shown in Table 1. Ourstatistical analyses of LUTS symptoms and protein expressions of

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