Relation between acute urinary retention, chronic prostatic inflammation and accompanying elevated prostate-specific antigen

Abstract

Objective. To determine if there is a relationship between acute urinary retention (AUR), the prostate-specific antigen (PSA) level and chronic inflammation of the prostate. We therefore studied patients with benign prostatic obstruction (BPO) with (n=64) or without (n=168) acute urinary retention (AUR) who underwent transurethral resection of the prostate (TURP) in a retrospective case control study. Material and methods. Between 2001 and 2004, a total of 232 patients underwent TURP due to BPO with or without AUR. The mean values of age, prostate volume, weight of resected prostate and PSA level and the histopathologic results of patients with and without AUR were compared. χ² analysis was used to examine the relationship between prostatic inflammation and AUR. The contribution of each variable to AUR was assessed by means of multiple linear regression. Results. A total of 64 patients (28%) were operated on for AUR due to BPO. There were no statistical differences between patients with or without AUR with respect to the mean values of PSA, percent free PSA, prostate size or weight of the resected prostate tissue. Elevated PSA values (≥4.0 ng/ml) were detected in 64% and 38% of the patients in the AUR and non-AUR groups, respectively (p=0.01). Histopathological re-evaluation demonstrated that chronic prostatic inflammation was present in 56% and 37% of the specimens in the AUR and non-AUR groups, respectively (p=0.014). In the AUR group, the mean PSA level was significantly higher in patients with than without prostatic inflammation (7.75±5.26 vs 5.07±3.21 ng/ml; p=0.022). The odds ratio of AUR for patients with chronic prostatic inflammation and elevated PSA was determined as 4.14 (95% CI 1.65–10.41). Multiple linear regression revealed that prostatic inflammation made a significant contribution to AUR. Conclusions. Chronic prostatic inflammation may be histopathological evidence of both elevated PSA level and AUR; hence it may play a role in the pathophysiology of AUR.