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The “prostate-pelvic syndrome” theory used in patients with type-III prostatitis and its correlation with prostate volume

BMC Urology volume 25, Article number: 9 (2025) Cite this article

Abstract

Background

Type-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of “prostate-pelvic syndrome (PPS)” and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear.

Objective

The aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males.

Methods

The clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis.

Results

Of the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old.

Conclusions

Type-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.

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Introduction

Type-III prostatitis, also namely chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is the most common prostate disease in adult males below 40 years old, which has a serious negative impact on the quality of life of patients [1]. The pathogenesis of type-III prostatitis has not been fully elucidated, and its diagnostic process and treatment plan were adopted according to the classification system published by the National Institutes of Health (NIH) in 1995, which have left most doctors and patients dissatisfied. The UPOINT classification method proposed by Shoskes et al. [2] in 2009 has improved the efficacy of type-III prostatitis, but its diagnostic process is still cumbersome. The UPOINT still requires the tests of the expressed prostatic secretion (EPS) and lower urinary tract pathogen localization (LUTPL), which have little clinical significance. Studies have shown that there is no significant correlation between the severity of symptoms of type-III prostatitis and the leukocyte and bacterial counts in EPS [3, 4]. There is no difference in the types and quantities of pathogenic microorganisms in LUTPL of type-III prostatitis patients compared to healthy individuals [5].

Clinical and basic studies have shown that type-III prostatitis was not a single disease, but a clinical syndrome. Personalized comprehensive treatment with symptoms of type-III prostatitis as the core was more effective than single treatment targeting the etiology of this disease [6]. Therefore, the Chinese urological experts proposed the new theory of “prostate-pelvic syndrome (PPS)” and recommended to using it to replace the term of type-III prostatitis [7]. The advantages of PPS theory are that it removes LUTPL and invasive EPS tests, and diagnoses and treats prostate diseases through symptoms of type-III prostatitis, non-invasive routine urine test, male urinary system ultrasound examination, and personalized comprehensive treatment. We hypothesized that PPS theory simplified and optimized the diagnosis and treatment process of type-III prostatitis, which might has high clinical guidance and application value for urology and male outpatient work. However, the practical application results of PPS theory in clinical practice are still rare. Additionally, autopsy and medical imaging studies have found that the normal prostate volume (PV) of adult males below 40 years old is about 20 mL, and histological benign prostatic hyperplasia (BPH) usually occur at the age of 40 [8,9,10]. PV is a risk factor that can affect the lower urinary tract symptoms (LUTS) of prostate diseases in men aged 40 and above [11]. However, there are no reports on whether it affects the symptoms of prostate diseases in adult males under 40 years old.

In response to the above-mentioned problems found in clinical practice, in order to exclude the influence of LUTS caused by histological BPH that could occur in men aged 40, adult type-III prostatitis patients below 40 years old were selected as the subjects for this study. The purpose of this study is to use the PPS diagnostic criteria for the first time to diagnose type-III prostatitis in adult males below 40 years old. In the present study, we verified the clinical results of PPS diagnosing type-III prostatitis in adult males under 40 years old and analyzed the relationship between PPS in adult males below 40 years old and PV ≥ 20 mL as well as the related factors for the main symptoms of PPS. It is our expectation that the use of PPS theory can provide better diagnosis and treatment for prostate diseases in young men.

Material and methods

Study subjects

In this retrospective study (Registered Address: https://www.medicalresearch.org.cn, Clinical Trial No: MR-34–24-035332), a total of 560 consecutive type-III prostatitis outpatients aged 18–39 with detailed medical history, various examination results and a course of more than 3 months were enrolled. Patients were visited the North District of the First Affiliated Hospital of Anhui Medical University (Anhui Public Health Clinical Center) from August 2018 to May 2023. The protocol of this study conformed to the Helsinki Declaration as revised in 2013. The study was sanctioned and informed consent for this retrospective analysis was waived by the ethics committee of the North District of the First Affiliated Hospital of Anhui Medical University (Anhui Public Health Clinical Center) (No.PJ-YX2023-043F1).

The selection criteria of the present study were as follows: (a) adult type-III prostatitis patients below 40 years old; (b) ultrasonography records of the urinary system including the prostate. The following exclusion criteria were used in this study: (a) lack of ultrasonography for the urinary system and prostate; (b) infections, tuberculosis, tumors, and trauma that occurred in the urinary system; (c) abnormal prostatic nodules detected by ultrasound examination; (d) ureteral calculus, bladder diseases, urethral stricture, chronic epididymitis, seminal vesiculitis, varicocele, diabetes, neurogenic bladder, mental disease, etc. that affected urination function and pelvic pain; (e) malignant tumors; (f) serious illnesses in important organs such as the heart, liver, and kidneys; (g) diseases of gonadal axis organs and the use of 5-α reductase inhibitors, sex hormones and other drugs that might affect the volume of the prostate; (h) alcoholics and ethanol addicts; (i) surgeries with any pelvic and prostate.

Study methods

Data collection

The clinical data of the patients were extracted and recorded in this study, including age, medical history, medication history, clinical characteristics, routine urine and results of urological ultrasound examinations including the prostate. Telephone follow-up was also conducted to supplement the psychological symptoms, educational levels and economic income levels. All patients included in the final analysis underwent routine urine and transabdominal ultrasound (TAUS) examinations of the urinary system and prostate. Routine urine tests were conducted by professional laboratory physicians in our hospital. The TAUS examinations including the measurement of the three diameters of the prostate were completed by experienced ultrasound doctors. PV was calculated using the ellipsoid formula (anteroposterior diameter × left–right diameter × upper-down diameter × π/6) [12]. There were literature reports that when the bladder volume was less than 400 mL, the TAUS measurement results of PV had good consistency with the results of transrectal ultrasound measurement [13]. In addition, TAUS examination can also screen the condition of bilateral kidneys, bilateral ureters and bladder to exclude non-prostate diseases.

Definition of diagnostic criteria and indicators

The diagnostic criteria for PPS are patients who meet either of the two main symptoms, with or without secondary symptoms, and have a disease course of ≥ 3 months [7]. At the same time, a detailed medical history inquiry, physical examinations, routine urine, urological and prostate ultrasound examinations were completed for the first visit to rule out chronic LUTS and/or pelvic pain symptoms caused by urinary tract infections, ureteral stones, urological tumors and pelvic/prostate surgeries. The main symptoms of PPS are: (a) pain symptoms (PS): recurrent pelvic pain or discomfort; (b) voiding symptoms (VS): LUTS of abnormal urination, such as frequent urination and not finishing urination. The secondary symptoms of PPS are: sexual dysfunction, psychological symptoms, reproductive dysfunction or other symptoms. Patients with a score greater than 1 in either of the main symptoms can be classified as PPS (only secondary symptoms cannot be used as a diagnostic basis). As shown in Table 1, the severity of PPS symptoms is mainly determined by the main symptoms score based on NIH-chronic prostatitis symptom index (NIH-CPSI) [14].

Table 1 Scoring criteria for PPS
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The diagnostic criteria for type-III prostatitis (based on the prostatitis classification system published by NIH in 1995 [14] and the Chinese version of the Diagnosis and Treatment Guidelines for Chronic Prostatitis/Chronic Pelvic Pain Syndrome [15]) are as follows: (a) clinical symptoms (required item): mainly manifested as recurrent pelvic pain or discomfort, and/or LUTS of abnormal urination, with or without sexual dysfunction, with a course of more than 3 months; (b) routine urine (required item): urinalysis before prostate massage is normal; (c) prostate palpation (required item): the gland is full, normal in size or enlarged, with a tough or uneven texture, or has inflammatory nodules, which may have localized tenderness; (d) EPS routine (required item): the characteristic of inflammatory type is that under the microscope, the white blood cell count in EPS is ≥ 10/HP, and the phospholipids bodies in EPS decrease or disappear; (e) urine bacterial culture is negative before and after prostate massage (recommended item); (f) ultrasound examination (optional item): the size of the prostate is normal or slightly reduced or slightly larger, the internal echo is normal or uneven, with or without prostate calcification, and the echo of the prostate capsule is enhanced, rough, thickened or unclear.

The diagnostic criteria for PPS are different from those for traditional type-III prostatitis in that PPS removes LUTPL and invasive EPS tests, and diagnoses prostate diseases through symptoms of type-III prostatitis, non-invasive routine urine test, and male urinary system ultrasound examination. The flow chart of patients ultimately included in the analysis of this study was shown in Fig. 1.

Fig. 1
figure 1

Flow chart of the included patients

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Statistical analysis

Continuous variables were first subjected to normality tests by Kolmogorov- Smirnov test. The mean ± standard deviation (‾χ ± S) and t test were adopted in continuous variables with a normal distribution and homogeneous variance. The median (3rd-1st quartile) (M [Q3-Q1]), Mann–Whitney U test (comparison between two groups) and Kruskal Wallis test (comparison between multiple groups) were adopted in continuous variables with non-normal distribution. The constituent ratio or rate (%) and chi-square tests were adopted in the categorical variables. The correlation between categorical variables and continuous variables was analyzed using Spearman correlation analysis. The related factors for the main symptoms of PPS were analyzed by multivariate logistic regression models, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). SPSS 22.0 software was used for statistical analyses (Statistical Package for the Social Sciences, IBM Corporation, NY, USA). Two-tailed P < 0.05 was considered to be statistically significant.

Results

According to the selection and exclusion criteria, 12 patients who lacked prostate ultrasound examination were excluded. A total of 548 patients with type-III prostatitis aged 18–39 were finally included in the analysis.

Composition of patients with type-III prostatitis (PPS) in this study

The disease duration of 548 patients with type-III prostatitis aged 18–39, with a median age of 30 years, ranged from 3 to 120 months, with a median duration of 6 months. Among 548 patients with type-III prostatitis who met the PPS diagnosis in this study, 229 patients had LUTS, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with VS, PS and VS + PS defined according to the concept of PPS, as shown in Table 2.

Table 2 Composition of patients with type-III prostatitis (PPS) in this study
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Comparison of relevant indicators between different main symptom groups in adult PPS patients below 40 years old

There were significant differences in PV, disease duration, sexual dysfunction, psychological symptoms and sedentariness (occupational environment) among the three main symptoms groups (P < 0.05). For pairwise comparison, PV in the VS group was larger than that in the PS group, and the disease duration was longer than that in the PS group (P < 0.05, Table 3 and Fig. 2). Spearman correlation analysis showed that VS was positively correlated with PV and disease duration (P < 0.05), while four secondary symptoms were not related to PV (P > 0.05), and PS was positively correlated with psychological symptoms and sedentariness (P < 0.05), as shown in Table 4.

Table 3 Comparison of age, PV, disease duration, ejaculation frequency, sexual dysfunction, psychological symptoms, reproductive dysfunction, education level, income, sedentariness and prostate calcification in PPS patients under different main symptoms [M (Q3-Q1)] or N (%)
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Fig. 2
figure 2

Comparison of prostate volume and disease duration in PPS patients under different main symptoms. Abbreviations: PPS, prostate-pelvic syndrome; VS, voiding symptoms; PS, pain symptoms

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Table 4 Spearman correlation analysis between different symptoms, age, disease duration, PV, ejaculation frequency, Sedentariness, prostate calcification, education level and income in PPS patients
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Analysis of related factors for different main symptoms in adult PPS patients below 40 years old

On the basis of univariate analysis, variables with two-tailed P < 0.05 were taken as covariates for the multivariate logistic regression analysis of PPS main symptoms, such as PV, disease duration, sexual dysfunction, psychological symptoms, and sedentariness. The main symptoms of PPS patients were taken as the dependent variable, and multivariate logistic analysis was carried out with the stepwise forward method under the introduced variables and excluded variables levels of 0.05 and 0.10. The assignment of categorical variables is: 1 = VS, 0 = non-VS; 1 = PS, 0 = non-PS. Multivariate logistic analysis showed that PV, disease duration, sexual dysfunction, psychological symptoms and sedentariness were independent related factors for VS in adult PPS patients below 40 years old (P < 0.05, Fig. 3). As having subjective consciousness in the assessment of sexual dysfunction, psychological symptoms and sedentariness, PV and disease duration should be relatively independent objective related factors for VS in adult PPS patients. As shown in Fig. 4, psychological symptoms and sedentariness were positively related factors for PS in adult PPS patients (P < 0.05). VS + PS in PPS patients was only associated with one variable of sexual dysfunction, and there were no data results from the Hosmer and Lemeshow Test. Therefore, the logistic regression equation for VS + PS related factors was not suitable and logistic regression analysis was not conducted.

Fig. 3
figure 3

Multivariate logistic regression analysis of VS-related factors in PPS patients (Forward Stepwise). Abbreviations: PPS, prostate-pelvic syndrome; VS, voiding symptoms; CI, confidence intervals. Notes: Regression equation, β = -0.331, SE = 0.087, Wald = 14.646, P = 0.000, OR = 0.718; R2 = 0.292; Hosmer and Lemeshow Test: χ2 = 12.734, P = 0.121

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Fig. 4
figure 4

Multivariate logistic regression analysis of PS-related factors in PPS patients (Forward Stepwise). Abbreviations: PPS, prostate-pelvic syndrome; PS, pain symptoms; CI, confidence intervals. Notes: Regression equation, β = -0.895, SE = 0.094, Wald = 90.343, P = 0.000, OR = 0.409; R2 = 0.247; Hosmer and Lemeshow Test: χ2 = 8.156, P = 0.418

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Analysis of detection rate and related indicators of PV ≥ 20 mL in adult PPS patients below 40 years old

The detection rate of PV ≥ 20 mL in adult PPS patients below 40 years old was 13.9% (76/548). The detection rate of PV ≥ 20 mL in the PPS group varied and increased with age (trend χ2 = 18.396, P = 0.000). The proportion of VS, junior high school or below education level, and prostate calcification patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group (P < 0.05), while the proportion of PS patients was lower than that in the PV < 20 mL group (P < 0.05). Age in the PV ≥ 20 mL group was larger than that in the PV < 20 mL group, and the disease duration was longer than that in the PV < 20 mL group (P < 0.05), as shown in Table 5. Multivariate logistic regression analysis showed that PV ≥ 20 mL and disease duration were the related factors of VS in adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL (Fig. 5).

Table 5 Comparison of age, disease duration, ejaculation frequency of PPS patients and the proportion of PPS patients under different indicators in the PV < 20 mL and PV ≥ 20 mL groups [M (Q3-Q1) or N (%)]
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Fig. 5
figure 5

Multivariate logistic regression analysis of VS-related factors including PV ≥ 20 ml in PPS patients (Forward Stepwise). Abbreviations: PPS, prostate-pelvic syndrome; VS, voiding symptoms; CI, confidence intervals

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Discussion

The relationship between type-III prostatitis and PPS in adult males below 40 years old

Type-III prostatitis is the most common prostate disease in adult males below 40 years old. It is clinically characterized by chronic lower urinary tract and/or pelvic pain symptoms, with or without sexual dysfunction, mental symptoms, etc. [16, 17]. In this study, 548 patients with type-III prostatitis having completed routine urine and the results of urological and prostate ultrasound examinations were enrolled, while patients with urinary tract infections and non-prostate related chronic lower urinary tract and/or pelvic pain symptoms were excluded. According to the diagnostic criteria of PPS, this study showed that 548 adult type-III prostatitis patients below 40 years old fully met the diagnosis of PPS, including 229 VS patients, 159 PS patients, and 160 VS + PS patients. Therefore, logically, it could be assumed that type-III prostatitis in adult males below 40 years old could be replaced by PPS.

Studies on PV in adult patients with type-III prostatitis or PPS below 40 years old

So far, studies on normal PV in adult males below 40 years old have mainly been conducted through autopsy and medical imaging. In a study of 67 male autopsies, it was found that the average PV of prostate samples under 18 years old was 13.75 mL, and the average PV of prostate samples aged 19–45 years old was 24.44 mL [8]. In another study, Xia et al. [18] conducted autopsies on 111 males aged 20–29 and 84 males aged 30–39, and the results showed an average PV of about 20 mL, with a prostate specific gravity close to 1. Some researchers have also found that in the absence of prostate disease, the PV measured by magnetic resonance imaging in 539 male volunteers aged 16–20 and 420 male volunteers aged 21–25 were 8.32 (0.983–16.762) mL and 11.56 (1.620–20.584) mL, respectively [19]. Recently, Zhang et al. [10] reported that the PV measured by ultrasound examination in 1851 male physical examinees aged 18–39 was 14.33 (12.36–16.76) mL. This suggests that normal PV in adult males below 40 years old is approximately 20 mL, with the vast majority being less than 20 mL.

There were few studies on PV in adult patients below 40 years old with type-III prostatitis or prostate-related symptoms. In a comparative study of type-III prostatitis in adolescents and young adults, it was found that the average PV measured by transrectal ultrasound in 120 outpatients with type-III prostatitis aged 20–39 was (21.0 ± 4.9) mL, ranging from 12.0 to 33.0 mL [20]. In another study, researchers examined prostates of 44 patients with type-III prostatitis at an average age of 41 using magnetic resonance imaging. They found that 6 patients had PV > 35 mL and one 38-year-old type-III prostatitis patient had LUTS and sexual dysfunction [21]. Kim et al. [22] examined prostates of 968 patients aged 21–88 with prostate-related symptoms using transrectal ultrasound and found that the average PV of 3 patients aged 20–30 and 8 patients aged 30–40 were (23.0 ± 6.1) mL and (22.8 ± 6.5) mL, respectively. In Our study, the maximum value of PV in 548 adult PPS patients below 40 years old was 37.96 mL, with 76 cases having PV > 20 mL. Our results indicated further demonstrated that the presence of PV > 20 mL in adult males under 40 years old was not an isolated case, which should be given clinical attention by scholars.

The relationship between PV and prostate-related LUTS in adult males

In clinical trial and community population studies, in addition to age, maximum urine flow rate, residual urine output after urination and serum prostate-specific antigen, there was also a certain correlation between PV and the risk of progression of moderate to severe prostate-related LUTS in adult males [23]. The studies on the relationship between PV and prostate-related LUTS in men aged 40 and above mainly focused on middle-aged and elderly males aged 50 and above, and LUTS in this age range was related to prostate obstruction caused by increased PV induced by BPH [24, 25]. Total PV was not significantly linearly related to the severity of prostate-related LUTS [26], and it could affect the effect of α1-receptor blockers alone in treating LUTS [27]. Currently, there are no reports on the relationship between PV and prostate-related LUTS in adult males under 40 years old. This study, for the first time, explored the relationship between PV and the main symptoms of PPS in adult males below 40 years old. Our results showed that in adult PV was positively correlated with VS, negatively correlated with PS, and not related to the four secondary symptoms for PPS patients below 40 years old. PV was independent related factors for VS that once PV increased one unit, the risk of VS in PPS patients increased by 14.0%. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group, while the proportion of PS patients was lower than that in the PV < 20 mL group. This may be related to the fact that the enlarged PV mainly affects the VS symptoms of adult PPS patients under 40 years old, but has little effect on PS symptoms. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL, which might be related to the benign prostatic obstruction caused by enlarged PV, and had a similar pathological anatomical mechanism to prostate obstruction symptoms caused by prostate enlargement in males aged 40 and above. However, the pathogenesis of benign PV enlargement in adult PPS patients below 40 years old may be different from that in males aged 40 and above. The former may be related to prostate congestion and edema caused by chronic inflammation in the prostate. It was reported that 71.4% of type-III prostatitis patients had congestion and dilation of the peripheral venous plexus around the prostate [21]. The latter is mainly caused by BPH, and when combined with chronic inflammation in the prostate, it may exacerbate the increase in PV. In addition, our results also found that PPS patients with PV ≥ 20 mL had a longer disease duration compared to those with PV < 20 mL and that the specific mechanisms were unclear. This may be related to the longer disease duration of chronic inflammation in the prostate. The more obvious local congestion and edema is found in the prostate, the risk of PV ≥ 20 mL in the prostate is higher.

The application value of PPS theory in adult males below 40 years old

The concept of PPS is an innovative theory summarized based on more than 20 years of clinical and basic study achievements in type-III prostatitis defined by the NIH classification method in China. PPS removes LUTPL and invasive EPS tests that have little clinical significance, further simplifying and optimizing the diagnostic process of type-III prostatitis and providing personalized comprehensive treatment based on clinical symptoms. The results of this study indicated that PPS could diagnose type-III prostatitis in adult males below 40 years old, which was not only suitable for clinical application but also for clinical study, which had high theoretical and practical use value. In the future, we will conduct a multi-center, bigger population prospective clinical controlled study and follow-up work on the diagnosis and treatment of type-III prostatitis in adult males below 40 years old using PPS theory and the criteria for type-III prostatitis, to further validate the advantages of PPS theory in clinical efficacy and to draw safer conclusions. Logically speaking, combined with serum prostate-specific antigen testing, the PPS theory could also be generalized to older type-III prostatitis patients without BPH and prostate tumors.

Limitations of the study

The limitations of this study must be mentioned. Firstly, the clinical application of PPS theory is currently only in China, and there is a lack of international literature reporting on PPS theory, which has not yet been internationally recognized. However, we are actively promoting the dissemination of PPS theory. Secondly, the sample size of patients with type-III prostatitis in adult males below 40 years old in a single clinical center was relatively small, and the interpretation of the results needed to be cautious. Further validation of this result will be needed in future prospective studies with multiple centers and larger sample sizes. Thirdly, as this was a retrospective study lacking longitudinal data, there was no comparison of the clinical efficacy between PPS criteria and NIH criteria in diagnosing and treating patients with type-III prostatitis, and our next step is to use these two criteria for conducting a prospective controlled study. Furthermore, the prostate TAUS examinations used to calculate PV were not performed by the same ultrasound doctor and ultrasound equipment, so there must be some operational errors. However, experienced and skilled ultrasound doctors will try to minimize such deviations. Despite these limitations, this study using PPS theory has diagnostic process strengths in diagnosing prostate diseases in young men.

Conclusion

The present study demonstrated that type III prostatitis in Chinese adult males below 40 years old could be diagnosed with PPS theory, and PV and disease duration were two independent related factors for VS in adult PPS patients below 40 years old. Our results also showed for the first time that the PPS theory optimized and simplified the diagnosis protocol for type-III prostatitis in adult males below 40 years old, which was suitable for clinical promotion and application.

Data availability

All data generated or analyzed during this study are available from the first author on reasonable request.

Abbreviations

PPS:

Prostate-pelvic syndrome

PV:

Prostate volume

VS:

Voiding symptoms

PS:

Pain symptoms

NIH:

National Institutes of Health

EPS:

Expressed prostatic secretion

LUTPL:

Lower urinary tract pathogen localization

BPH:

Benign prostatic hyperplasia

LUTS:

Lower urinary tract symptoms

TAUS:

Transabdominal ultrasound

OR:

Odds ratio

CI:

Confidence intervals

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Acknowledgements

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Funding

This study was supported by the project of the Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation Foundation (No. 2022APKLGUD02), Anhui Medical University Funded Project (2023xkj132), and the National Natural Science Foundation of China (82100815). The funding agencies had no direct impact on the design of the study and collection, analysis and interpretation of the data and the preparation or approval of the manuscript.

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Author notes

  1. Cheng Yang, He-Xi Du and Chao-Zhao Liang contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, 230022, China

    Xiao-Ma Zhang, Wei-Yi Li, Zong-Yao Hao, Cheng Yang, He-Xi Du & Chao-Zhao Liang

  2. Department of Urology, Anhui Public Health Clinical Center, Hefei, 230012, China

    Xiao-Ma Zhang & Lei Zhou

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Contributions

ZXM and LCZ conceived and designed the study. LCZ was responsible for the implementation and feasibility analysis of the research, the support of research funds, the quality control and revision of the manuscript. ZXM, DHX and ZL collected and analyzed clinical data and drafted the manuscript. LCZ and HZY designed the study and participated in the revision of the manuscript. YC, DHX and LWY assisted in detailed statistical analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Cheng Yang, He-Xi Du or Chao-Zhao Liang.

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Ethics approval and consent to participate

The study was in accordance with the Helsinki Declaration as revised in 2013. The ethics committee of the North District of the First Affiliated Hospital of Anhui Medical University (Anhui Public Health Clinical Center) approved the study (No: PJ-YX2023-043F1) and waived the informed consent for this retrospective analysis.

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Zhang, XM., Li, WY., Hao, ZY. et al. The “prostate-pelvic syndrome” theory used in patients with type-III prostatitis and its correlation with prostate volume. BMC Urol 25, 9 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12894-025-01689-8

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BMC Urology

ISSN: 1471-2490

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