[Application of simplified urine-semen-urine testing method as a screening tool for chronic prostatitis]

Objective To evaluate the clinical utility of the simplified urine-semen-urine (USU) test as a preliminary screening tool for stratified assessment and treatment of chronic prostatitis. Methods A retrospective cohort of 114 men between January 2021 and December 2024 who met NIH diagnostic criteria and had not received recent antibiotics were enrolled in this study. In a paired subset of 16 patients who underwent both USU and Meares-Stamey four-glass testing, diagnostic agreement was assessed using the agreement rate and Cohen's Kappa. Patients were classified by USU into bacterial (Type Ⅱ), inflammatory (Type ⅢA), and non-inflammatory (Type ⅢB) groups and received stratified management (Type Ⅱ: targeted antibiotics; Type ⅢA: empirical antibiotics plus symptomatic care; Type ⅢB: lifestyle modification and symptomatic care). Finally, the improvement rate of NIH-CPSI score and the bacterial clearance rate 56 days after treatment were taken as the primary endpoints to evaluate the predictive value of clinical outcome based on the USU classification. Results The detection rate of Type Ⅱ disease in the USU group was 28.9%. Paired analysis showed that the consistency rate of the two methods was 87.5% (95%CI： 71.3%－100.0%), and the Kappa coefficient was 0.74, suggesting a high degree of consistency. All the inconsistent cases were single positive for USU. The success rate of type Ⅱ patients was the highest at 56 days of treatment (69.7%), and the bacterial clearance rate reached 84.8%. Linear mixed effects modeling showed the fastest symptom improvement in Type Ⅱ, and Ridge logistic regression identified USU classification as an independent predictor of treatment success (Type Ⅱ OR=2.94). Conclusion The USU test method is helpful in identifying the population that benefits from antibiotic treatment in real-world conditions (Type Ⅱ), and can avoid excessive treatment for Type ⅢB patients. As a preliminary screening tool for chronic prostatitis, the USU test method has certain potential application value.