The Association Between Asymptomatic Inflammatory Prostatitis (Category IV) and Premature Ejaculation: A Histopathology-Based Clinical Study

This study aimed to evaluate the relationship between histopathologically confirmed asymptomatic inflammatory prostatitis, also known as National Institutes of Health (NIH) category IV prostatitis, and premature ejaculation (PE) in men undergoing transurethral resection of the prostate (TUR-P). A retrospective analysis was performed on 84 of 218 patients who underwent TUR-P for benign prostatic obstruction. Prostate tissue inflammation was graded according to severity, extent, and anatomical localization. The NIH–Chronic Prostatitis Symptom Index (NIH-CPSI) and Premature Ejaculation Diagnostic Tool (PEDT) questionnaires were reviewed, and patients with symptomatic prostatitis were excluded. PE was classified based on PEDT scores, and intravaginal ejaculatory latency time (IELT) data were analyzed. Definite or probable PE was detected in 46.4% of patients. Higher inflammatory grade, stromal localization, and diffuse inflammation were significantly associated with higher PEDT scores ( p = 0.006, p = 0.022, p = 0.012, respectively). IELT was inversely correlated with PEDT (ρ = −0.46, p < 0.001) and was shorter in patients with extensive or stromal inflammation. These findings indicate that asymptomatic (NIH category IV) prostatitis is significantly associated with PE-related parameters in men undergoing TUR-P. Subclinical prostatic inflammation, particularly of stromal and extensive types, may contribute to impaired ejaculatory control and reduced latency, acting as a facilitating rather than a primary factor in the pathogenesis of PE.