Prostatitis--clinical and bacterial studies.

Forty men with clinical prostatitis were studied to determine the value of symptomatology and categorization and 30 (75%) were classified as having prostatitis on the basis of prostatic localization studies. Of these 3 (10%) had chronic bacterial prostatitis, 18 (60%) had chronic abacterial prostatitis, and 9 (30%) had prostatodynia. No patient had acute bacterial prostatitis. Although Enterobacteriaciae were isolated from the 3 men with chronic bacterial prostatitis, these bacteria along with Staphlococcus aureus, Streptococcus faecalis, and Chlamydia trachomatis were isolated from a further 6 patients. The mean pH of the expressed prostatic secretion was measured for each group and was found to be 7.6 for those with chronic bacterial prostatitis, 7.1 for chronic abacterial prostatitis, 6.5 for prostatodynia, and 6.9 for those with urethritis suggesting that this test may be of value in the diagnosis of chronic bacterial prostatitis.     

The treatment of prostatitis

PURPOSE: Prostatitis are frequently recognized in general practice and often are a diagnosis and therapeutic challenge. We review here the updated knowledge on diagnosis and therapy of prostatitis. CURRENT KNOWLEDGE AND KEY POINTS: Prostatitis are divided into acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic prostatitis/ chronic pelvic pain syndrome (III) and asymptomatic inflammatory prostatitis. Chronic prostatitis/ chronic pelvic pain syndrome are divided into : inflammatory (IIIA) and noninflammatory (IIIB). Treatment of prostatitis should follow evidence based guidelines recently published. Acute prostatitis should be treated by ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or cotrimoxazole 960 mg bid for 4 weeks (CIII). When bacteremia occurs third generation cephalosporin with gentamicin should be used (CIII). In chronic bacterial prostatitis ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or norfloxacine 400 mg bid or cotrimoxazole 960 mg bid for 4 weeks may be used (BIII). FUTURE PROSPECTS AND PROJECTS: Molecular techniques should improve the etiological diagnosis of prostatitis and their treatment.     

Managing prostatitis in the elderly

Bacterial prostatitis is primarily a disease of elderly men, and it is the most common urinary tract infection seen in this age group. Urosepsis from prostatitis or prostatic abscess occurs less frequently than with urological manipulation, but must always be considered in elderly men with prostatitis. This article focuses on the diagnosis and antibiotic treatment of bacterial prostatitis in the elderly.     

Treatment of prostatitis with antiinflammatory agents and α-blockers

Prostatitis is the most common urologie diagnosis made in men younger than 50 years of age. The prevalence of prostatitis has been reported to be 11 % to 16% for the general population. Chronic prostatitis is the most common form of prostatitis, accounting for more than 90% of the cases. The pathophysiology of chronic prostatitis is unknown. Nonsteroidal anti-inflammatory agents, α-blockers, and antibiotics appear to be beneficial in treating patients with chronic prostatitis, but may not produce spectacular cure rates. Patients with prostatitis experience considerable morbidity in terms of quality of life and may remain symptomatic for many years.     

The management of chronic prostatitis in men with HIV

Prostatitis is a common urologic diagnosis. Although treatment algorithms are available for this poorly understood entity, several adaptations must be made in order to accommodate the therapeutic needs of HIV-positive patients. The most important consideration when treating HIV-infected patients for prostatitis is their current immune status, whether they are immunocompromised or not (non-progressive disease or reconstituted with highly active antiretroviral therapy). A treatment algorithm for those with chronic bacterial prostatitis (Category II), chronic nonbacterial prostatitis (Category IIIA), and prostatodynia (Category IIIB) is presented in this article. In the HIV-positive patient population, there is a greater likelihood for atypical pathogens including fungi, tuberculosis, anaerobes, and viruses. Because the HIV-infected patient is at increased risk for the development of prostatic abscess and urosepsis than the general population, increased monitoring and evaluation and longer-term appropriately directed antimicrobial therapy are required.     

Prostatitis and male factor infertility: A review of the literature

Prostatitis is the most common urologic diagnosis in men under the age of 50 years. Given the prostate’s intimate association with male reproductive function, prostatitis has long been suspected of playing a role in male subfertility. Strong evidence for a direct impact of prostatitis on male fertility is lacking. This article presents a brief overview of the disease entities known collectively as prostatitis and a review of the current literature on the association between prostatitis and seminal fluid variables, sperm morphology and function, seminal reactive oxygen species, antisperm antibodies, and their impact on male fertility.     

Prostatitis revisited: new definitions,new approaches

Prostatitis syndromes represent an important health care problem resulting in considerable morbidity and expenditure of health care resources. Comparison of the traditional and consensus classification schemes demonstrates no changes in the traditional categories of acute bacterial prostatitis and chronic bacterial prostatitis. Examining only the EPS, however, results in diagnosis of half of the patients with inflammatory CP/CPPS. An optimal diagnostic strategy required evaluation of the VB3 and SFA in addition to the traditional EPS examination. Such precision is necessary for research studies, but whether such precision is important clinically remains unproved. The new interest in optimal evaluation and characterization of patients with chronic prostatitis and related conditions has resulted in important research initiatives examining the etiology and optimal treatment for this large group of patients.     

EPS中性粒细胞弹性蛋白酶测定在慢性前列腺炎诊断治疗中的意义

目的探讨慢性前列腺炎患者前列腺液（EPS）中中性粒细胞弹性蛋白酶（NE）浓度检测在慢性前列腺炎诊断治疗中的意义。方法对70例慢性前列腺炎患者（观察组）及70例正常对照（对照组）EPS行NE浓度测定、前列腺液常规检查、细菌培养及NIH前列腺炎症状评分（CPSI）。观察组患者治疗4周后,再次进行NE测定、WBC计数、CPSI。结果观察组患者EPS中NE浓度、WBC计数、CPSI间两两比较均呈正相关。NE浓度、CPSI、WBC计数组间比较,P均〈0．05。观察组患者治疗前后NE水平、WBC计数、CPSI比较,P〈0．05。结论测定EPS中NE浓度对慢性前列腺炎的诊断和治疗有一定的指导作用。     

Prostatitis: Updates on diagnostic evaluation

Prostatitis accounts for almost two million of.ce visits to urologists and primary care physicians. The label "prostatitis" refers to a diverse constellation of symptoms and disease processes. The diagnosis and treatment of this disorder presents numerous challenges for the physician, including a lack of abnormal .ndings on physical examination, laboratory tests, and radiographic images. In this article, we offer a review of the current literature and recommendations for the evaluation and diagnosis of the patient presenting with prostatitis.     

Persistent urethritis and prostatitis due to Trichomonas vaginalis: A case report

The present report describes a case of persistent urethritis accompanied by prostatitis due to Trichomonas vaginalis in a young male patient. The importance of the laboratory diagnosis of trichomoniasis in persistent or recurrent urethritis (ie, testing samples from multiple sites) is highlighted, with the aim of improving the clinical recognition of this pathogen.     

The new age of prostatitis

Prostatitis has long been a poorly understood and poorly characterized entity. Characterized in 1980 as a "wastebasket of clinical ignorance," it has only recently begun to be studied effectively. Prostatitis represents over 2 million medical office visits per year in the United States, and is the diagnosis given to 8% of urology clinic patients. Its prevalence may be as high as 10% among the male population at large. Sufferers report a sickness impact of prostatitis that is similar to myocardial infarction or Crohn’s disease. Less than 10% of cases of prostatitis are easily demonstrable to have a bacterial cause; these respond to conventional antimicrobial treatment. The etiology, pathogenesis, and optimum treatment for the remaining 90% of sufferers of this disease complex are quite unclear. Application of clinical research techniques and molecular biology promise new insight into this challenging and difficult problem.     

Persistent urethritis and prostatitis due to Trichomonas vaginalis: A case report

The present report describes a case of persistent urethritis accompanied by prostatitis due to Trichomonas vaginalis in a young male patient. The importance of the laboratory diagnosis of trichomoniasis in persistent or recurrent urethritis (ie, testing samples from multiple sites) is highlighted, with the aim of improving the clinical recognition of this pathogen.     

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

Background  

There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).     

Prostatic abscess of Klebsiella pneumoniae complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.     

Akanthozyten und Proteinurie bei einem 47-jährigen Mann

We report the case of a 47-year old male patient who presented in our nephrological outpatient unit with acute prostatitis with increased serum creatinine levels and macrohematuria following repeated successful antibiotic treatments for prostatitis. The patient was able-bodied and capable of reporting that he had taken no medication other than the antibiotic medication prescribed. Initial findings of classic nephritic sediment, significant proteinuria and the onset of acute kidney failure lead to the suspicion of nephritic syndrome, which was not confirmed by an otherwise inconclusive biopsy. A diagnosis was reached only after bone marrow biopsy and later findings from the renal biopsy: isolated vascular light chain nephropathy and marginal zone B-cell lymphoma with plasma cell differentiation, the causes of which remain unclear. Following initial steroid and antibiotic treatment the patient received further oncological treatment according to the R-CHOP protocol.     

Prostatitis: Epidemiology of inflammation

Approximately 8 million prostatitis-related outpatient visits per year have been reported worldwide. Only a small percentage presents with bacterial prostatitis. Chronic pelvic pain syndrome/prostatodynia is a frustrating disease for patients and caregivers. This paper is an attempt to analyze causes and types of inflammation and to determine if inflammation may have an impact on treatment and outcome. Is inflammation even a relevant factor in the diagnosis of chronic pelvic pain syndrome? Do we need to begin to look for different factors involved in the development of this often crippling disease?     

Economic impact of chronic prostatitis

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.     

Acute and chronic prostatitis: diagnosis and treatment

Several distinct types of prostatitis, or prostatitis syndromes, are now recognized. The most common types include acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. Bacterial prostatitis, caused mainly by enterobacteria, is often difficult to cure, and chronic bacterial prostatitis is a common cause of relapsing recurrent urinary tract infection in men. Nonbacterial prostatitis, the most common syndrome, is an inflammation of the prostate of unknown cause. Patients with prostatodynia typically have sterile cultures and normal prostatic secretions but demonstrate an acquired voiding dysfunction on video-urodynamic testing. Since nonbacterial types of prostatitis have no recognized infectious cause, treatment using antimicrobial agents is ineffective and unwarranted.     

Prostatitis syndromes: an update for urologic practice

OBJECTIVE: Five learning points will review and interpret the advances in the field of prostatitis that have occurred over the last decade. LEARNING POINT #1: The clinical syndrome of prostatitis and related conditions is one of the most common clinical encounters in urology. LEARNING POINT #2: The etiology/pathogenesis of the chronic prostatitis syndromes appears to be an inter-related, multifactorial cascade beginning with an initiating event and culminating with a chronic neuropathic state. LEARNING POINT #3: The NIH classification of the chronic prostatitis syndromes is appropriate for not only research studies but also routine clinical practice. LEARNING POINT #4: A careful evaluation of the lower urinary tract and a standardized assessment of symptoms is essential in the management of prostatitis patients. LEARNING POINT #5: A "best evidence-based" approach to the treatment of the prostatitis syndromes is possible.