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.     

Treatment response to conventional and novel therapies in chronic prostatitis

Chronic prostatitis is a common and poorly understood condition that significantly impacts quality of life. Conventional therapy usually consists of prolonged courses of antibiotics; however, the efficacy of this approach is defined better by clearance of bacteria than by improvement in symptoms. Newer therapies with some evidence for efficacy include α blockers, anti-inflammatory drugs, phytotherapy (quercetin, bee pollen), physiotherapy, neuroleptics, and others with unique actions (finasteride, pentosan polysulfate). The National Institutes of Health Chronic Prostatitis Symptom Index is a validated symptom score that, in preliminary use, appears to be responsive to patient improvement. As more well-designed clinical trials in chronic prostatitis and chronic pelvic pain syndrome come to completion, physicians will be able to make rational treatment choices for patients with this common and frustrating condition.     

The treatment of chronic bacterial prostatitis

Chronic bacterial prostatitis, the most common cause of recurrent urinary tract infections in the male patient, is a clinical entity accurately defined by two essential features: (1) recurrent urinary tract infections and (2) persistence of gram-negative bacteria in the prostatic secretion. Chronic bacterial prostatitis is mainly a bacteriologic diagnosis and, therefore, sequential bacteriologic localization cultures are the only way to correct diagnosis. Thirty-five of 39 patients (90%) with chronic bacterial prostatitis were cured of their disease either by a short-term (14- day) intramuscular kanamycin treatment or a long-term (average of five months) oral co-trimoxazole, pure trimethoprim or ciprofloxacin treatment; selected patients suffering from chronic bacterial prostatitis with an associated pathology such as benign enlargement of the prostate, associated occasionally with infected prostatic calculi, who did not respond to medical therapy alone, were cured by a combined adequate antibacterial and surgical (a modified retropubic prostatectomy) treatment. All the patients were followed up for at least one year and most patients several years following treatment.Die chronische bakterielle Prostatitis ist die häufigste Ursache rezidivierender Harnwegsinfektionen bei männlichen Patienten. Das klinische Bild wird im wesentlichen durch zwei Charakteristika geprägt: 1. rezidivierende Harnwegsinfektionen, 2. Persistenz gramnegativer Bakterien im Prostatasekret. Die Diagnose chronische bakterielle Prostatitis beruht im wesentlichen auf bakteriologischen Untersuchungen, und kann folglich nur durch sequentiell entnommene Kulturen, die eine Lokalisation zulassen, gestellt werden. Von 39 Patienten mit chronischer bakterieller Prostatitis wurden 35 (90%) durch antimikrobielle Therapie geheilt. Verabreicht wurde entweder eine Kurzzeit (14-Tage-)Therapie mit Kanamycin i. m. oder eine Langzeit (durchschnittlich 5-Monate-)Therapie mit oralem Cotrimoxazol, Trimethoprim allein oder mit Ciprofloxacin. Einzelne Patienten, die neben der chronischen bakteriellen Prostatitis andere Veränderungen wie eine benigne Prostatahypertrophie aufwiesen und gelegentlich auch infizierte Prostatasteine hatten und auf die medikamentöse Therapie allein nicht ansprachen, wurden durch kombiniertes Vorgehen mit adäquater antibakterieller und chirurgischer Therapie geheilt. Dabei wurde eine modifizierte Methode zur retropubischen Prostatektomie eingesetzt. Alle Patienten wurden mindestens ein Jahr, einige mehrere Jahre lang nachbeobachtet.     

Rat model of experimental bacterial prostatitis

A reproducible rat model of chronic bacterial prostatitis was developed employing a defined bacterial pathogen to study the pathophysiology of acute and chronic bacterial prostatitis. The progression of inflammation and its consequences following the retrograde introduction of bacteria through the acute and finally the chronic stages of prostatitis can be documented with microbiological, histological, ultrastructural and immunologic data. This model has many striking similarities to the natural history of human chronic bacterial prostatitis and further microbiological, antimicrobial and immune modulation or manipulation of this model should help us to further delineate the pathogenic mechanisms involved in this chronic infective disease.Zum Studium der Pathophysiologie der akuten und chronischen bakteriellen Prostatitis wurde ein reproduzierbares Rattenmodell für die chronische bakterielle Prostatitis entwickelt, dabei wird ein definierter bakterieller Erreger verwendet. Das Fortschreiten der Entzündung und ihrer Folgeerscheinungen nach retrogradem Einführen der Bakterien über die akuten und schließlich die chronischen Stadien der Prostatitis kann mit mikrobiologischen, histologischen, ultrastrukturellen und immunologischen Daten dokumentiert werden. Dieses Modell hat bemerkenswerte Ähnlichkeiten mit dem natürlichen Verlauf der chronischen bakteriellen Prostatitis beim Menschen; weitere mikrobiologische, antimikrobielle und immunmodulierende oder anderweitige Veränderungen dieses Modells dürften dazu beitragen, daß die Pathomechanismen dieser chronischen Infektionskrankheit weiter abgeklärt werden können.     

Review of modern trends in the treatment of chronic bacterial prostatitis (C. B. P.)

Careful, lower urinary tract localization studies have to be used to classify patients in the chronic bacterial prostatitis group and others. Considerable progress has been made in understanding the pathophysiology and developing rational approaches for treatment of patients with chronic bacterial prostatitis. Ciprofloxacin is a new quinolone carboxylic acid derivate with marked activity against both gram-negative and gram-positive bacteria. A critical analysis of the most recent achievements in the area of chronic bacterial prostatitis is presented.Die Abgrenzung der chronischen bakteriellen Prostatitis gegenüber anderen Krankheiten erfolgt durch sorgfältige Untersuchungen zur Lokalisation der Infektion in den unteren Harnwegen. In der Aufklärung der Pathophysiologie der chronischen bakteriellen Prostatitis und Entwicklung rationaler Therapien wurden erhebliche Fortschritte gemacht. Ciprofloxacin ist ein neues Carboxylsäure-Chinolon das hohe Aktivität gegen gramnegative wie grampositive Bakterien besitzt. Die neuesten Errungenschaften auf dem Gebiet der chronischen bakteriellen Prostatitis werden einer kritischen Analyse unterzogen.     

Assessment of the UTI criteria for bacterial prostatitis in japan

A clinical study of a new oral fluoroquinolone was conducted in bacterial prostatitis for the assessment of the UTI criteria in Japan. It is concluded that evaluation of efficacy is possible after seven-day administration in acute bacterial prostatitis (ABP), and after 14-day administration in chronic bacterial prostatitis (CBP). In ABP, the cure evaluation can be done 14 days after the treatment period. Further studies on the pathogenicity of coagulase-negativeStaphylococcus were found to be necessary. When isolates from expressed prostatic secretion (EPS) are employed before administration, isolation from VB₃ should not be used for evaluation of efficacy.In einer klinischen Studie zur bakteriellen Prostatitis mit einem neuen Fluorochinolon wurden die japanischen Kriterien zur Therapie von Harnwegsinfektionen überprüft. Als Schlußfolgerung ergab sich, daß die Wirksamkeit bei der akuten bakteriellen Prostatitis (ABP) nach sieben-tägiger und bei der chronisch bakteriellen Prostatitis (CBP) nach 14-tägiger Therapie bestimmt werden kann. Bei der ABP kann die Heilung 14 Tage nach Therapieabschluß beurteilt werden. Weitere Studien sind zur Pathogenität der koagulase-negative Staphylokokken erforderlich. Falls vor Therapiebeginn Isolate aus dem Prostatasekret herangezogen wurden, sollten zur Wirksamkeitspüfung keine Isolate aus dem Exprimaturin verwendet werden.     

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.     

Prostatitis. Work-up and treatment of men with telltale symptoms

Prostatitis describes a spectrum of disorders involving inflammation of the prostate gland. This common yet poorly understood condition produces an array of symptoms, the most common of which are urinary obstruction, perineal pain, and ejaculatory complications. Although several theories have been proposed regarding its etiology, the exact mechanism of disease remains elusive. Definitive diagnosis can be hampered by a somewhat cumbersome testing procedure, but symptomology tends to be a reliable guide for treatment. Although treatment with antibiotics often fails, the fluoroquinolones are among the most effective agents for symptom management. Other interventions that may be appropriate include alpha-1-adrenergic blockers, a 5-alpha reductase inhibitor, or surgery. Chronic prostatitis may result in repeated urinary tract infections and chronic pain syndromes.     

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.     

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.     

Prostatitis: Updates on diagnostic evaluation

Prostatitis accounts for almost 2 million office 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 present numerous challenges for the physician, including a lack of abnormal findings 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.     

Self-reported history of sexually transmitted infection and chronic prostatitis symptoms: a cross-sectional study of a Nigerian undergraduate population

The aetiology of chronic prostatitis is poorly understood. A cross-sectional study of a population of male undergraduates in Nigeria, using a questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and some other relevant sex-related questions, was conducted. A total of 14.9% of the population had chronic prostatitis symptoms (CPSs) defined as a pain score of four or more on the NIH-CPSI pain subscale. Approximately 26 or 12% of the population had at least one, or ≥ 2 location(s) of pain, respectively. The presence of CPS was found to correlate with a self-reported history of sexually transmitted infection (STI) (r = +0.237; P < 0.05) and 73% of those with a self-reported history of STI had CPS. Both voiding scores and quality-of-life scores were significantly higher in subjects with CPS, compared with those without CPS. Self-reported history of STI may be an important aetiological factor for chronic prostatitis/chronic pelvic pain symptoms.     

Quality of life is impaired in men with chronic prostatitis

OBJECTIVE: Health-related quality of life (HRQOL) impairment may be a central component of chronic prostatitis for men afflicted with this condition. Our objective was to examine HRQOL, and factors associated with HRQOL, using both general and condition-specific instruments. DESIGN: Chronic Prostatitis Cohort (CPC) study. SETTING: Six clinical research centers across the United States and Canada. PARTICIPANTS: Two hundred seventy-eight men with chronic prostatitis. MEASUREMENTS AND MAIN RESULTS: The Short Form 12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) were measures used. CPC subjects' MCS scores (44.0 +/- 9.8) were lower than those observed in the most severe subgroups of patients with congestive heart failure and diabetes mellitus, and PCS scores (46.4+/-9.5) were worse than those among the general U.S. male population. Decreasing scores were seen in both domains with worsening symptom severity (P < .01). History of psychiatric disease and younger age were strongly associated with worse MCS scores, whereas history of rheumatologic disease was associated with worse PCS scores. Predictors of more severe NIH-CPSI scores included lower educational level and lower income; history of rheumatic disease was associated with higher scores. CONCLUSIONS: Men with chronic prostatitis experience impairment in the mental and physical domains of general HRQOL, as well as condition-specific HRQOL. To optimize the care of men with this condition, clinicians should consider administering HRQOL instruments to their patients to better understand the impact of the condition on patients' lives.     

The DABBEC phenotyping system: towards a mechanistic understanding of CP/CPPS

There is an urgent need to elucidate the mechanistic basis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), as the current methods of symptom-based diagnosis and treatment have failed. Here, we propose a phenotyping system that bridges the gap between the symptom-based diagnosis and treatment of the present and the mechanistic approach of the future. Our phenotyping system uses the Chronic Prostatitis Collaborative Research Network (CPCRN)-recommended algorithm in combination with the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) as a basis for diagnosis, while incorporating novel domains for quantitative assessment and stratification of CP/CPPS patients. We believe this novel system will serve to help advance our understanding of the roles of the patient's genome and proteome in the etiology of CP/CPPS. We predict that, as we begin to understand the mechanistic basis of CP/CPPS pathology and progression, we will develop specific treatments that will aim to cure the disease, rather than merely quell the symptoms.     

Do antibody-coated bacteria prove bacterial prostatitis?

Using the immunofluorescence technique in 187 patients with bacteriologically proven prostatitis according to the Meares-Stamey test demonstrated a significant amount of antibody-coated bacteria (ACB) in their ejaculates. The ACB test was useful to discriminate between chronic bacterial prostatitis and prostatodynia with a sensitivity of 65% and a specifity of 92%; likewise the ACB test is superior to complement and coeruloplasmin estimation in the ejaculate by radial immunodiffusion usually recommended for the differential diagnosis of inflammatory and psychosomatic diseases of the prostate.Bei 187 Patienten mit der Verdachtsdiagnose einer Prostatitis wurde der immunofluoreszenzmikroskopische Nachweis von Antikörpern auf Bakterien im Ejakulat, der sogenannte Antibody-Coated-Bacteria (ABC)-Test verglichen mit den Ergebnissen der 4-Gläser-Probe nachMeares undStamey. Der ABC-Test konnte mit einer Sensitivität von 65% und einer Spezifität von 92% zwischen einer chronisch bakteriellen Prostatitis und einer Prostatodynie unterscheiden. Der Nachweis von Komplement und Coeruloplasmin im Ejakulat mit Hilfe der radialen Immundiffusion eignet sich dagegen weniger zur Differentialdiagnostik einer erregerbedingten Prostatitis und einer psychosomatischen Erkrankung der Prostata.     

Category III chronic prostatitis/chronic pelvic pain syndrome: Insights from the National Institutes of Health Chronic Prostatitis Collaborative Research Network studies

Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.     

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.     

Prostatitis and male factor infertility: A review of the literature

Prostatitis and male infertility are frequent disorders, and the role of prostatitis in male infertility has been under discussion for more than 30 years. Many researchers have shown relevant links between the two. Although a causal relationship has not been definitely demonstrated, increasing evidence shows that chronic prostatitis has a relevant negative impact on male fertility potential, at least in certain subgroups. In the following review, we focus on the present state of knowledge on the role of chronic prostatitis as an etiologic factor in male infertility.     

Advanced therapy for prostatitis: Minimally invasive and invasive therapies

The clinical syndromes of chronic prostatitis range from well-defined chronic bacterial infections to poorly defined chronic pelvic pain syndrome, previously referred to as prostatodynia and abacterial prostatitis. Faced by the obscure nature of the disease, its protracted course, and the poor response to oral medication, urologists have considered alternative treatment options. This article reviews the indications and outcomes of minimally invasive and invasive therapies for chronic prostatitis syndromes and discusses their potential use and benefits.     

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.