Fleroxacin (Ro 23-6240) distribution in canine prostatic tissue and fluids.

The distribution of fleroxacin (Ro 23-6240) in canine prostatic tissue and fluids was investigated under steady-state conditions during intravenous infusion. Mean ratios of fleroxacin concentration in tissue and fluids over concentration in plasma were 1.57 +/- 0.25 for prostatic tissue, 1.12 +/- 0.28 for prostatic secretion, and 0.93 +/- 0.14 for prostatic interstitial fluid. These levels and concentrations in urine were several times higher than the MIC for most pathogens that cause chronic bacterial prostatitis and urinary tract infection. The MICs for several isolates of Escherichia coli were only slightly affected by canine prostatic secretion, human prostatic tissue extract, and human urine. Clinical trials with fleroxacin appear justified for chronic bacterial prostatitis and urinary tract infection.     

The perplexing problem of prostatitis.

Prostatitis presents the physician with a perplexing problem. It is seen often but is not easily treated. The acute form is serious but responds to antibiotic therapy. Chronic prostatitis does not respond well to any form of therapy, and opinion is divided regarding its cause. Bacterial localization tests have helped significantly in the diagnosis of chronic prostatitis. When Gram-negative organisms are found only in the prostatic fluid or in the last voided urine, bacterial prostatitis can be diagnosed. Most antibiotics, however, do not cross prostatic epithelium to combine with prostatic fluid; those that do are not effective against Gram-negative organisms. New agents hold promise but lack the test of time. While some cases of chronic disease definitely are caused by bacterial infection, most probably are not. The diagnosis in these instances is abacterial prostatitis. Treatment is symptomatic and varied. A phenomenon that adds to the mystery of etiology is the fact that antibiotics, particularly tetracycline, may help. Psychotherapy often is needed but seldom is accepted. The physician must rule out underlying causes, such as a physical abnormality of the urinary system, for any form of prostatitis before considering it an isolated disorder.     

Antimicrobial treatment of prostatitis

The aim of this review is to emphasize the role of antimicrobial treatment in prostatitis. Especially in chronic bacterial prostatitis, the selection of an appropriate antimicrobial agent with optimal pharmacokinetics for prostatic secretion and tissue is important. The theoretical background of drug penetration into the prostate is outlined, emphasizing the phenomenon of ion-trapping and the role of nonionic diffusion of weak acids, bases and amphoteric drugs across biological membranes with a pH gradient. Determination of drug concentrations in human prostatic secretion are problematic because of possible urinary contamination. Studies have been carried out mainly in healthy volunteers. The results have to be interpreted with caution, if not care was taken to rule out or at least identify urinary contamination. Analyzing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, it becomes obvious that the fluoroquinolones differ not only in plasma concentrations but also in their penetration ability to these sites. In spite of intensive investigations, our knowledge is still limited concerning the mechanisms that govern the transport of antibiotic drugs into and their activity in the various prostatic compartments and how the findings can be applied clinically. Nevertheless, overall the concentrations at the site of infection of most of the fluoroquinolones with this indication should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis caused by susceptible pathogens.     

Antimicrobial treatment of prostatitis

The aim of this review is to emphasize the role of antimicrobial treatment in prostatitis. Especially in chronic bacterial prostatitis, the selection of an appropriate antimicrobial agent with optimal pharmacokinetics for prostatic secretion and tissue is important. The theoretical background of drug penetration into the prostate is outlined, emphasizing the phenomenon of ion-trapping and the role of nonionic diffusion of weak acids, bases and amphoteric drugs across biological membranes with a pH gradient. Determination of drug concentrations in human prostatic secretion are problematic because of possible urinary contamination. Studies have been carried out mainly in healthy volunteers. The results have to be interpreted with caution, if not care was taken to rule out or at least identify urinary contamination. Analyzing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, it becomes obvious that the fluoroquinolones differ not only in plasma concentrations but also in their penetration ability to these sites. In spite of intensive investigations, our knowledge is still limited concerning the mechanisms that govern the transport of antibiotic drugs into and their activity in the various prostatic compartments and how the findings can be applied clinically. Nevertheless, overall the concentrations at the site of infection of most of the fluoroquinolones with this indication should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis caused by susceptible pathogens.     

Treatment of prostatitis

The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection to chronic pain syndromes, in which the prostate gland is inflamed. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias, decreased libido or impotence, painful ejaculation and low-back and perineal pain. Physical examination often fails to clarify the cause of the pain. Cultures and microscopic examination of urine and prostatic secretions before and after prostatic massage may help differentiate prostatitis caused by infection from prostatitis with other causes. Because the rate of occult infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis. If the patient responds to therapy, antibiotics are continued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal anti-inflammatory drugs, alpha-blocking agents, anticholinergic agents or other therapies may provide symptomatic relief.     

Do Escherichia coli extract and cranberry exert preventive effects on chronic bacterial prostatitis? Pilot study using an animal model

Traditional first-line treatment of chronic bacterial prostatitis (CBP) is administration of empirical antibiotics. However, the efficacy rate is low and long-term antibiotic therapy can result in adverse events and bacterial resistance. For these reasons, a new treatment or preventive modality that can replace traditional antibiotic therapy is required. There are several reports that E. coli extract has a preventive effect on recurrent urinary tract infection (UTI). Cranberries are also known to have beneficial effects in preventing UTI. To evaluate the preventive effect of E. coli extract and cranberries on CBP, 48 rats were randomly divided into 4 groups; control, ciprofloxacin, E. coli extract, and cranberry groups. All drug treatments were conducted for 3 weeks, and then we developed a CBP rat model. After 4 weeks, the results of microbiological culture of prostate and urine samples as well as histological findings for the prostate were analyzed for each group. The infection rate in the ciprofloxacin group was significantly lower than that in the control group. The microbiological cultures of the prostate and urine samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathologic examination showed significantly decreased prostatic inflammation in all groups compared with the control group. These results suggest that E. coli extract has a potential preventive effect on the development of CBP, and cranberry also exhibits promising activity in this context.     

Preventive effect of ginsenoid on chronic bacterial prostatitis

Empirical antibiotic therapy is the preferred primary treatment modality for chronic bacterial prostatitis (CBP). However, this method of treatment has a low success rate and long-term therapy may result in complications and the appearance of resistant strains. Therefore a new alternative method for the prevention of CBP is necessary. There are several reports that ginsenoid has a preventive effect on urinary tract infection (UTI). To evaluate the preventive effect of ginsenoid on CBP compared to conventional antibiotics, we carried out an experiment in a rat model of the disease. Four groups of adult male Wistar rats were treated with the following medications: (1) control (no medication), (2) ciprofloxacin, (3) ginsenoid, and (4) ciprofloxacin/ginsenoid. All medications were given for 4 weeks, and then we created a CBP model in the animals by injecting an Escherichia coli Z17 (O2:K1;H^?) suspension into the prostatic urethra. After 4 weeks, results of microbiological cultures of prostate and urine samples, as well as histological findings of the prostate in each group were analyzed. The microbiological cultures of the prostate samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathological examination showed a significantly decreased rate of infiltration of inflammatory cells into prostatic tissue and decreased interstitial fibrosis in the ginsenoid group compared with the control group. Inhibition of prostate infection was greater in the group receiving both ginsenoid and antibiotic than in the single-medication groups. Although the findings of this study suggest a preventive effect of ginsenoid, preventive methods for CBP are still controversial.     

Rosamicin—a New Drug for the Treatment of Bacterial Prostatitis

Rosamicin, a new macrolide substance, was investigated in dogs and humans with regard to its usefulness for the treatment of bacterial prostatitis and compared with the well-known macrolide erythromycin. In dogs with normal and experimentally infected prostates, concentration ratios for rosamicin in prostatic secretion, interstitial fluid (obtained from implanted tissue chambers), and tissue were significantly higher than for erythromycin. The difference was even more pronounced in human prostatic tissue, obtained by transurethral resection. With its broad spectrum against many common urinary pathogens, rosamicin seems to be a promising drug for the treatment of acute and chronic bacterial prostatitis.     

Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis

We investigated the incidence and characteristics of acute bacterial prostatitis after transrectal prostate biopsy, based on urine and blood cultures, treatment method, and outcome. Four hundred and fifty-seven patients who underwent transrectal prostate biopsy in our hospital between November 2003 and October 2006 were reviewed. These patients were treated with 200 mg levofloxacin orally twice daily for 4 days, beginning 12 h before biopsy, and with 200 mg isepamicin sulfate given intravenously just before the biopsy. In patients who developed acute prostatitis urine and blood cultures were checked. All organisms isolated in urine or blood cultures were tested for antibiotic susceptibility of the 457 patients, first-biopsy was performed in 371 and re-biopsy was done in 86. Acute bacterial prostatitis developed in 6 patients (1.3%). Acute prostatitis developed after a first-biopsy in 2 patients (0.5%) and after re-biopsy in 4 patients (4.7%), showing a significant difference. All of the urine and blood cultures yielded levofloxacin-resistant Escherichia coli. Immediate intravenous cephalosporin or carbapenem was effective for all of these patients. We concluded that the use of levofloxacin could be a risk factor for acute bacterial prostatitis after transrectal prostate biopsy, due to an increase in fluoroquinolone-resistant E. coli in the rectum. The incidence of prostatitis was higher in re-biopsy patients. We consider that patients should receive levofloxacin for a shorter period before biopsy to avoid generating fluoroquinolone-resistant strains. Treatment with cephalosporin or carbapenem is recommended for patients with acute prostatitis after prostate biopsy.     

Transrectal ultrasound appearance of granulomatous prostatitis

Granulomatous prostatitis is an uncommon condition that can masquerade as prostatic carcinoma on both digital rectal exam and prostate ultrasound. It occurs most often after acute urinary tract infection, transurethral prostate resection, or needle biopsy. It can be seen in systemic granulomatous diseases and after intravesical bacillus Calmette-Guerin (BCG) therapy for bladder carcinoma. In some cases it is idiopathic. Six patients who underwent transrectal ultrasound of the prostate and subsequent transrectal ultrasound-guided biopsy had histologic diagnosis of granulomatous prostatitis. One patient was undergoing BCG therapy for bladder cancer. Two patients had recent urinary tract infections. The other three patients had no known predisposing conditions. Sonographically, the glands were enlarged in five patients, with multiple large and small hypoechoic zones throughout the peripheral, transition, and central zones. The appearance was similar to that seen in diffuse prostatic carcinoma. In one patient, a solitary hypoechoic lesion in the peripheral zone, indistinguishable from carcinoma, was present. Granulomatous prostatitis should be considered in the differential diagnosis of focal and diffuse abnormality with prostatic ultrasound.     

Prostatitis

Several distinct types of prostatitis, or prostatitis syndromes, are now recognized. The most common forms include acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. Bacterial prostatitis, caused mainly by coliform bacteria, Pseudomonas, and Enterococcus faecalis, is often difficult to cure and usually requires extended therapy (4-16 weeks) with an appropriate antimicrobial agent that achieves therapeutic levels in the prostatic secretory system. About 90% of men with prostatitis have nonbacterial prostatitis or prostatodynia. Nonbacterial prostatitis 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 videourodynamic testing. Because nonbacterial types of prostatitis have no recognized infectious cause, treatment using antimicrobial agents is ineffective and unwarranted.     

Approach to men with urethritis and urologic complications of sexually transmitted diseases

The most important causes of urethritis, and epididymitis in younger men, are C. trachomatis and N. gonorrhoeae. Management of these syndromes requires a thorough sexual history, genital examination, evaluation for objective and laboratory evidence of infection, antimicrobial therapy directed toward the major etiologies, and evaluation and treatment of sexual partners. Treatment of N. gonorrhoeae requires use of a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C. trachomatis and nongonococcal urethritis. With recommended regimens, microbiologic failure is infrequent in compliant patients. Recurrent urethritis is frequent, however. The management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient, documentation of urethritis, and re-treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions. Additional treatment beyond this point usually is not indicated, even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions. The most important causes of prostatitis, and epididymitis in older men or men with urethral structural abnormalities, are classical urinary tract pathogens rather than sexually transmitted pathogens. Management of these infections includes documentation of the infection and treatment directed toward the specific pathogen. Men with symptoms of "prostatitis" must be evaluated using both urine and prostatic secretions to document infection and inflammation. The majority of men with such symptoms do not have an infection that can be documented. These men respond poorly to medications. Men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure. In some cases, however, the disease is intractable, and chronic suppression with antimicrobials may be necessary.     

Urinary plasma protein patterns in acute prostatitis.

We evaluated the diagnostic utility of urinary alpha1-microglobulin, alpha2-macroglobulin and albumin in the diagnosis of acute prostatitis. We studied 133 men (43 +/- 17 years) with, and a reference population (n=36, 41 +/- 16 years) without, urinary tract infection. Prostatectomy samples were used to study the potential interference between prostatic proteins and protein analysis. Urinary alpha2-macroglobulin/albumin ratio was significantly lower in prostatitis compared to the reference population, cystitis or acute pyelonephritis (p < 0.0001). Low alpha2-macroglobulin concentrations in prostatitis are due to inhibition (p = 0.0001) of the immune reaction between alpha2-macroglobulin in presence of polyclonal rabbit antibodies (used for immunonephelometry) by soluble prostatic proteins (+/- 60 kDa) which appear in urine in acute prostatitis. The urinary alpha1-microglobulin/creatinine ratio diagnoses acute pyelonephritis (sensitivity 100% and specificity 87%) and the urinary alpha2-macroglobulin/albumin ratio diagnoses acute prostatitis (sensitivity 100% and specificity of 90%). Stepwise multinomial logistic regression analysis reveals that urinary alpha1-microglobulin, alpha2-macroglobulin, albumin and creatinine provide optimal differentiation between acute pyelonephritis and acute prostatitis (pseudo R2=0.83; Loglikelihood -30.55, p < 0.000001). In conclusion, the combination of hematuria and absence of urinary alpha-2-macroglobulin is diagnostic for acute prostatitis. Even without hematuria, alpha2-macroglobulin remains lower compared to patients without prostatitis.     

Use of a solid-phase radioimmunoassay and formalin-fixed whole bacterial antigen in the detection of antigen-specific immunoglobulin in prostatic fluid.

The prostatic fluid of two patients with Escherichia coli bacterial prostatitis was analyzed for evidence of a local immune response to bacterial infection. A solid-phase radioimmunoassay was modified to measure the immunoglobulin (Ig)A and IgG antigen-specific antibody responses to infecting bacteria in serum and prostatic fluid from patient. Formalin-fixed whole E. coli were used as antigen. In one patient with acute E. coli prostatic infection, measurements of antigen-specific antibody confirm the presence of a systemic and local immune response. However, in another patient with a chronic E. coli prostatitis, a primarily local immune response was demonstrated. The response measured in the prostatic fluid appears to be locally stimulated and specific for the infecting bacteria. Furthermore, IgA was the predominant immunoglobulin involved in the local prostatic immune response to infection. Although elevations of serum IgA antigen-specific antibody levels were short-liver after treatment of prostatic infection, local IgA antigen-specific antibodies were detected for as long as 1 yr after the initial infection in both patients studied.     

Preventive effect of selenium on chronic bacterial prostatitis

The antibiotic treatment rate of chronic bacterial prostatitis (CBP) is low, and long-term administration can result in adverse events and bacterial resistance. For these reasons, a new preventive modality, which can replace traditional antibiotic therapy, is required. To evaluate the preventive effect of selenium on CBP, the pre-treatments were divided into four groups, administered for 4 weeks, as follows: (1) control, (2) ciprofloxacin, (3) selenium, and (4) ciprofloxacin and selenium. Then, drip infusion of a bacterial suspension (Escherichia coli Z17, O2:K1; H–) into the prostatic urethra of Wistar rats was conducted to induce CBP. In 4 weeks, the results of microbiological culture of prostate and urine samples as well as histological findings of the prostate in each group were analyzed. Selenium decreased bacterial infection significantly; the decrease in infiltration rate of inflammatory cells into prostate tissues in the selenium group was similar to that in the control group. The effect of hindering bacterial infection on prostate tissue was greater in the group administered both selenium and an antibiotic than in other groups given only one of the agents. Although the findings of this study suggest that selenium can have a preventive effect against the occurrence of CBP, methods to prevent CBP are still controversial.     

Prostatitis

Classification of patients with prostatic complaints into one of the categories of bacterial or nonbacterial prostatitis or prostatodynia (see Table 3) enables a physician to give rational advice to men with confusing symptoms. By examining the prostatic fluid of patients with prostatic symptoms, a physician may easily identify those men with prostatodynia who will never respond to antimicrobial or anti-inflammatory agents. Carefully obtained fractionated cultures of the urine will usually distinguish patients with bacterial and nonbacterial prostatitis, so that only those men who have bacterial prostatitis are treated with long courses of antimicrobial agents. Although recent measurements documenting elevated IgA and IgG in the EPS of men with nonbacterial prostatitis support theories of an antigenic cause for the prostatic inflammation and symptoms, the causes for this inflammation must still be identified. In addition, the etiology of prostatodynia is also unclear. As a result, the optimal treatment for most patients with nonbacterial prostatitis and prostatodynia remains unknown.     

生殖支原体在慢性非细菌性前列腺炎患者中感染的研究

目的 采用培养法、两种聚合酶链反应（PCR）技术，对长春地区部分慢性非细菌性前列腺炎患者的前列腺液标本进行生殖支原体（Mg）的检测，以探讨Mg感染在慢性非细菌性前列腺炎的作用和地位。方法 本地区部分慢性非细菌性前列腺炎患者487例，取其前列腺液标本接种于自制培养基37℃培养，同时进行两种PCR技术检测。并与75名正常对照组进行比较。结果 在487例慢性非细菌性前列腺患者的前列腺液标本中，Mg阳性率达7．39％（36／487）；在75名正常的前列腺液标本中Mg阳性率为1．33％（1／75），两者比较，差异有统计学意义（X^2=3．88，P〈0．05）。结论 本地区慢性非细菌性前列腺炎患者的Mg感染率较高，认为Mg可能是引起慢性非细菌性前列腺炎重要病原体之一，性传播疾病防治工作中应加防范。     

Urinary retention in adults: diagnosis and initial management

Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alphaadrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.     

65例慢性细菌性前列腺炎病原学及其药敏试验分析

目的探讨复发性、难治性前列腺炎抗生素治疗的可能性。方法分析65例复发性、难治性前列腺炎患者的前列腺液细菌培养及药敏试验结果。结果65例前列腺液标本分离出的致病菌以革兰阳性菌为主,共56例(76.92%)。所分离致病菌除对万古霉素有很好的敏感性外,对临床常用抗生素均呈不同程度耐药。结论对慢性细菌性前列腺炎的治疗,关键是需要正确的病原学诊断和药物敏感试验指导下合理使用抗生素。     

合并肛周疾病的慢性前列腺炎前列腺液细菌培养、药敏的临床分析

目的探讨合并肛周疾病的慢性前列腺炎患者的前列腺液中细菌分布及耐药情况,为临床治疗提供依据。方法我院泌尿外科拟诊为慢性前列腺炎的患者共502例,均进行细菌培养及药敏实验,根据患者是否合并肛周疾病进行分组：合并肛周疾病的为A组,其余为B组,对两组数据进行统计分析。结果 502例慢性前列腺炎患者中,A组75人（14.94%）。A组前列腺液培养阳性率及复合感染率明显高于B组,两组培养的菌株分布中以金黄色葡萄球菌及表皮葡萄球菌为主,且两组间无差异（P〉0.05）。A组中培养的大肠埃希氏菌的菌株比例为16.67%,明显高于B组的8.04%（P=0.014）;铜绿假单胞菌株在A组中的比例为8.33%,明显高于B组的1.93%（P=0.006）。药敏试验结果显示葡萄球菌主要对万古霉素、呋喃妥因、庆大霉素的敏感率较高,大肠埃希氏菌主要对呋喃妥因、庆大霉素、头孢噻肟及罗红霉素等敏感率较高。结论伴有肛周疾病的慢性前列腺炎患者以细菌复合性感染为主,细菌培养、药敏试验有其特点,据此指导临床用药。