慢性前列腺炎在急性附睾炎发病中的关联度分析

目的 探讨慢性前列腺炎(CP)在急性附睾炎(acute epididymitis.AE)发病中的作用及两者发病的关联度.方法 将1998年1月至2009年1月年以来222例慢性前列腺炎与181例急性附睾炎患者随机分为急性附睾炎组及慢性前列腺炎组,比较AE伴有CP发病率与CP伴发AE的发病率,分析两者发病率差异性及关联度.结果 急性附睾炎组同时伴发慢性前列腺炎发病率为96.68%(175/181例),未伴发CP者6例.慢性前列腺炎组急性附睾炎发病率为13.96%(31/222例),未伴发CP者191例.附睾炎组CP发病率高于慢性前列腺炎组AE发病率,采用t检验两者差异有统计学意义.结论 附睾炎组CP发病率明显高于慢性前列腺炎组AE发病率,CP的存在是急性附睾炎发病的重要基础性因素,但不能排除急性附睾炎引起前列腺炎的可能,两者有重要关联度.     

The influence of inflammation of the human male genital tract on secretion of the seminal markers α-glucosidase, glycerophosphocholine, carnitine, fructose and citric acid

Biochemical analysis was made of specific accessory gland products in the ejaculates of 362 men suffering from various acute inflammatory diseases of the reproductive tract and 33 normozoospermic patients acting as controls. The ejaculate content of the epididymal markers alpha-glucosidase and L-carnitine, but not glycerophosphocholine, was significantly reduced in ejaculates from men with epididymitis; citric acid was reduced in men suffering from prostatitis; both citric acid and alpha-glucosidase were reduced in men suffering from adnexitis. The ejaculate content of epididymal and prostatic markers in prostato-urethritis (adnexitis), where the exact localization of the inflammation was unclear, was not as low as in epididymitis or prostatitis. Seminal vesicle function, as judged from semen volumes and seminal fructose, was not different in these groups of patients. The results, although strongly related to the clinical diagnosis, were unrelated to the microbiological flora of the semen and indicate that both the epididymis and the prostate glands are involved in some forms of adnexitis.     

精路炎症对精子密度和活率的影响

目的　了解精路炎症患者精子密度和活率的变化及其对生育影响。方法　选取慢性前列腺炎患者 5 0例 ,慢性附睾炎患者10例和正常生育者 10例 ,对其精液常规参数进行比较。结果　前列腺炎组的精子密度与正常组无显著差异 ,而精子活率显著低于正常组 (P <0 .0 5 ) ;附睾炎组精子密度和精子活率与正常组均无显著差异。结论　慢性前列腺炎患者的精子活率较正常生育者明显降低 ,而附睾炎患者无变化 ,提示慢性前列腺炎对生育可能有影响     

Chronic prostatitis: comments on infectious etiologies and antimicrobial treatment

Twenty-three males with the clinical diagnosis of chronic prostatitis were evaluated for a bacterial etiology by the Stamey and Meares method. In addition, 16 patients, regardless of culture results, were placed on either cefadroxil or oral carbenicillin antimicrobial therapy. Culture results identified only four (17%) of 23 patients with bacterial prostatitis: coagulase-negative Staphylococcus (2), Enterobacter agglomerans (1), and Haemophilus parainfluenzae, and coagulase-negative Staphylococcus (1). Four of seven patients who received oral carbenicillin and three of nine patients who received cefadroxil reported symptomatic relief. This study did not identify a common etiology for chronic prostatitis or a consistently effective antimicrobial treatment. Rather, we observed that the etiologic agent in most cases of chronic prostatitis (83%) could not be identified by routine bacteriologic culture. Future research efforts in chronic prostatitis must address not only treatment regimens but expand the search for etiologic agents.     

Urologic manifestations of AIDS

The frequency of urological manifestations of AIDS appears to be increasing at the present time: between 1985 and 1988, 38 HIV1 seropositive patients were examined in the Urology department. In seven cases, the positive serology was discovered during investigation of a urogenital infection and 21 patients suffered from declared AIDS. The reasons for admission to hospital were: urogenital infection: 14 cases, dominated by epididymitis (7) and prostatitis (5), characterized by their frequent progression towards abscess formation; tumours: 6 cases, including 5 Kaposi sarcomas of the penis; and, lastly, neurological manifestations, chronic renal failure and urological diseases unrelated to AIDS. This study indicates that serology should be performed routinely in cases with a known risk factor and/or with an atypical urogenital condition, particularly infectious. The adoption of aseptic techniques and rigorous protection of the entire surgical team is now absolutely necessary.     

Antibody-coated bacteria in the ejaculate: a possible test for prostatitis.

An immunofluorescence technique was used to study antibody coating of bacteria in ejaculates from 14 healthy individuals and 51 patients with complaints compatible with the diagnosis of prostatitis. Quantitative bacteriological cultures in the ejaculate were positive in 2 healthy individuals (14%) and in 25 patients with prostatic symptoms (49%). Antibody-coated bacteria could be demonstrated in 25 patients with prostatic symptoms (49%), 8 of whom had negative bacterial cultures, but in none of the healthy individuals. All 5 patients with epididymitis had antibody-caoted bacteria in the ejaculate. The 13 patients with antibody-coated bacteria in the ejaculate were given antibiotic treatment and the bacteria disappeared in 8 cases. The results document the presence of a (presumably local) immune response in bacterial prostatitis. Antibody coating of bacteria in the ejaculate seems to be helpful in the diagnosis of bacterial prostatitis.     

Significance and problems of Chlamydia detection in urologic patients

Chlamydiae represent the aetiological agent in non-gonococcal urethritis in about 50% of the cases, but it is also increasingly recognized that Chlamydia trachomatis can cause prostatitis or epididymitis. The introduction of methods for the direct detection of chlamydia in clinical materials allows early diagnosis and therefore effective antibiotic therapy. The new tests however give both false positive and false negative results.     

Effect of cefoperazone on acute prostatitis and epididymitis

Cefoperazone (CPZ) was intravenously administered to rabbits and the concentration of CPZ in the accessory male genitals was determined. The epididymis, prostate and testicles had a high enough concentration of CPZ to kill various kinds of bacteria. Therefore, CPZ was applied to 11 clinical cases of acute epididymitis and 4 cases of acute prostatitis, but clinical effects were not so satisfactory in the cases of acute epididymitis.     

Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: andrological implications

There is a consensus on the diagnostic management of bacterial prostatitis (acute and chronic). In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) the diagnostic approach remains unclear, because inflammatory and noninflammatory CP/CPPS might be one entity with varying findings over time. The WHO definition of male accessory gland infection does not differentiate between prostatitis, epididymitis, and other inflammatory alterations of the urethral compartment. The definition therefore cannot be further accepted as a rational tool for the diagnosis of prostatitis and related diseases in urological andrology. Therapy in infectious prostatitis is standardised and antibiotics are the primary agents. Andrological implications are well defined, side-effects are minimal. CP/CPPS therapy has the goal to reduce pelvic pain. However, treatment regimens are not as standardised. Andrological side-effects are well defined and mainly due to the functional background of these agents.     

Genital infections in men associated withChlamydia trachomatis

The advent of new diagnostic procedures has made it possible for urologists to detect chlamydial presence in genital infections. Many studies have shown chlamydial association with urethritis. However, its presence in prostatitis and epididymitis has not been clearly defined yet. In this study we investigated the presence of Chlamydia trachomatis using enzyme linked immuno assay (ELISA) antigen and antibody detection method in sexually active men with different genital infections. We have found that in 32.1% of patients with non-gonococcal urethritis chlamydial antigen is detectable. We also have been able to detect chlamydial antigen in two patients with chronic non-bacterial prostatitis, but in no patients with epididymitis. We conclude that besides its presence in urethritis, there is an association between chlamydia and chronic prostatitis. Yet, further studies are needed to delineate this association more clearly.     

Local antibody in semen for rapid diagnosis of Chlamydia trachomatis epididymitis

Etiologic studies including micro-immunofluorescence serology for Chlamydia trachomatis were done on 45 consecutive men with acute epididymitis. Of the men 21, all less than 35 years old, had type specific Chlamydia trachomatis antibody in the semen. All patients with semen antibody also had Chlamydia trachomatis antibody in the serum, while only a few of the patients without semen antibody had serum antibody. Chlamydia antibody titers in the semen specimens were higher than those in the sera and they persisted longer. In only 1 patient with semen antibody was another potential etiological agent for epididymitis demonstrated, while most of the patients without semen antibody had bacterial causes for the epididymitis. It was concluded that measurement of Chlamydia trachomatis antibody in semen offered a noninvasive, sensitive and specific method, useful despite prior antibiotic therapy, for diagnosis of the etiology of epididymitis in young men.     

Detection of Chlamydia trachomatis in urethra of patients with urogenital infection

Between January, 1984 and August 1986, we examined 151 male patients with urogenital infections including 114 cases of urethritis, 18 cases of epididymitis, 19 cases of prostatitis at the outpatient clinic of the department of urology, Toho University's Ohmori Hospital. The positive rate for Chlamydia trachomatis from the urethra based on cell cultures was 29.0%, (30.5% for urethritis, 27.8% for epididymitis, and 21.1% for prostatitis). The positive rate for non-gonorrheal urethritis was 33.0% and chlamydia infections were complicated by gonorrheal urethritis in 23.3% of the cases. The mean age of the patients with positive Chlamydia trachomatis was 31.9 years. The route of infection in 77.8% of the cases was sexual intercourse the most common cause of which was infection from a prostitute in 62.1% of the cases. The latent period was in most cases from 2-3 weeks.     

EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU).

A short version of the UTI Guidelines elaborated by the Urinary Tract Infection Working Group of the Health Care Office of the European Association of Urology is presented. The topics include classification, diagnosis, treatment and follow-up of uncomplicated UTI, UTI in children, UTI in diabetes mellitus, renal insufficiency, renal transplant recipients and immunosuppression, complicated UTI due to urological disorders, sepsis syndrome, urosepsis, urethritis, prostatitis, epididymitis, orchitis and principles of perioperative prophylaxis in urology.     

Diagnosis and therapy of acute prostatitis, epididymitis and orchitis

Acute genitourinary infections represent an important problem in daily urological practice. Standardised diagnostic procedures and therapeutic guidelines, as far as they exist, are mandatory to minimise the risk for severe sequelae and to optimise the therapeutic outcome. The present overview details diagnostic steps, therapeutic guidelines and the management of potential sequelae of acute prostatitis, acute epididymitis and acute orchitis. Acute prostatitis does not seem to represent a major diagnostic and therapeutic problem as long as prostatic abscess formation is absent. In acute epididymitis the development of epididymo-orchitis is unpredictable despite adequate therapy and is of particular concern to andrologists because of its potential significance for male fertility. In contrast to these diseases, acute primary orchitis is a rare event, mostly occurring as mumps orchitis, without standardised treatment guidelines.     

Clinical study of levofloxacin (DR-3355) on uro-genital infections--with special reference to usefulness for chronic prostatitis]

The clinical usefulness of levofloxacin, an optical active isomer of ofloxacin, was investigated on uro-genital infections. Patients who were treated with the drug included 2 with complicated urinary tract infections (UTI), 29 with chronic prostatitis and 3 with chronic non-chlamydial epididymitis. Levofloxacin was given to each patient at a dose of 300 mg or 400 mg a day for 7-14 days (average 12.0 +/- 0.5 days). In 2 cases of chronic UTI, infected by P. aeruginosa in one case and P. stutzeri in another case, the isolates were eradicated, and the clinical efficacy was moderate or excellent. For evaluating the effectiveness on chronic prostatitis, the patients were divided into 2 groups; group I (G-I) was chronic bacterial (number of isolates including GNR or E. faecalis, greater than or equal to 10(4) ml) and group II (G-II) was chronic non-bacterial prostatitis (number of isolates including GPC less than or equal to 10(3)/ml). A complete bacteriological response was obtained in all 7 cases, classified in G-I, but in 20 of the 27 isolates, (74.1%) in G-II. In 3 cases of chronic non-chlamydial epididymitis, the response was moderate. In safety profile, there were slight elevations in the laboratory values of glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) in one case, and that of GOT in another case. As for side effects, a 69-year-old male complained of dizziness, and anorexia after 10 days on the drug, but recovered 2 days after discontinuance of the drug.     

Coccidioidomycosis of prostate and epididymis. With urethrocutaneous fistula

Coccidioidomycosis is usually a benign respiratory ailment seen in the American southwest. Dissemination is rare, and symptomatic genitourinary involvement is even rarer. An unusual case of coccidioidomycosis is presented with epididymitis, prostatitis, and urethrocutaneous fistula. If the disease is suspected, diagnosis can be made easily on the basis of clinical, pathologic, bacteriologic, and immunologic findings. Treatment is hazardous and must be individualized in patients with genitourinary involvement.     

附睾肿物的超声诊断与鉴别诊断

目的:通过分析附睾肿物的超声特征,提高对附睾肿物的超声诊断及鉴别诊断水平。方法:回顾性分析1990年1月~2004年12月在我院接受手术治疗的179例附睾肿物患者,对病理诊断和超声特征进行分析。结果:179例患者,年龄(51.4±14.7)岁。附睾肿物包括附睾囊性肿物98例,非特异性附睾炎症27例,附睾结核33例,附睾肿瘤21例。附睾疾病中囊性肿物超声诊断率93.8%;附睾结核与附睾炎不易鉴别,两者主要区别在于附睾结核常同时合并肾、输尿管、膀胱、前列腺和睾丸等多脏器结核,在出现寒性脓疡、钙化灶,与皮肤形成窦道时易诊断;附睾肿瘤多为良性,恶性少见,应结合病史、体格检查和超声特征综合鉴别。结论:超声检查对附睾肿物的诊断和鉴别具有重要临床价值,是附睾疾病的首选影像学检查方法。     

Tuberculous epididymo-orchitis and prostatitis: a case report

The worldwide prevalence of tuberculosis (TB) is still high, remaining almost unchanged over the past century. The genitourinary tract belongs to one of the most common sites of extrapulmonary TB. Although rare, epididymal TB may be the only clinically evident location of infection. We present an unusual case of tuberculous epididymitis and prostatitis, demonstrating the need for insistent diagnostic procedures to confirm diagnosis. The treatment of choice is primarily medical, consisting of a combination of three or four anti-TB drugs, sometimes combined with surgery.     

Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method

OBJECTIVE: To investigate the role of semen cultures versus segmented urine cultures for the diagnosis of bacterial chronic prostatitis. MATERIAL AND METHODS: We retrospectively examined 895 patients (age range 17-67 years) who met the consensus criteria for clinical chronic prostatitis/chronic pelvic pain syndrome, 50.1% of whom had dysuria and/or perineal discomfort, 37.4% infertility of unknown etiology and 12.5% erectile dysfunction. Segmented urine cultures, including expressed prostatic secretions (EPSs) and semen culture, were performed in all patients. RESULTS: Of the 895 patients, 182 had significant positive cultures for Gram-negative microorganisms (Escherichia coli was the commonest specimen isolated: 70.4% of cases) and 283 had significant positive cultures for Gram-positive microorganisms. We compared the culture yield in EPS and/or the urine voided after prostatic massage (VB3) sample (four-glass method) with that of the semen sample. In the Gram-negative group, 32 patients were diagnosed by means of semen culture (negative EPS and/or VB3 sample) and in only five cases was a positive diagnosis made despite a negative semen culture (positive EPS and/or VB3 sample). In the remaining subjects, diagnosis was performed with the aid of both EPS/VB3 sample and semen (both of which were positive). In the Gram-positive group, there was significant growth of such microorganisms in semen in every case considered positive, but in only 46 cases was diagnosis achieved via EPS and/or VB3 sample. A diagnosis of chronic prostatitis by Gram-positive microorganisms in these patients was only considered when the same microorganism was retrieved in repeated cultures without previous treatment. Only three cases met such criteria (all of whom had negative EPSs). To evaluate the diagnostic efficiency of the semen and EPS samples, we analyzed their sensitivity and specificity, obtaining higher sensitivity in semen than EPS samples for significant Gram-negative cultures: 97% vs 82.4%. In significant Gram-positive cultures, the sensitivity of semen samples was 100%, compared to only 16.1% for EPS. CONCLUSIONS: A semen sample has higher sensitivity than an EPS for the diagnosis of bacterial chronic prostatitis. In our clinical work-up, first-void urine and a semen culture are considered the only tests necessary to diagnose chronic prostatitis.     

Serum sialic acid levels in patients with acute prostatitis or acute epididymitis

The serum sialic acid concentration in 17 male healthy adults, 11 patients with acute prostatitis and 12 patients with acute epididymitis was measured with a specific enzymatic assaykit. The concentration was studied in relation to erythrocyte sedimentation rate, total serum protein and its fraction, C-reactive protein, and white blood cell count. Blood samples were obtained from the patients immediately before antimicrobial chemotherapy and the subsequent 3, 5, 7, 14, and 28 days. The pretreatment sialic acid concentration in the patients was significantly greater than that in the control subjects (P greater than 0.001). The mean serum sialic acid concentration in the patients reached a maximum level 3 days after the beginning of the treatment, and then gradually decreased. There was a significant correlation between the daily change of the serum sialic acid level and those of the erythocyte sedimentation rate, alpha2-globulin, and alpha1-globulin. Serum sialic acid proved to be a useful biochemical marker in acute prostatitis and acute epididymitis.