Treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin lowers serum prostate specific antigen

PURPOSE: We compared baseline and post-therapy prostate specific antigen (PSA) in patients with chronic bacterial prostatitis who were treated with levofloxacin or ciprofloxacin. MATERIALS AND METHODS: Subset analysis was done using a randomized, multicenter, double-blind, active control trial of 500 mg levofloxacin daily for 28 days vs 500 mg ciprofloxacin twice daily in 28 days in men with chronic bacterial prostatitis. RESULTS: Of the 377 men in the intent to treat population, including 197 treated with levofloxacin and 180 treated with ciprofloxacin, 35 on levofloxacin and 37 on ciprofloxacin with baseline PSA greater than 4 ng/ml were included in this analysis. Excluded from analysis were 2 levofloxacin treated patients with extremely high PSA at baseline (62 and 103 ng/ml, respectively). Mean baseline PSA +/- SD in the patients analyzed was 8.33 +/- 4.46 ng/ml, which decreased to 5.36 +/- 3.82 ng/ml after therapy. There was no significant difference in the mean change in PSA between the levofloxacin and ciprofloxacin groups. Approximately 42% of patients with increased baseline PSA had a post-therapy PSA of 4 ng/ml or less. Of patients who were microbiologically evaluable and had normalized PSA after therapy levofloxacin eradicated the pathogen in 90.9% (10 of 11). However, of patients in whom post-therapy PSA remained increased the microbiological eradication rate was 69.2% (9 of 13). Similarly 93.3% of the ciprofloxacin group (14 of 15 patients) with normalized post-therapy PSA experienced microbiological eradication compared with 61.5% (8 of 13) with continued increased PSA after therapy. CONCLUSIONS: Approximately 20% of patients diagnosed with chronic bacterial prostatitis had increased PSA. A significant decrease in PSA was observed in these patients after treatment with levofloxacin or ciprofloxacin. An association was observed between bacterial persistence and the likelihood that PSA would return to normal.     

Elevated serum prostate-specific antigen due to acute bacterial prostatitis

Elevated serum prostate-specific antigen secondary to acute bacterial prostatitis occurred in 2 patients. This cause of increased PSA has not been documented previously.     

Seminal vesiculography in chronic bacterial prostatitis

A total of 15 patients with proved chronic bacterial prostatitis underwent bilateral seminal vesiculography to determine the morphological appearance of the seminal vesicles and the ampulla ducti deferentis in this condition. A pathological condition, such as segmental stenosis or complete shriveling of the seminal vesicles, was obvious in 21 of 24 vesiculograms (87.5 per cent), while malformations of the ampulla were seen in 7 (29.1 per cent). The role of chronic bacterial prostatitis as an important pathogenetic factor in the history of epididymo-orchitis is discussed.     

Association of antisperm antibodies with chronic nonbacterial prostatitis

Antisperm antibodies are significant in male factor infertility. The prevalence of antisperm antibodies in the infertile population is approximately 10 percent, and it is not cost-effective to test for these antibodies in every male partner of an infertile marriage. Earlier studies have demonstrated a higher prevalence of antisperm antibodies among men with a history of bacterial prostatitis or urethritis. Because of this established association, we measured the prevalence of serum antisperm antibodies, using a gel agglutination assay, in 28 men with chronic nonbacterial prostatitis and in age-matched control group of 69 men without a history of prostatitis. The prevalence was 25 percent (test subjects) and 7.2 percent (controls) (p less than 0.05). This finding indicates that nonbacterial prostatitis is a risk factor for the presence of serum antisperm antibodies and that subfertile men with a history of nonbacterial prostatitis should be tested for these antibodies.     

Bacterial localization in antibiotic-refractory chronic bacterial prostatitis

Chronic bacterial prostatitis, that has become resistant to antibiotic therapy, remains a frustrating clinical entity for both clinicians and patients. Twenty men with a history of documented bacterial prostatitis, that had become resistant to appropriate antibiotic therapy, were studied in an attempt to determine where the bacteria had become localized, and possibly explain their survival in a relative bactericidal environment. The antibiotics were discontinued for 4 weeks, and cultures of the expressed prostatic secretions, tissue biopsies, histology, and ultrastructure were correlated. Twelve (60%) of the tissue biopsies cultured presumed pathogens. In six of the tissue-positive cases, the expressed prostatic secretion was negative. Specific electron micrographs demonstrate exopolysaccharide coated micro-colonies of bacteria firmly attached to the ductal and acinar walls. This mode of growth helps explain some of our difficulties in the diagnosis and treatment of chronic bacterial prostatitis. © 1993 Wiley-Liss, Inc.     

经直肠抗菌药物离子导入和经尿道射频热疗联合治疗慢性细菌性前列腺炎

１９９３年１２月至１９９５年３月，采取经直肠抗菌药物离子导入和经尿道射频热疗联合治疗慢性细菌性前列腺炎１２３例，其中经直肠抗菌药物离子导入治疗２８例，治愈率２８．５％，显效率４６．４％，总有效率７５％；经尿道射频热疗２７例，治愈率２２．２％，显效率４４．４％，总有效率６６．６％；两种方法联合治疗６８例，治愈率６１．７％，显效率２９．４％，总有效率９１．２％。结果提示两种方法联合治疗慢性细菌性前列腺炎疗效较好。     

细胞因子及热休克蛋白在慢性前列腺炎患者精浆中的含量及其临床意义

目的:探讨慢性细菌性前列腺炎以及慢性前列腺炎/慢性骨盆疼痛综合症(CP/CPPS)患者精浆中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)以及热休克蛋白70(HSP70)的含量及临床意义。方法:采用酶联免疫吸附测定法(ELISA)对36例慢性细菌性前列腺炎(Ⅱ型)、43例炎症型慢性非细菌性前列腺炎即炎症型慢性骨盆疼痛综合征(ⅢA型)、46例非炎症型慢性非细菌性前列腺炎即非炎症型慢性骨盆疼痛综合征(ⅢB型)患者及25例健康志愿者精浆中TNF-α、IL-1β以及HSP70含量进行测定分析,并将HSP70的表达与慢性前列腺炎症状评分进行相关性分析。结果:慢性细菌性前列腺炎患者精浆中细胞因子(TNF-α、IL-1β)以及HSP70含量明显高于CP/CPPS患者及正常对照组。CP/CPPSⅢA型患者精浆中IL-1β的含量明显高于CP/CPPSⅢB型患者及正常对照组。CP/CPPS患者精浆中HSP70的含量明显低于正常对照组。慢性细菌性前列腺炎患者精浆中HSP70的含量与CPSI评分呈显著负相关。结论:精浆中HSP70的含量能够作为评价慢性细菌性前列腺炎病情程度的分子生物学指标。IL-1β能够作为CP/CPPS分型诊断指标。对于慢性细菌性前列腺炎患者,HSP70具有细胞保护功能。CP/CPPS患者精浆中HSP70表达的抑制可能与T细胞功能受损有关。     

慢性前列腺炎患者前列腺液、尿液电解质测定及其相关性研究

目的　检测慢性前列腺炎患者及正常对照组前列腺液、尿液中K 、Na 、Cl-、Ca2 等电解质浓度 ,探讨各组间几种电解质的相关性。　方法　对 79例前列腺炎患者、31例正常对照组的前列腺液、尿液的K 、Na 、Cl-、Ca2 等浓度进行测定并分组分析。　结果　前列腺炎患者组与正常对照组前列腺液中K 、Na 、Ca2 浓度差异无显著性意义 (P >0 .0 5 ) ,Cl-浓度差异有显著性意义 (P =0 .0 0 1) ,患者组Cl-(6 8.6 3± 37.71)mmol/L浓度显著高于对照组 (4 5 .17± 19.79)mmol/L。治疗有效组中前列腺液K 浓度治疗前后分别为 (4 0 .6 6± 17.10 )mmol/L、(33.4 2± 17.2 7)mmol/L ;治疗无效组中前列腺液K 浓度治疗前后分别为 (37.5 7± 16 .93)mmol/L、(5 0 .6 6± 18.77)mmol/L。疼痛组与非疼痛组前列腺液K 浓度分别为 (36 .0 2± 12 .36 )mmol/L、(4 8.90± 16 .93)mmol/L。每组前列腺液K 浓度与前列腺液Ca2 浓度呈正相关以及尿液Na 浓度与尿液Cl-浓度呈正相关 (P均 <0 .0 5 )。　结论　前列腺炎患者治疗前后以及疼痛组与非疼痛组间 ,前列腺液K 浓度变化明显 ;前列腺液K 、Ca2 浓度之间和尿液Na 、Cl-浓度之间关系密切 ,均呈正相关。     

高压氧配合抗生素治疗慢性细菌性前列腺炎不育的临床观察

目的探讨高压氧(HBO)配合抗生素治疗慢性细菌性前列腺炎(CBP)所致不育的临床疗效及机制。方法将CBP不育患者83例按就诊的不同阶段分成两组,A组(51例)为抗生素配合高压氧治疗组,B组(32例)为单纯抗生素治疗组。结果A组的治愈率明显高于B组(P<0．01),A组无效率明显低于B组(P<0．01)。A组精液液化率治疗前后有明显改善(P<0．05),且较B组治疗后改善明显(P <0．05)。两组患者在治疗前后精子密度、精子活率、a、b级精子数方面都有改善(P<0．01或P<0．05),且A组较B组治疗后改善更大(P<0．01或P<0．05)。A组患者在治疗前后精浆Zn、SOD、AsAb转阴率、EPS-WBC、SPA方面都有明显改善(P<0．01),B组在EPS-WBC、SPA方面亦有改善(P<0．01),A组较B组治疗后在精浆Zn、SOD、AsAb阴转率、EPS-WBC、SPA方面改善更大(P<0．01或P<0．05)。A组较B组配偶受孕率明显高(P<0．01),且A组治疗后配偶受孕时间较B组提前(P<0．05)。结论抗生素配合HBO治疗较单纯抗生素治疗CBP不育,能够更有效的改善精液质量、提高受孕机率。     

慢性前列腺炎患者的疾病感知研究

目的 研究慢性前列腺炎(CP)患者的疾病感知特点.方法 选择疾病感知问卷中文修订版(CIPQ-R)进行CP患者疾病感知评价,国际慢性前列腺炎症状指数表(NIH-CPSI)及国际勃起功能指数表(IIEF-5)被用来评价CP患者的临床症状,对CP患者的疾病感知与慢性肝病进行对比并与临床症状进行相关分析.结果 CP患者CIPQ-R疾病周期性因子、情绪陈述因子分数偏高.Pearson相关分析显示疾病的同一性因子和情绪陈述因子与疾病感知其他因子密切相关;疾病感知各因子与临床症状评分相关性显著.结论 CP患者具有过度的负性疾病感知,使患者处于持久的不良心理应激状态下,对患者的疾病症状、生活质量、疾病预后造成较大的影响.     

Voiding dysfunction associated with "chronic bacterial prostatitis"

OBJECTIVE: The study was done to evaluate flowmetry parameters, bladder capacity and postvoiding residual volume (PVR) in patients with chronic bacterial prostatitis/category II according to the National Institute of Health (NIH) categorization of prostatitis syndromes (CBP/Cat.II). SUBJECTS AND METHODS: A prospective study of 42 patients with chronic CBP/Cat. II was undertaken. Clinical evaluation and the standard four-glass test with direct microscopy and culture were done for all patients. Flowmetry parameters and PVR were measured. Two groups were compared to the CBP/Cat.II group; a control age matched 42 males without lower urinary tract symptoms and 279 patients with prostatodynia/non-inflammatory chronic pelvic pain (CPP/Cat.IIIB). RESULTS: All the three groups had similar age. The CBP/Cat.II and CPP/Cat.IIIB patients had similar duration of symptoms. In CBP/Cat.II maximum flow rate (Q(max)), average flow rate (Q(ave)), and voided volume (V(ura)) were 12.8+/-5.9 ml/s, 7.4+/-3.4 ml/s, and 238.9+/-110.8 ml. These were significantly less than those for normal controls (21.3+/-4.2 ml/s, 12.2+/-3.4 ml/s, and 381.3+/-144.4 ml). The flowmetry findings in CBP/Cat.II group did not show statistically significant differences from those for CPP/Cat.IIIB group (Q(max), Q(ave), and V(ura) were 11.3+/-5.3 ml/s, 6.6+/-2.0 ml/s, and 230.5+/-88.8 ml). In CBP/Cat.II group, patients with Q(max) < 15 ml/s (25/42) had statistically significant longer duration of symptoms (33.6+/-19.3 compared to 13.1+/-6.3 months). CONCLUSION: In this study, CBP/Cat.II patients had significantly lower flowmetry parameters compared to matched age normals. The flowmetry parameters in this group were found similar to those in a group of CPP/Cat.IIIB patients. Voiding dysfunction in CBP/Cat.II may contribute to the longer duration of symptoms.     

前列腺内尿液返流在慢性前列腺炎发病中的作用

为探讨前列腺内尿液返流（ＩＰＵＲ）在慢性前列腺炎（ＣＰ）发病中的作用，应用核素尿路前列腺返流显像研究ＣＰ患者及正常人的ＩＰＵＲ情况，并比较其与ＣＰ症状评分的关系。结果：ＣＰ者的ＩＰＵＲ程度（用排尿后ＩＰＵＲγ图像的积分吸光度表示）为９７．６±２１．９，而正常对照为４７．８±１８．２，前者明显高于后者（Ｐ＜０．０１）。ＣＰ者的ＩＰＵＲ程度与其症状评分相关（ｒ＝０．９０２，Ｐ＜０．００１）。结论：ＩＰＵＲ与ＣＰ发病有关。     

Management of elevated prostate-specific antigen in men with nonbacterial chronic prostatitis

Elevated serum prostate-specific antigen (PSA) in the setting of acute or chronic bacterial prostatitis is common. Serum PSA, however, is much more variable in the setting of chronic nonbacterial prostatitis. Because elevated serum PSA is associated with prostate cancer and is used in screening programs for prostate cancer, patients with benign causes for elevation of serum PSA present a challenge. This article reviews the management of patients with elevated serum PSA and a diagnosis of chronic nonbacterial prostatitis.     

Acute and chronic bacterial prostatitis due to E. coli

Summary Inoculation of Escherichia coli (serotype O:6) into the bladder of male and female Mastomys (Praomys) natalensis produced severe prostatitis. In this rodent both male and female animals possess a well developed prostatic gland. The histologic and microbiologic course of the prostatic infection resembled strongly the human disease. Acute bacterial prostatitis was followed by the development of chronic bacterial or nonbacterial prostatitis. The infection persisted in some animals for up to six months. Prostatitis was observed histologically in all animals sacrificed six months postinfection. Animals responded to the infection with a rise of anti-lipopolysaccharide antibodies. No major morphologic differences were detected in the histologic pattern of the inflammatory process between animals with positive and negative bacterial cultures and between male and female animals.     

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.