Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21–62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3–8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.     

慢性前列腺炎伴非神经源性膀胱外括约肌协同失调的诊治(附21例报告)

目的:研究表现为非神经源性膀胱外括约肌协同失调(NNDSD)的慢性前列腺炎(CP)的特点及其生物反馈治疗疗效。方法:CP患者113例,诊断标准为有尿频、尿急、尿痛、排尿不尽、排尿困难等CP的典型症状大于3个月,且NIH-CPSI评分中第一和第二项评分≥1。经相关检查,排除尿道炎、间质性膀胱炎、尿道狭窄和神经源性膀胱等情况。113例均行尿动力学检查,分析尿流曲线,记录最大尿流率(Qmax)、最大逼尿肌排尿压(Pdet.max)、最大尿道压(MUP)和最大尿道闭合压(MUCP)等参数。对尿流动力学结果表现为NNDSD的患者行生物反馈治疗,10周后评估疗效。结果:CP患者113例中尿流动力学表现为NNDSD的21例(21/113,18.6%)。NNDSD患者治疗前后Qmax[(8.2±4.1)ml/s vs(15.1±7.3)ml/s]、Pdet.max[(125.1±75.3)cmH_2O vs(86.3±54.2)cmH_2O]、MUP[(124.3±23.3)cmH_2O vs(65.4±23.0)cmH_2O]和MUCP[(101.5±43.6)cmH_2O vs(43.5±16.7)cmH_2O]差异有统计学意义(P<0.05);生物反馈治疗前后NIH-CPSI疼痛评分[(4.0±2.0)分vs(2.2±1.7)分]、排尿评分[(7.9±2.1)分vs(2.2±1.9)分]、生活影响评分[(9.6±2.7)分vs(2.9±2.6)分]和总分[(21.7±4.8)分vs(8.4±4.6)分]差异有统计学意义(P<0.05)。结论:有下尿路症状的CP患者可能存在NNDSD,尿动力学主要表现为尿流率下降,排尿期膀胱内压力升高和部分患者尿道压力升高,尿动力学检查可以明确诊断及选择正确的治疗方法;盆底肌生物反馈治疗此类患者的近期疗效确切。     

人类前列腺药物透过性和前列腺炎的病原学诊断与治疗

前列腺同其他腺体器官一样富含血管、淋巴管及神经,是前列腺等腺体器官获得营养及实现内分泌与外分泌功能的重要组织学基础。以口服、肌肉注射、静脉注射及局部吸收方式给患者使用的抗菌药物与非抗菌药物都可被吸收到宿主血液内,并随血液循环到达前列腺及其他器官,然后通过毛细血管壁进入血管外组织。炎症反应造成前列腺组织不同程度损害以致通透性增高,使血液的白细胞、红细胞及药物等可大量渗出或漏出血管外和进入前列腺液。前列腺炎等前列腺疾病患者的前列腺损害常常是多种不同种类与性质的病原因子单独或混合作用所致,并且可具有较长的损害过程与多种不同类型的病理改变。因此前列腺炎的诊断与治疗也同临床其他疾病的诊断与治疗一样,既是一个相对复杂的和困难的问题,也是一个相对简单的和容易的问题。造成"困难与容易"的因素并不是前列腺的药物透过性,而主要是对致病因子的特性、患者前列腺与身体的病理和生理特点以及药物性质的了解。临床和病原学漏诊与误诊、前列腺化脓或坏死组织内病原因子释放、病原体变异、新的病原体感染、药物的选择与使用等,都是造成前列腺炎治疗困难的常见因素。     

Chronic prostatitis in Korea： a nationwide postal survey of practicing urologists in 2004

Aim： To examine the diagnosis and treatment of chronic prostatitis by means of a nationwide postal survey of practicing urologists in 2004. Methods： A random sample of 850 Korean urologists from the Korean Urological Association Registry of Physicians were asked to complete a questionnaire that explored practicing characteristics, attitudes and diagnostic and treatment strategies in the management of chronic prostatitis. Results： Of the 850 questionnaires sent, 302 were returned （response rate 35.5 %） and 275 were induced in the final analysis. More than 50 % believed in a multifactorial etiology for chronic prostatitis and 52 % considered chronic abacterial prostatitis to be bacterial in nature. For routine diagnostic assessment, the most commonly used tests were reported to be urinalysis （95.3 %）, analysis of expressed prostatic secretions （89.5 %） and digital rectal examination （81.1%）. Only a few urologists use specific lower urinary tract cultures. Symptom assessment according to the National Institute of Health-Chronic Prostatitis Symptom Index was less frequently used （12.7 %）. First choices for therapy included antibiotics （96.4 %）, alpha-blockers （71.6 %） and sitz baths （70.5 %）. If unsuccessful, urologists frequently continued to prescribe a second course of either alpha-blockers （69.5 %） or antibiotics （57.8 %）. Conclusion： These data provide a picture of current practice regarding the management of chronic prostatitis in Korea. The diagnostic and treatment practices for prostatitis do not follow standard textbook algorithms. Further studies are needed to elucidate the etiology and pathogenesis of chronic prostatitis and to establish guidelines for its diagnosis and treatment.     

前列腺炎诊治中几个问题的探讨

目的提高前列腺炎的诊治水平。方法对近5年来临床工作中遇到的前列腺炎漏诊、误诊及认识有误的病例进行分析、探讨。结果有12例急性前列腺炎被误诊、漏诊，其中5例误诊为上呼吸道感染，7例诊断为尿路感染。15例前列腺增生（BPH）伴慢性前列腺炎者，漏诊了前列腺炎。17例慢性前列腺炎伴有其它泌尿生殖系疾病者，漏诊了其中之一。15例前列腺液常规中白细胞数与前列腺炎严重程度及治疗效果不一致。4例B超检查提示前列腺炎，患者无不适，按前列腺炎治疗后反而出现症状。结论前列腺炎诊治中尚存在一些问题。临床工作中需开阔思路，多做肛指检查。对症状、体征、前列腺液检查、B超检查结果等进行综合考虑，才能作出正确的诊断和治疗。     

口服强的松治疗ⅢA型前列腺炎的随机对照研究

目的 探讨口服强的松对Ⅲ型前列腺炎的治疗效果。方法 将常规治疗效果不佳的ⅢA型前列腺炎患者随机分为两组,试验组口服强的松,对照组重复常规治疗。治疗前后分别用慢性前列腺炎改良症状评分表调查两组患者的CPSI评分。结果 试验组治疗前后平均CPSI评分分别为30.9和5.0分,治疗后明显降低(P<0.001)。对照组分别为29.6和26.6分,其差别有统计学意义(0.005相似文献   

Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic floor biofeedback treatment

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To investigate the features of chronic prostatitis presenting with dysfunctional voiding (DV) and the effects of pelvic floor biofeedback (PFB).

PATIENTS AND METHODS

The study included 21 patients, diagnosed by having symptoms for ≥3 months, including urinary frequency and urgency, voiding difficulty, upper abdominal or perineal discomfort, and with a score of ≥1 on the first and second part of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI). Patients with bacterial prostatitis, urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All patients had a urodynamic examination, to assess the uroflow curve, maximum urinary flow rate (Q_max), maximum detrusor pressure during the storage phase (P_det.max), maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) were recorded. PFB was carried out in patients with non‐neurogenic detrusor sphincter dyssynergia, and the effects evaluated after 10 weeks.

RESULTS

Before and after PFB treatment the mean (sd ) Q_max, P_det.max, MUP, MUCP were 8.2 (4.1) vs 15.1 (7.3) mL/s, 125.1 (75.3) vs 86.3 (54.2) cmH₂O, 124.3 (23.3) vs 65.4 (23.0) cmH₂O and 101.5 (43.6) vs 43.5 (16.7) cmH₂O, all significantly different (P < 0.05). The respective differences in the pain, urination and life impact subdomain scores, and total scores, of the NIH‐CPSI were 4.0 (2.0) vs 2.2 (1.7), 7.9 (2.1) vs 2.2 (1.9), 9.6 (2.7) vs 2.9 (2.6) and 21.7 (4.8) vs 8.4 (4.6), and all differences were significant (P < 0.05).

CONCLUSIONS

There might be DV in patients with chronic prostatitis and lower urinary tract symptoms. Urodynamics showed a low Q_max and increasing intravesical pressure and, in some patients, increasing urethral pressure. Urodynamics could be used to help in the diagnosis, and to select the most appropriate treatment. PFB had satisfactory short‐term effects on these patients.     

Chronic prostatitis/pelvic pain syndrome: MRI findings and clinical correlations

We aimed to evaluate whether pelvic magnetic resonance imaging (MRI) could play a role in better assessing chronic pelvic pain syndrome. We evaluated 44 male patients (median 41 aged) with a clinical history of painful pelvic symptoms, lasting for at least three of the previous 6 months, associated with urinary, anorectal and sexual disorders in the absence of bacterial prostate infection. All these patients underwent ultrasound (US) and MRI evaluation of the pelvis. Prostate imaging findings, such as gland morphology evaluated by US and prostatic signal intensity on MRI, appeared normal in the majority of patients (38/44; 82%). Extraparenchymal alterations were found in 28 patients (63.6%); the most frequent was the dilatation of periprostatic vein plexus (20/28; 71.4%), significantly correlated to chronic pelvic pain syndrome (p = 0.0013), regardless of different clinical presentations. This finding was tested in a control group of 90 patients, demonstrating an excellent specificity (97%), good positive predictive value (87%) and diagnostic accuracy (80%). MRI confirmed its high capability in evaluating prostatic and extraprostatic structures. Periprostatic vein dilatation, which identified approximately two‐thirds of the patients with chronic pelvic pain syndrome using pelvic MRI, significantly correlated to chronic pelvic pain syndrome, independently of patient age, symptoms and prostatic volume.     

前列安栓治疗慢性前列腺炎综合征的疗效观察

目的 评估前列安栓在治疗慢性前列腺炎综合征中的临床疗效。方法 采用随机开放前瞻对照试验方法,将120例慢性前列腺炎患者随机分为两组:前列安栓治疗组(A组)和常规治疗对照组(B组),分别采用前列安栓联用氧氟沙星或单用氧氟沙星治疗。以前列腺按摩液(EPS)检查和NIH前列腺炎症状评分作为评估手段,对每个患者随访4周观察临床疗效。结果 本研究中共有6例患者未能完成第2周的随访而退出试验,其中A组2例在第1周末因腹痛、腹泻拒绝进一步治疗,B组2例失访,2例因对疗效不满意而退出,其余病例均完成了4周的随访。结果显示:前列安栓治疗组临床痊愈10例(17.2％),显效20例(34.5％),有效19例(32.6％),总显效率51.7％,总有效率83.3％,明显优于对照组(总显效率和总有效率分别为31.7％和66.7％),P<0.01。结论 前列安栓直肠给药联合口服抗生素对慢性前列腺炎综合征具有较好的疗效。前列安栓直肠给药是治疗慢性前列腺炎的新选择。     

Non-specific eosinophilic granulomatous prostatitis responded favorably to an antimicrobial agent and a hydrocortisone

A case of non-specific eosinophilic granulomatous prostatitis is presented. The patient was a 55-year-old man who was hospitalized with complaints of acute urinary retention and high-grade fever. Results of digital examination and transrectal ultrasonography of the prostate and elevated prostatic specific antigen were suggestive of prostatic cancer. Transrectal needle biopsy of the prostate was performed. Histological examination of the specimens revealed the formation of histiocytic granulomas with eosinophilic infiltration. The patient responded favorably to combination therapy with an antimicrobial agent and a hydrocortisone.     

Questionnaire survey of Japanese urologists concerning the diagnosis and treatment of chronic prostatitis and chronic pelvic pain syndrome

OBJECTIVES: We performed a questionnaire survey to investigate various issues in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome by Japanese urologists and to clarify the circumstances surrounding prostatitis in Japan. METHODS: Japanese urologists (n = 1869) were surveyed by mail using a 17-item questionnaire to determine current diagnostic and treatment practices for prostatitis/chronic pelvic pain syndrome. RESULTS: Only 1.5% (11/739) of urologists diagnosed chronic prostatitis/chronic pelvic pain syndrome using the 4-glass test, while most did so using the 2-glass test (voided bladder [VB]2 and VB3, or VB2 and expressed prostatic secretion [EPS]). Approximately half (55.2%; 412/746) did not perform urine cultures to differentiate chronic bacterial prostatitis from chronic abacterial prostatitis/chronic pelvic pain syndrome. Approximately half (46%; 343/746) did not count the number of leukocytes in VB2 or VB3/EPS to differentiate chronic abacterial prostatitis from chronic pelvic pain syndrome. Although many urologists (63.8%; 459/720) thought that chronic abacterial prostatitis/chronic pelvic pain syndrome was not an infectious disease, many chose antimicrobial agents as the primary treatment. More than half (52.2%; 384/735) of all urologists felt pessimistic about dealing with chronic prostatitis/chronic pelvic pain syndrome compared to treating benign prostatic hypertrophy or prostate cancer, because of the high number of complaints by patients and their own lack of confidence in diagnosing and treating the condition. CONCLUSION: There is much confusion and frustration among Japanese urologists about chronic prostatitis/chronic pelvic pain syndrome. Further studies are needed to elucidate its etiology and pathogenesis, and to establish guidelines for its diagnosis and treatment.     

普米克令舒雾化吸入治疗小儿急性感染性喉炎的疗效观察

目的探讨普米克令舒雾化吸入治疗小儿急性感染性喉炎的有效方式及临床价值。方法把2011年3月～2012年8月接受住院治疗且满足急性感染性喉炎确诊条件的92例患儿划分为甲乙两个小组,甲组接受常规治疗,乙组采用普米克令舒进行治疗。结果甲组无效13例（28．26％）,有效23例（50．00％）,显效10例（21．73％）,总有效率为71．74％。乙组无效1例（2．17％）,有效12例（26．09％）,显效33例（71．74％）,总有效率97．87％。两组治疗总有效率之间差异显著（P〈0．05）。乙组患儿采用普米克令舒进行治疗,声嘶、发热、吸气性呼吸困难、吸气性喉鸣及犬吠样咳嗽等症状消失时间较甲组有显著的减少（P〈0．05）。结论普米克令舒雾化吸人治疗小儿急性感染喉炎起效快、疗效显著,应值得推广使用。     

慢性前列腺炎诊治及疗效评价(附600例报告)

目的：探讨慢性前列腺炎的诊断标准。方法：调查600例慢性前列腺炎病例的实验室诊断结果,按照美国国立卫生研究所（NIH）制定的前列腺炎症状评分（CPSI）标准,进行NIH分类和疗效的判定。应用喹酮类抗生素4－12周,根据病情适当应用α受体阻滞剂、热疗或前列腺按摩疗法。结果：按NIH分类,本组Ⅱ型80例（13．3％）,ⅢA型335例（55．8％）,ⅢB型185例（30．9％）。治疗6周前后CPSI症状评分判定：临床治愈138例（23％）,显效（CPSI减少＞15）372例（62％）,有效（CPSI减少＞15）60例（10％）。无效30例（5％）。结论：两杯判定试验（PPMT法）进行前列腺炎的诊断分类简单易行。CPSI是一种较好的疗效评价方法。喹诺酮类抗生素、α受体阻滞剂和止痛剂等药物的联合应用对慢性前列腺炎具有较好疗效。     

慢性细菌性前列腺炎283例综合治疗的临床研究

目的探讨慢性细菌性前列腺炎的有效治疗方法。方法283例慢性细菌性前列腺炎（CBP）患者随机分成3组：综合治疗组95例：抗生素加前列腺注药、尿道加压灌药;抗生素组94例;中成药组94例。治疗2个月,随访1～3个月,对比分析3种疗法的疗效。结果综合治疗组慢性前列腺炎症状指数（CPSI）平均分值由治疗前的19．4±5．2减少到治疗后的5．2±3．2,抗生素组和中成药组CPSI分别由治疗前的15．3±6．2和16．3±5．0减少到治疗后的10．2±2．2和13．2±3．2,综合治疗组、抗生素组和中成药组的前列腺液常规正常的患者分别为75例（78．99％）、48例（51％）、32例（32．2％）;3组细菌培养转阴者分别为85例（89．5％）、64例（68％）和24例（24％）。综合治疗组与其他2组之间均有非常显著性差异（P〈0．01）。结论综合疗法治疗CBP疗效满意,优于单一治疗方法。     

Controversies in perioperative management and antimicrobial prophylaxis in urologic surgery

Abstract:   The Japanese Urological Association (JUA) recently published guidelines for the prevention of perioperative urologic infections. Although the general remarks in the JUA guidelines are almost similar to those in guidelines previously published by the Centers for Disease Control and Prevention (CDC) and in the European Association of Urology (EAU) guidelines, their differences leave several questions that need to be answered. To clarify agreements and differences in guidelines for perioperative management in urologic interventions for development of more optimal guidelines, reports and reviews previously published were overlooked and discussed. In terms of surgical site infections (SSI) in urologic surgery, consensus for open and endoscopic-instrumental procedures is still somewhat controversial, while a consensus has not yet emerged for its use in laparoscopic procedures. Further research is required to determine what is an optimal prophylactic protocol to effectively prevent both SSI and remote infections (RI).     

罗非昔布联合抗生素治疗慢性前列腺炎

目的:探讨罗非昔布治疗慢性前列腺炎的有效性及安全性.方法:采用随机对照方法,对101例慢性前列腺炎患者应用罗非昔布加抗生素治疗(罗非昔布组)进行8～12周的临床观察,按照美国国家卫生研究院慢性前列腺炎症状评分(NIH CPSI)评估疗效:并与同法应用相同的抗生素对照组(124例)进行比较.结果:罗非昔布组NIH-CPSI总分、疼痛与不适症状评分及排尿症状评分平均降低均较对照组显著(均P＜0.05);罗非昔布组和治愈、显效、总有效率(95.05%)明显高于对照组(52.42%)(P＜0.05).治疗期间罗非昔布组共发生轻度药物不良反应5例(4.95%).结论:罗非昔布联合抗生素治疗慢性前列腺炎疗效显著,安全性好.     

紫黄生肌膏对慢性感染创面血管生成及血管内皮生长因子和血管生成素-1表达的影响

目的:观察紫黄生肌膏对大鼠慢性感染性创面血管生成及血管内皮生长因子(VEGF)和血管生成素(Ang)-1表达的影响.方法:将84只SD大鼠随机分为4组,分别是空白组、模型组、贝复济组、紫黄生肌膏组,造模成功后,除空白组外,其余组每天换药前在创面上涂粪液1 mL,保留30 min后予以清洁换药,于用药后3、7、14 d观...     

Chronic bacterial prostatitis: Theoretical and experimental considerations

Summary The results of the treatment of chronic bacterial prostatitis are disappointing. The current status of antimicrobial and immunological research is described. While both a local and systemic antibody response is demonstrated in acute bacterial prostatis, only a local antibody production is found in chronic bacterial prostatitis. This response as reflected in the expressed prostatic secretion is specific for the infecting organism and immunoglobulin A is the major antibody class involved. Drug penetration into the prostate has mainly been studied in dogs and the ideal drug appears to be a lipid-soluble base which will concentrate in the slightly acidic prostatic secretion because of ion-trapping. However, these results are not directly applicable to humans because of the slight alkalinity of human prostatic secretion, the localization of the chronic inflammatory process in the interstitium, and the evidence of an active secretory mechanism for trimethoprim. The clinical consequences of these findings are discussed in relation to several recent studies and the treatment with lipid-soluble bases with a low plasma protein binding over extended periods is recommended.     

通淋汤治疗慢性前列腺炎的临床与实验研究

目的：探讨通淋汤治疗慢性前列腺炎的疗效及机制。方法：临床研究与应用前列康治疗１００例慢性前列腺炎对比，观察３００例服用通淋汤治疗效果。实验研究对小鼠进行抗炎、镇痛实验以及抑菌实验。结果：临床研究表明通淋汤组总有效率８６％，明显高于前列康组（总有效率５３％）。实验研究表明通淋汤有抑制小鼠炎性肿胀及肉芽肿生长、降低毛细血管通透性及抑菌功效。结论：通淋汤有抗炎、镇痛及抑菌效果，可有效地治疗慢性前列腺炎。