Диагностика и лечение хронического абактериального простатита категории III, ассоциированного с герпесвирусами

Use of the UPOINT Chronic Prostatitis/Chronic Pelvic Pain Syndrome Classification in European Patient Cohorts: Sexual Function Domain Improves Correlations

Multidisciplinary approach to prostatitis.

Numerous studies have established that chronic prostatitis/ chronic pelvic pain syndrome ( CP/CPPS) is the focus of attention of the global medical community, because it is the most common type of disease, the treatment of which has largely unsatisfactory results.Purpose of the work: to conduct a comparative analysis of the microbiota of prostate secretions in patients with CP/CPPS IIIa and IIIb using mass spectrometry of microbial markers (MSMM).Material and methods. A prospective comparative study was conducted from 2018 to 2023 at the SM-Clinic medical center. 205 patients with prostatitis-like symptoms and 70 males who applied for a screening examination with no complaints at the age of 25 to 50 years were selected. The subjects were divided into three groups: group 1 – patients with CP/CPPS category IIIa, group 2 ( n = 85) patients with CP/CPPS category IIIb with clinical manifestations of chronic prostatitis and group 3 ( n = 70) – without clinical manifestations prostatitis/control group. A study of the microbiota of prostate secretions was carried out using gas chromatograph mass spectrometer "Maestro" (LLC "Interlab", Russia).Results. The results of statistical analysis showed that the level of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and the control group, was significantly higher ( p = 0.0020 ; p < 0.0001; p < 0.0001; p = 0.0254; p = 0.0254). It was revealed that in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and healthy people, there was a significant increase in the total load of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses . When analyzing the relationship between the absolute number of microorganisms, it was revealed that an increase in the level of many microorganisms is associated with an increase in the probability of detecting a leukocyte level 10. An analysis of the relationship between the occurrence of individual microorganisms and leukocyte values in prostate secretions ≥10 showed that an increase in the indicators of many microorganisms, compared with the control group, increased the chances of having a leukocyte level ≥10 several times.Conclusion. Identification of microbial associations in prostate secretions using the MSMM method and an increase in the total load of microorganisms in patients with CP/CPPS IIIa, compared with CP/CPPS IIIa and the control group, suggests the role of infection in a certain part of patients with CP/CPPS IIIa, which dictates the need to change the view of the urologist in the diagnosis and treatment strategy of these patients.

EVALUATION OF THE BACTERIAL FLORA OF THE PROSTATE USING A 16S rRNA GENE BASED POLYMERASE CHAIN REACTION

In this study urine and prostatic secretion samples of patients with chronic prostatitis were investigated for various prostatitis pathogens and the correlation between clinical symptoms. A total of 60 patients with chronic prostatitis were examined, prostatic secretion and urine specimens were evaluated under direct microscopy after staining with Giemsa and Gram. The selective media were used to investigate the presence of bacterial pathogens, Mycoplasma hominis and Ureaplasma urealyticum. Based on the laboratory findings of patients, 11(18.3%) were found to have chronic bacterial prostatitis, 49 (81.7%) were found to have chronic pelvic pain syndrome. Organisms isolated in patients with chronic bacterial prostatitis includedEscherichia coli in four cases, Staphylococcus aureus in two cases andPseudomonas aeruginosa, Klebsiella pneumoniae, coagulase-negative staphylococci, Enterococcus faecalis and diphtheroids in one case each. Of the 49 patients with chronic pelvic pain syndrome, U. urealyticum was isolated in seven and M. hominis in one of the patients. Premature ejaculation was more frequently detected in the patient group with chronic bacterial prostatitis than the patient group with chronic pelvic pain syndrome. Analysis of etiology of chronic prostatitis in our patients showed that U. urealyticum and E. coli were common pathogens of chronic prostatitis. We concluded that chronic bacterial prostatitis may increase the risk of premature ejaculation. Key words: Chronic prostatitis, etiology, Ureaplasm urealyticum, Mycoplasma hominis, premature ejaculation.

Numerous studies have established that chronic prostatitis/ chronic pelvic pain syndrome ( CP/CPPS) is the focus of attention of the global medical community, because it is the most common type of disease, the treatment of which has largely unsatisfactory results. Purpose of the work: to conduct a comparative analysis of the microbiota of prostate secretions in patients with CP/CPPS IIIa and IIIb using mass spectrometry of microbial markers (MSMM). Material and methods. A prospective comparative study was conducted from 2018 to 2023 at the SM-Clinic medical center. 205 patients with prostatitis-like symptoms and 70 males who applied for a screening examination with no complaints at the age of 25 to 50 years were selected. The subjects were divided into three groups: group 1 – patients with CP/CPPS category IIIa, group 2 ( n = 85) patients with CP/CPPS category IIIb with clinical manifestations of chronic prostatitis and group 3 ( n = 70) – without clinical manifestations prostatitis/control group. A study of the microbiota of prostate secretions was carried out using gas chromatograph mass spectrometer "Maestro" (LLC "Interlab", Russia). Results. The results of statistical analysis showed that the level of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and the control group, was significantly higher ( p = 0.0020 ; p < 0.0001; p < 0.0001; p = 0.0254; p = 0.0254). It was revealed that in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and healthy people, there was a significant increase in the total load of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses . When analyzing the relationship between the absolute number of microorganisms, it was revealed that an increase in the level of many microorganisms is associated with an increase in the probability of detecting a leukocyte level ≥10. An analysis of the relationship between the occurrence of individual microorganisms and leukocyte values in prostate secretions ≥10 showed that an increase in the indicators of many microorganisms, compared with the control group, increased the chances of having a leukocyte level ≥10 several times. Conclusion. Identification of microbial associations in prostate secretions using the MSMM method and an increase in the total load of microorganisms in patients with CP/CPPS IIIa, compared with CP/CPPS IIIa and the control group, suggests the role of infection in a certain part of patients with CP/CPPS IIIa, which dictates the need to change the view of the urologist in the diagnosis and treatment strategy of these patients

An economic analysis of antiviral therapy in patients with advanced hepatitis C virus disease: still not there!

PREDICTORS OF PATIENT RESPONSE TO ANTIBIOTIC THERAPY FOR THE CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: A PROSPECTIVE MULTICENTER CLINICAL TRIAL

Background: in recent decades, advancements indiagnostic methods for viral infections have stimulated increased interest in studying the role of herpesviruses in disorders of the reproductive system. Emerging evidence has suggested their potential involvement in the pathogenesis of chronic nonbacterial prostatitis. Aim: the study aimed to analyze the microbiota of prostatic secretions (MPS) in patients diagnosed with chronic nonbacterial prostatitis associated with herpesviruses, utilizing mass spectrometry of microbial markers (MSMM). Materials and Methods: a prospective comparative study was conducted from 2018 to 2023, which included two groups: study group — 61 male participants aged 25–50 years presenting with symptoms indicative of prostatitis and the presence of herpesviruses in the MPS; control group — 70 healthy asymptomatic patients of the same age group had no complaints undergoing routine screening. Results: average levels of Herpes simplex virus types 1 and 2 (HSV-1/2), cytomegalovirus, and Epstein–Barr virus (EBV) in prostatic secretions, as determined by MSMM, were significantly higher in patients with chronic nonbacterial prostatitis associated with herpesviruses compared to the control group. These values are presented as medians with interquartile ranges (×105 cells/mL): HSV-1/2: 36.5 (25; 64.5) vs. 2 (2; 2), respectively (p<0.0001); Cytomegalovirus: 51.5 (22.75; 124) vs. 6.5 (3.5; 11.75) (p<0.0001); EBV: 13.5 (5.75; 32.25) vs. 2 (0.2; 2.25) (p<0.0001). Additionally, patients with chronic nonbacterial prostatitis exhibited a significant increase in the total microbial load (10566 (4809; 16654) ×105 cells/mL vs. 2152 (1196.75; 3612.5) ×105 cells/mL, p<0.0001). Subgroup analysis revealed elevated levels of the following microbial taxa in the study group: Cocci and bacilli: Streptococcus mutans (anaerobic) and Staphylococcus aureus (p<0.0001 and p=0.0004, respectively); Anaerobes: Clostridium difficile, Clostridium ramosum, Eggerthella lenta, Lactobacillus spp., and Peptostreptococcus anaerobius (p<0.0001); Actinobacteria: Actinomyces viscosus and Rhodococcus spp. (p<0.0001); Fungi and yeasts: Aspergillus spp. (p=0.0316) and Candida spp. (p=0.0002). Conclusion: the observed increase in viruses load in patients with chronic prostatitis underscores the critical need to examine prostatic secretions for viral pathogens. These findings suggest that herpesviruses may act as a contributing factor in sustaining the chronic inflammatory process. This evidence supports the inclusion of targeted antiviral therapy in the comprehensive management of chronic nonbacterial prostatitis, with the potential to enhance diagnostic accuracy and therapeutic outcomes for affected individuals. Keywords: herpesviruses, microbiota, prostate secretion, mass spectrometry of microbial markers, microorganisms. For citation: Stepanov V.S., Kadyrov Z.A., Faniev M.V., Ishonakov Kh.S. Microbiota of prostate secretion in patients with chronic category III nonbacterial prostatitis associated with herpesviruses. RMJ. 2024;11:13–18. DOI: 10.32364/2225-2282-2024-11-3

THE CHRONIC PROSTATITIS-CHRONIC PELVIC PAIN SYNDROME CAN BE CHARACTERIZED BY PROSTATIC TISSUE PRESSURE MEASUREMENTS

The aim of the study was to analyze the role of the herpes simplex virus and cytomegalovirus in the etiology of chronic abacterial prostatitis. We examined 98 men with chronic abacterial prostatitis category IIIB, the comparison group consisted of 40 healthy men. In order to confirm viral etioloigi, all patients underwent additional specific examination: serological markers (antibodies (AT) of IgM and IgG classes were determined by ELISA), as well as virological (DNA of viruses in prostate secretion or ejaculate by PCR). To establish the duration of infection, the avidity index (AI) of IgG class antibodies was determined. According to the study, the criteria for the activity of a viral infection are determined: these are IgM, low-avid IgG, virus DNA in prostate secretions or ejaculate. According to the results of the study, in 20 patients (25.9%) of all seropositive patients, according to a specific examination, one or several criteria for the activity of a viral infection were detected, this indicates a recent infection or activation of herpes virus infection (herpes virus + cytomegalovirus), which may explain the clinical picture of chronic prostatitis. The main criterion for the diagnosis of chronic abacterial prostatitis herpetic and cytomegalovirus etiology is the detection of virus DNA in the prostate secretion or ejaculate by PCR.

1089 HEAT-SHOCK PROTEIN 70 EXPRESSION IN THE SEMINAL PLASMA OF PATIENTS WITH CHRONIC BACTERIAL PROSTATITIS AND CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study.

The objective: effectiveness of the drug PHARMAPROST manufactured by SYSTEM PHARM (Ukraine) in patients with benign prostatic hyperplasia (BPH) I degree in combination with chronic abacterial prostatitis, (NIH USA, category IIIa CP/CPPS – chronic prostatitis and chronic chronic syndrome) pain with signs of inflammation), assessment of the quality of treatment by patients, the study of intolerance and possible side effects of the study drug.Materials and methods. The Ukrainian Institute of Sexology and Andrology studied the clinical efficacy of PHARMAPROST manufactured by SYSTEM PHARM (Ukraine) in patients with grade I BPH in combination with chronic abacterial prostatitis.Study design: examined and treated 60 men with BPH I degree in combination with chronic abacterial prostatitis, aged 48 to 66 years and disease duration from 6 months to 12 years. The treatment program consisted of two courses of rectal suppositories PHARMAPROST for 10 days a night, the interval between courses was 20 days. All 60 patients completed the full course of treatment.Evaluation of effectiveness: the study included two visits (before and after treatment), during which a history was collected, physical examination, laboratory examination of ejaculate (clinical analysis and bacteriological examination), questionnaire, uroflowmetry, ultrasound. The effectiveness of treatment was evaluated 30 days after the end of the course.Results. The obtained data confirm the clinical efficacy of PHARMAPROST presented inUkraine by SYSTEM PHARM (Ukraine) in 60 patients with a combination of grade I BPH and chronic abacterial prostatitis (NIHUSA, category IIIa CP/CPPS – chronic prostatitis/chronic pelvic syndrome) signs of inflammation). High clinical (89.6–91.7 %) efficacy of this drug has been proven. Treatment was accompanied by good tolerability and minimal side effects.Conclusions. The use of the drug PHARMAPROST in the treatment of patients with chronic abacterial prostatitis and BPH I degree is clinically justified and effective (89.6–91.7 %). The use of the drug PHARMAPROST is accompanied by good tolerability and a small number of side effects (8.3 %). The obtained results allow to recommend the use of the drug PHARMAPROST as monotherapy of patients with a combination of BPH I degree and chronic abacterial prostatitis.

The purpose of this study was to assess the diagnostic value and potentially protective capacity of heat-shock protein 70 (HSP70) in chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this study, seminal plasma levels of cytokines (tumor necrosis factor-α (TNF-α) and interleukin 1β (IL-1β)) and HSP70 were evaluated by enzyme-linked immunosorbent assay in 80 men: 15 healthy controls, 16 men with chronic bacterial prostatitis, 23 men with CP/CPPS IIIA and 26 with CP/CPPS IIIB. The HSP70 levels in chronic bacterial prostatitis and CP/CPPS patients were correlated with chronic prostatitis symptom index (CPSI). Significantly increased levels of cytokines (TNF-α and IL-1β) and HSP70 were observed in seminal plasmas from patients with chronic bacterial prostatitis compared with CP/CPPS patients and controls. However, only IL-1β was significantly elevated compared with CP/CPPS IIIB and controls in patients with CP/CPPS IIIA. HSP70 levels in CP/CPPS patients were significantly lower than that in controls. HSP70 concentration in seminal plasma was negatively correlated with CPSI in chronic bacterial prostatitis. The results indicated that HSP70 and IL-1β appear to be the most reliable and predictive surrogate markers to diagnose chronic bacterial prostatitis and CP/CPPS, respectively. HSP70 has an important protective role in the regulation of cell functions in chronic bacterial prostatitis. CP/CPPS would probably be detrimental to the ability of T cells and consequently suppress the expression of HSP70.