Chronic Bacterial Prostatitis Research Articles

Levofloxacin Versus Ciprofloxacin in the Treatment of Urinary Tract Infections: Evidence-Based Analysis.

Urinary tract infections (UTIs) are one of the most common bacterial infections acquired both in community and hospital. Fluoroquinolones, represented by levofloxacin and ciprofloxacin, are widely used for treatment of UTIs. However, it remains controversial for the comparison between the 2 drugs, which propelled us to conduct the first evidence-based research on this topic. To establish their relative efficacy and safety, we searched Pubmed, embase, and Web of Science for randomized controlled trials (RCTs) for UTIs. A total of 5 RCTs were finally included, involving 2,352 patients and a systematic review and meta-analysis were performed to compare the end-of-therapy and posttherapy clinical success rate, microbial eradication rate and adverse event rate. Jadad score and Review Manager 5.3.0 version were applied respectively to evaluate the study quality and heterogeneity. There was no significant difference between levofloxacin and ciprofloxacin group in end-of-therapy or posttherapy clinical success rate and microbial eradication rate (p > 0.05). As for adverse event rate, the 2 drugs were comparable and both safe for clinical use. Based on one included trial and pharmacological research, we raised hypothesis that levofloxacin was superior to ciprofloxacin for treatment of E. coli-induced chronic bacterial prostatitis (CBP) and it required a further study to prove it.

Highland Influence on Chronic-bacterial-prostatitis and Developing-reason of Prostate-cancer, KSA

This work was for "Highland (HL) Influence on Chronic-bacterial-prostatitis (CBP) and Developing-reason of Prostate-cancer (PCa), KSA"; the purpose was to determine CBP percentage at HL "Taif"; and influence of location factors on CBP percentage and indication of its developing-reason to causing PCa. It may negatively affected other body organs and may reach death of males' society, affected marital and community life. Used medical methods for cases taster (CsT) from patients were diagnosed as suffered from CBP. That were used direct and indirect identification by "CHROMagar Orientation Medium", and "VITEK 2 System (BioMerieux, France)". The pathogenic bacteria were found in more than a quarter of the CsT as (26 and 29%). That were Staphylococcous aureus (Staph. aureus), Escherichia coli (E. coli), Staphylococcous epidermidis (Staph. epidermidis) and Streptococcus species (Strept. Spp) in (36.2%, 9.5%, 5.7% and 4.3%) respectively. Pathogenic bacteria Staph. aureus represented more than third of CsT. E. coli represented tenth and it was dangerous for its transmission from UT and GT easily. Staph. epidermidis was present on the skin and represented normal flora can easily contaminated. Strept. Spp represented less than tenth, can transferred to prostate tissue and cause CBP leading to PCa. Concluded the CBP infection was present in HL and had developing-reason for PCa, the conditions must followed to reduce it to prevent condition of turning into PCa. Recommended best periodic follow-up to detect CBP infection presence to protect against infection and its PCa developing-reason. Cases CBP infection must treated and PCa cases should not neglected or tolerated.

The use of Lactobacillus casei DG\xae prevents symptomatic episodes and reduces the antibiotic use in patients affected by chronic bacterial prostatitis: results from a phase IV study

PurposeTo evaluate the efficacy of Lactobacillus paracasei CNCM I-1572 (L. casei DG®) in both prevention of symptomatic recurrences and improvement of quality of life in patients with chronic bacterial prostatitis (CBP).MethodsPatients with CBP attending a single Urological Institution were enrolled in this phase IV study. At enrollment, all patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG® (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before (enrollment, T0) and 6 months (T2) after the treatment. Both safety and adherence to the treatment were evaluated 3 months (T1) after the enrollment. NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The outcome measures were the rate of symptomatic recurrence, changes in questionnaire symptom scores and the reduction of antibiotic use.ResultsEighty-four patients were included. At T2, 61 patients (72.6%) reported a clinical improvement of symptoms with a return to their clinical status before symptoms. A time dependent improvement in clinical symptoms with significant changes in NIH-CPSI, IPSS and QoL (mean difference T2 vs T0: 16.5 ± 3.58; − 11.0 ± 4.32; + 0.3 ± 0.09; p < 0.001), was reported. We recorded that L. casei DG® treatment induced a statistically significant decrease in both (p < 0.001) symptomatic recurrence [1.9/3 months vs 0.5/3 months] and antibiotic use [− 7938 UDD]. No clinically relevant adverse effects were reported.ConclusionsL. casei DG® prevents symptomatic recurrences and improves the quality of life in patients with CBP, reducing the antibiotic use.

Sexuality, Sexual Orientation and Chronic Prostatitis

Chronic prostatitis (CP) is a common health condition in men. Albeight obvious, a relationship between microbial induced prostatic inflammation and sexual function has not been as thoroughly investigated. Aiming to investigate possible associations between sexuality/sexual orientation and chronic bacterial prostatitis, we retrospectively evaluated 1783 visits (2009-2019) owing to investigation of prostatitis-like symptoms and routine follow up. A total of 389 patients, provided information regarding sexual orientation and sexuality. The mean age was 45,5 years. According their report, 92.28% were heterosexual, 6.16% homosexual and 1.54% bisexual. Regarding sexuality, 26,6% reported multiple sexual partnerships while 73,4% reported single sexual partnerships. There was a statistically significant association between chronic bacterial prostatitis as initial diagnosis and having multiple sexual partnerships. In contrast, the association between CBP and sexual orientation was not statistically significant Similarly, no significant association between any therapy outcome and having multiple sexual partners was established. Our findings suggest a connection between sexual practices and the onset of CBP which should be further investigated in order to reach to scientific conclusions.

Vacuum interference therapy in the complex treatment of patients with chronic bacterial prostatitis

Scientific substantiation of combined electric vacuum exposure in patients with chronic bacterial prostatitis (CBP). The 90 patients with CBP aged 27-55 years were examined and were divided into 3 equal groups by the method of simple randomization. Patients of the main group received vacuum interference therapy procedures, the comparison group received interference therapy without vacuum exposure, and the control group received only standard drug therapy that was also prescribed in the first two groups. The effectiveness of therapy was assessed before, immediately after and 6 months after using the NIH-CPS, IPSS, QOL scales, trans-rectal ultrasound examination of the prostate gland, bacteriological examination and microscopy of a native preparation of prostate secretion and uroflowmetry. An improvement in the clinical symptoms of CBP was found largely in the groups receiving physiotherapy. In the main group there was a more significant volume decrease in the inflammatory-altered prostate gland (by 31.5%), in the comparison group the volume of the prostate gland decreased by 14%, and in the control group - by 9.6% that indicates the most pronounced anti-inflammatory effect of electro-vacuum actions. In the main group, there was also a more pronounced positive dynamics of dysuric disorders' indicators and maximum urination rate compared to the comparison and control groups. A higher clinical efficacy of vacuum interference therapy in patients with CBP (93.3%) has been proven compared with interference therapy (80.0%) and standard therapy (66.6%). The data obtained confirm the advantages and usage prospects of the combined physiotherapeutic effects.

How urologists deal with chronic prostatitis? The preliminary results of a Mediterranean survey

We performed a questionnaire survey to investigate various issues in the diagnosis of chronic prostatitis (CP) performed by Greek urologists and to assess some aspects of prostatitis workup in Greece. Replies were compared with those of Italian clinical research partners in an attempt to clarify the CP diagnostic approaches in Southern European Mediterranean countries. We translated the original Italian questionnaire presented by Magri and Montanari in the frame of a urological congress held in Milan on October 26th, 2018. Τhis 5-item questionnaire explores clinical practice characteristics, attitudes, and diagnostic strategies for the management of chronic prostatitis (Chronic Bacterial Prostatitis or Chronic Prostatitis/Chronic Pelvic Pain Syndrome, according to NIH criteria). After its validation the questionnaire was uploaded in the internet and Greek healthcare professionals were invited by mail to respond. Responses were compared with those of Italian urologists, in order to determine similarities and differences in attitudes between clinicians regarding the diagnostic assessment of CP. There is a wide variation in participants' preferences for diagnostic methods, laboratory tests and clinical examinations both in Italy and in Greece. In both countries many diagnostic tests performed in affected patients are only geared to exclude other treatable conditions (e.g., benign prostatic hyperplasia, bladder cancer), but more suitable methods and tests for the assessment of CP are less frequently used. Urologists' choices for the diagnostic workup of CP, show a wide international or intra-national variability between Greece and Italy. Although several diagnostic tests are available to differentiate and categorize the types of CP, a large number of urologists use less suitable methods and tests. This fact reflects both the lack of consensual vision in the literature and the difficulties encountered on a daily basis by the physicians. Under the light of this evidence, the need of studies establishing consensual guidelines for the optimal diagnosis of CP is becoming imperative.

Lithogenic Potential of Ureaplasma in Chronic Prostatitis

Introduction: The role of Ureaplasma spp. (UPs) in the pathogenesis of chronic prostatitis is debated. The lithogenic potential of UPs could be a risk factor for the development of chronic prostatitis. Methods: A total of 143 patients with identification of UPs were retrospectively selected from a database including patients with prostatitis-like symptoms who were studied according to the same protocol including clinical, microbiological and microscopic evaluation, and transrectal prostate ultrasound. A control group of patients with negative UPs was considered including 393 with chronic bacterial prostatitis (CBP), 42 patients with Chlamydia trachomatis (CT), and 781 patients with chronic pelvic pain syndrome. UPs and Mycoplasma hominis (MH) were identified using a semiquantitative assay. Results: Calcifications were observed more frequently in patients with UPs (64%) than in patients with CBP without UPs (39%), CT infection (37%), and chronic pelvic pain syndrome (29%) (p < 0.0001). UPs were isolated in VB1 alone in 35 patients (urethral UPs), in expressed prostatic secretion (EPS) or post-massage urine (VB3) or sperm in 77 patients (prostatic UPs) and associated with other pathogens in 31 patients (associated UPs). Calcifications were more frequent in prostatic UPs (71%) and associated UPs (73%) than in urethral UPs (34%). Mean NIH-CPSI scores were not significantly different between groups, although mean WBC counts of sperm of patients with urethral UPs were significantly lower than in patients with prostatic UPs (p = 0.000) and associated UPs (p = 0.002). Conclusions: UPs identification in the urogenital fluids is related to higher rates of prostate calcifications. The ability of UPs to promote the formation of calcifications could be related to the chronicization of prostate infection. In particular, the presence of UPs in VB3/EPS/sperm is associated with higher rates of calcifications and high WBC sperm counts, suggesting a partial or full causative role of UPs in the pathogenesis of this disease.

Характеристика микробиоты и цитокинового профиля спермоплазмы у больных хроническим бактериальным простатитом

BACKGROUND One of the leading causes of the occurrence of chronic bacterial prostatitis (CBP) in men is infection, microecological disorders of the urogenital tract and cytokine-mediated mechanisms of inflammation of the prostate gland, which actualizes a comprehensive study of the clinical and bacteriological features of CBP from the perspective of a symbiotic approach in the framework of a new scientific field - infectious symbiology. OBJECTIVE to study the characteristics of spermogram, microbiota, and the cytokine profile in men with chronic bacterial prostatitis (CBP) and CBP complicated by infertility. MATERIALS AND METHODS A comprehensive study of patients with CBP and CBP complicated by infertility, in comparison with conditionally healthy individuals, was conducted. Species identification of microorganisms was carried out according to biochemical characteristics and the genetic method (sequencing of strains). The biological properties of the microbiota were evaluated: growth properties, biofilm formation, antipeptide activity against the cytokines IL-10, RAIL-1, TNF-, INF- and IL-17 (8 parameters). Immunological parameters of sperm plasma included 13 parameters: the content of cytokines TNF-, INF-, Rail, interleukins (IL) -1, 2, 4, 6, 8, 10, 17, immunoglobulin (Ig) A, lactoferrin and lysozyme. To evaluate sperm plasma, the following quantities were determined: ejaculate volume, pH, sperm plasma liquefaction, total sperm count, sperm count per 1 ml, motility, number of progressively motile, non-progressive motile and motionless spermatozoa, number of round cells, white blood cells, spermatogenesis cells, erythrocytes, erythrocytes, cells, sperm agglutination and aggregation (16 parameters in total). The results are statistically processed. RESULTS Data were obtained on changes in biofilm formation, antipeptide activity of microbiota (especially pronounced in corynebacteria), sperm plasma cytokine profile (increased TNF , IL-2, 6, 17), as well as IgA and lactoferrin, which can be used to build a prognostic model of reproductive pathology tract of men and their fertile activity. CONCLUSION The study of the antipeptide activity of microbiota in combination with the cytokine profile of ejaculate allows us to recommend them as a biotarget for diagnostic, preventive and therapeutic measures for chronic prostatitis in men, which contribute to solving the medical and social problem of preventing male infertility and contributes to the development of health-saving technologies with incorporating elements of personalized medicine.

Does the four-glass test still have a place in microbiological evaluation of chronic prostatitis? Findings from an Indian tertiary care centre

Background: Chronic prostatitis (CP) is a bothersome disease affecting young and middle-aged men. Routine cultures often fail to localize the source of infection. Although the four-glass test is considered the gold-standard test for evaluating CP, it has found less favour in clinical practice. We re-inspected its utility in patients suffering from CP. Methods: Seventy cases of CP of Indian origin were enrolled. The four-glass test was conducted, and the samples were labelled as VB1, VB2, VB3 and EPS. A quantitative culture and drug sensitivity test for 16 antimicrobials was performed. Results: Samples from 61 patients ( Mage=36 years) were analysed. Chronic bacterial prostatitis was identified in 29 (47.5%) cases. Enterococcus spp. were the most common isolate, followed by Escherichia coli. A wide variability in positivity pattern was noted in the four-glass test. The most common pattern was for only the EPS sample to be positive (nine cases; 16.1%), followed by all four samples to be positive (seven cases; 12.5%). High susceptibility was found (94–100%) against third-generation cephalosporins, meropenem, amikacin, gentamicin and nitrofurantoin. Conclusions: The four-glass test is still important in the evaluation of CP. In about half of the cases examined in this study, bacterial localization could be made to the prostate. Level of evidence: Level IIIb.

SC107 - Escherichia coli Nissle 1917 as adjuvant therapy in patients with chronic bacterial prostatitis: a non-blinded, randomized, controlled trial

SC107 - Escherichia coli Nissle 1917 as adjuvant therapy in patients with chronic bacterial prostatitis: a non-blinded, randomized, controlled trial

Эффективность рекомбинантного интерферона альфа-2b в лечении хронического рецидивирующего бактериального простатита

Chronic recurrent bacterial prostatitis (HRBP) affects the reproductive function and negatively affects the quality of life of men. The multifactorial pathogenesis of this disease causes the failure of antibiotic therapy and some cases, requires an in-depth study of the mechanisms of disease development and additional treatment methods. of the study: to study of the effectiveness of immunoactive therapy (recombinant interferon alpha-2b with an antioxidant complex) in combination with antibacterial therapy in patients with HRBP. Prospective trial: examination and treatment of 62 patients. Two groups: I (study) group (n=31) received antibacterial therapy (ABT) and a therapy with recombinant IFN Alpha-2b based medication with antioxidant complex (vitamins E and C), II (control) group (n=31) received only ABT. The examination plan included questionnaires (NIH - CPSI, IPSS, Hamilton), general blood and urine tests, biochemical blood tests, urethral scrapings for PCR diagnostics, plasma testosterone, native, electron microscopy, culture test and immunoferment analysis of the prostate sercet, uroflowmetry, Transrectal ultrasonography (TRUS). When monitoring the clinical picture according to questionnaires (IPSS, NIH-CPSI, Hamilton scale) and laboratory indicators, 1 month after treatment, a significant reduction in symptoms was observed in both groups, and after 3, 6, and 12 months - in patients of group I. The Combination of an antibacterial drug and recombinant interferon alpha-2b in the treatment of HRBP provides more effective relief of the infectious and inflammatory process in the long term than antibacterial monotherapy.

The efficacy of Adenoprosin® in combined treatment of patients with chronic bacterial prostatitis

Background. Chronic bacterial prostatitis is a common disease clinically diagnosed based on signs of inflammation and the presence of infection in the prostatic fluid. Standard antibiotic therapy in most cases does not lead to a decrease in the number of recurrences. In this connection, an integrated approach is often used in therapy, and in addition to antibacterial therapy, biostimulators, extracts of various plants and animals are prescribed. One of the main advantages of these prescriptions is that the drugs have minimal side effects.Objective. To assess the effectiveness of the use of Adenoprosin® in the combined treatment of patients with chronic bacterial prostatitis.Material and methods. 60 patients aged from 24 to 50 years old (average age is 31.3 ± 2.8 years) with a diagnosis of chronic bacterial prostatitis were examined and treated, the duration of the disease ranged from 6 months to 15 years (average duration of the disease is 1.5 ± 0.3 years). The patients were divided into two groups: group I included 30 patients who were treated with antibacterial drugs and Adenoprosin®, group II included 30 patients who were treated with antibacterial drugs only. The course of treatment lasted 30 days, the total time of observation of the patients was 3 months. Clinical control was carried out at the first visit to the urologist, on the 14th, 28th, 45th and 90th days from the start of therapy and included filling out the following: The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), The International Prostate Symptom Score (IPSS) and Quality of Life (QoL), as well as the International Index of Erectile Function (IIEF-5) questionnaire in order to identify the possible effect of therapy on sexual function.Results. The analysis revealed that the use of the Adenoprosin® in complex therapy in patients with chronic bacterial prostatitis reduces the overall score of the NIH-CPSI questionnaire by an average of 4 points. When conducting a questionnaire at the end of treatment, 2 (6.6%) patients in the group II noted dissatisfaction with the therapy, on the 90th day of observation, complaints of dissatisfaction with the treatment remained in 1 (3.3%) patient. In 5 (16.6%) patients of the group II, against the background of the therapy, there was no subjective improvement in the treatment; on the 90th day of observation, the number of unsatisfied patients remained the same. Analysis of the results of microscopy of the prostatic fluid and microflora after treatment on day 28 showed the decrease in the content of leukocytes in the group I patients – less than 10 leukocytes in the field of vision in 25 (80%) patients, which was higher in comparison with patients of the group II – 21 (70%). In 5 (16.6%) patients of the group I, the number of leukocytes in the prostatic fluid was in the range of 10–20 in the field of view, all patients had previously had recurrent forms of the disease. The number of leukocytes more than 10, after antibacterial therapy in the group II, was in 7 (23.3%) patients, of them 5 (16.6%) patients had recurrent forms of the disease, and 2 (6.6%) patients were diagnosed with prostatitis for the first time. Thus, the use of combination therapy in the group I, to a greater extent, reduced the inflammatory markers of the disease.Conclusion. The Adenoprosin® in complex therapy has a proven anti-inflammatory effect on the prostate gland, reduces the pain rapidly, decreases the total score of prostatic symptoms when analyzing the NIH-CPSI questionnaires, improves erectile function, reduces markers of inflammation in the pre-fetal gland and can be recommended for patients with chronic bacterial inflammation in the prostate gland.

Persistent Epididymitis Due to Bacteroides fragilis After Biopsy of the Prostate

To the Editor: Infectious and noninfectious etiologies account for epididymitis. In older men, bacteriuria caused by prostatic hypertrophy, urethral instrumentation, and urologic surgery including prostatic biopsy can all lead to infection of the epididymis.1 Enterobactereciae, like Escherichia coli and other coliforms, are the most common pathogens implicated in infectious epididymitis in men older than 35 years.2 Appropriate antibiotic therapy must empirically provide coverage of these organisms. The Centers for Disease Control and Prevention (CDC) guidelines consider fluroquinolones as the first-line agents.3 Obligate anaerobic microorganisms are not commonly reported as potential pathogens for epididymitis. We report the first case of acute epididymitis due to Bacteroides fragilis that did not respond to standard care of therapy and ultimately required surgical scrotal exploration and orchiectomy. A 72-year-old man presented to our institution complaining of progressively worsening swelling and pain of the left scrotum of 3-week duration. This started shortly after a transrectal ultrasound-guided biopsy of the prostate gland 1 month before our evaluation. Sulfamethoxazole/trimethoprim was prescribed postoperatively as prophylaxis. The patient had a history significant for chronic lymphocytic leukemia on ibrutinib, which was held because of concerns of active infection. The prostatic biopsy revealed prostatic adenocarcinoma with a Gleason score of 3 + 3 = 6. The patient had completed a two 10-day course of antibiotics, levofloxacin, and sulfamethoxazole/trimethoprim, respectively, with minimal relief. The prostatic specific antibody was 6.31 ng/mL before the biopsy. The white blood cell count was 12,000 cells/mm3, and creatinine 1.2 mg/dL. The urinalysis showed negative leukocyte esterase and urine culture showed less than 1000 CFU/mL. A scrotal ultrasound (Fig. 1) demonstrated marked left acute epididymitis with phlegmon in the tail of the epididymis and thickening of the left anterior scrotal wall. A trial of ertapenem was started. Because of persistent and increasing pain and swelling, the patient underwent an orchiectomy. Histological examination revealed evidence of acute and chronic epididymitis (Fig. 2). Tissue culture grew moderate Bacteroides fragilis. Speciation was confirmed by matrix-assisted laser desorption time-of-flight mass spectrometry. The minimum inhibitory concentration for metronidazole was 8 mg/L or less. The patient completed a short postoperative course of cefpodoxime with metronidazole without any postsurgical complications.FIGURE 1: Ultrasound demonstrating acute epididymitis (asterisk).FIGURE 2: A, Epididymis hematoxylin and eosin stain, magnification ×40. B, Hematoxylin and eosin stain, acute and chronic inflammation of the epididymis at ×200 magnification.Prostatic biopsies can rarely lead to chronic prostatitis and epididymitis (1%).4 Infections due to anaerobic bacteria of the genitourinary tract have been described, like periurethral abscess, prostatic abscess, urethritis, cystitis, but not of the epididymis.5 Szoke et al6 in their cohort of 50 patients with chronic prostatitis reported 93 anaerobes cultured from expressed prostatic secretions, with 13 isolates being Bacteroides urealyticus and Bacteroides species. In their review, the isolation of these bacteria was likely the etiology of therapy-resistant chronic bacterial prostatitis.6 We theorize that the transrectal prostatic biopsy likely introduced B. fragilis—which colonizes the gastrointestinal tract including the rectum and is often isolated from rectal abscesses—to the procedure site, which then spread to the epididymis. The patient was treated for epididymitis with appropriate empiric antibiotic therapies without clinical response. In these rare cases of therapy-resistant epididymitis, anaerobic bacteria should be considered as possible etiology. Collection of semen specimen or epididymal aspiration—in consultation with a urologist—can be considered for both aerobic/anaerobic cultures.7,8 Empiric anaerobic antibiotic coverage should also be considered in cases of epididymitis after transrectal prostatic biopsies. Maymonah Belal, MD Stony Brook Medical Center Stony Brook, NY,Monica Mcgee, MS, MT Department of Microbiology Veterans Affairs Medical Center Northport NYZeena Lobo, MD Division of Infectious Diseases Veterans Affairs Medical Center Northport, NYGeorge Psevdos, MD Division of Infectious Diseases Veterans Affairs Medical Center Northport, NY Stony Brook University School of Medicine Stony Brook, NY [email protected]

Eficácia Clínica da Antibioterapia na Prostatite Crónica por Microrganismos Resistentes aos Antibióticos de Primeira Linha

Introdução: Métodos: Resultados: Discussão: Conclusão: A prostatite crónica bacteriana corresponde a 5% - 10% dos casos de prostatite crónica, sendo responsável porum declínio significativo na qualidade de vida destes doentes. A abordagem terapêutica atual da prostatite crónica bacteriana baseia-se em antibioterapia de longa duração com fluoroquinolonas. Contudo, muitos destes casos recidivam com resistência e requerem antibioterapia, por vezes por via parentérica, em regime de internamento. Este trabalho apresenta uma revisão da literatura relativa à eficácia de alguns antibióticos, por via oral, no tratamento da prostatite crónica bacteriana por microrganismos resistentes aos antibióticos de primeira linha. Métodos: Revisão da literatura, seguindo a metodologia PICO, através da PubMed, utilizando como palavras-chave: “prostatitis”, “nitrofurantoin”, “macrolides”, “fosfomycin”, “amoxicillin”, “cephalosporins”, “tetracycline” e “doxycycline”. Resultados: Foram incluídos 15 estudos que avaliaram a eficácia clínica (cura clínica) e/ou microbiológica (erradicação bacteriana) em homens com prostatite crónica bacteriana por diversos agentes etiológicos tratados com fosfomicina, amoxicilina, macrólidos ou tetraciclinas. E Discussão: Em duas séries de casos publicadas, a fosfomicina e a combinação amoxicilina-ácido clavulânico apresentaram eficácia parcial na prostatite crónica bacteriana por Enterobacteriáceas multirresistentes. A combinação fluoroquinolona-macrólido revelou-se também muito eficaz na prostatite por agentes etiológicos tradicionais. A maioria da investigação sobre o papel dos macrólidos e tetraciclinas na prostatite crónica bacteriana está direcionada para agentes atípicos intracelulares, sendo de primeira escolha nesta etiologia. Conclusão: Dada a necessidade de novas alternativas para o tratamento da prostatite crónica bacteriana resistente, são precisos mais estudos nesta área.

297 - Evaluation of the effects of Treataprost herbal mixture at different doses on chronic bacterial prostatitis

297 - Evaluation of the effects of Treataprost herbal mixture at different doses on chronic bacterial prostatitis

Acupuncture as a Treatment Choice for Persistent Chronic Bacterial Prostatitis-Related Symptoms

Background and Aim: In several chronic bacterial prostatitis (CBP) cases, symptoms persist despite bacterial eradication. Since acupuncture has been shown to ameliorate the symptoms of chronic prostatitis/chronic pelvic pain syndrome, it may be an effective treatment option for clinically untreated CBP cases. In order to investigate the above hypothesis, we performed a pilot study. Methods: Patients with persistent CBP-related symptoms and confirmed bacterial eradication were randomly allocated to acupuncture or conventional medical treatment. Symptom burden was assessed at baseline, weeks 4 and 12. Eight patients received 30-min sessions of acupuncture twice weekly for 1 month (Group 1), ten patients received lornoxicam 8 mg orally once daily for 1 month (Group 2), eight patients received Serenoa repens (SR) 320 mg twice daily for 1 month (Group 3), and nine patients received pregabalin 25 mg twice daily for 1 month (Group 4). The primary outcome is the proportion of responders at week 4 with significant change from baseline in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and International Prostate Symptom Score (IPSS) at week 4. Secondary outcomes included ratings of clinical pain (visual analog scale) and quality of life at week 12. Results: At week 4, no statistically significant differences in the mean decrease of NIH-CPSI and IPSS total scores from baseline among groups were noted. After 12 weeks, none of the participants experienced complete resolution of pain. Differences in the mean pain and quality of life levels were statistically insignificant. Conclusion: Acupuncture is an effective treatment option for persistent CBP-related pain however is inferior to conventional medical treatment in reducing CBP-related lower urinary tract symptoms. For this reason, it may be offered in combination with medical therapy in patients with combined symptoms.

Новые возможности применения гиалуронидазы при хроническом простатите

The use of hyaluronidase contributes to improvement in microcirculation, destruction of biofilms and reducing of congestion in patients with chronic prostatitis. Based on this mechanism, the use Longidaza for the diagnosis of latent bacterial prostatitis was suggested. To evaluate diagnostic and treatment capabilities of the long-acting enzyme preparation Longidaza (rectal suppositories with an activity of 3000 IU), prescribed to patients with chronic prostatitis in routine clinical practice. A total of 39 men with chronic prostatitis of categories II and IIIa were included in open, prospective, non-interventional, comparative, single-center study. A microbiological study of expressed prostate secretion (EPS) was performed three times, at baseline, after using two suppositories Longidaza 3000 IU and after 7 weeks of therapy. From the 1st to the 10th suppository, Longidaza was used every 48 hours, then, from the 11th to the 20th suppository, it was prescribed every 72 hours. The isolation of the pathogen was an indication for the antibiotic therapy. The treatment outcome was evaluated by using NIH-CPSI scale and laboratory and microbiological analysis of EPS. Diagnostic stage. Initially, pathogens were isolated in 27 (69.2%) patients. The number of leukocytes in EPS averaged 25.9+/-2.3. The use of two suppositories Longidaza increased the number of patients with isolated pathogens to 33 (82%). In 7 out 12 patients with an initial diagnosis of abacterial prostatitis, the use of two suppositories of Longidaza contributed to isolation of the pathogen in EPS (58.3%). The number of leukocytes in the EPS after enzymatic provocation increased by 50.2%. Treatment stage. The number of patients with isolated pathogens decreased from 33 to 7 (17.9%). The pain intensity decreased on average to 2.2+/-0.4 points, and in 27 (69.2%) men dysuria resolved. The quality of life significantly improved up to 1.3+/-0.2 points. The total score on NIH-CPSI scale decreased on average from 17.3+/-1.9 to 3.9+/-0.3 (p<0.05). An increased number of white blood cells in EPS was seen only in 5 (12.8%) men. In many cases, bacterial prostatitis remains undiagnosed. Rectal suppositories Longidaza can be recommended for the diagnosis of the latent bacterial chronic prostatitis, since this drug contributes to detection of pathogen and inflammation.

Chronic bacterial prostatitis associated with androgen deficiency

Inflammation of the prostate gland occupies a significant proportion of inflammatory diseases of the genitourinary system. According to J.Potts et al. (2007), prostatitis is detected in 510% of the general male population. Today, one of the main problems associated with prostatitis is the narrowly targeted, often unwarranted treatment with its antibacterial drugs without taking into account the multifactorial nature of the pathogenesis and androgen dependence of the prostate gland. As a result, this leads to ineffective treatment of prostatitis amid growing antibiotic resistance. In turn, recent studies demonstrate key issues of testosterone and prostate gland relationship. These researches show that prostate metabolism is dependent on testosterone levels. The level of the hormone affects the course of chronic inflammation in the prostatic tissues. And also, that the number of bacterial agents that provoke pathological processes in the prostatic parenchyma directly depends on the degree of decrease in testosterone levels. This point of view is also supported by other studies. It was found that most patients with inflammation of the prostate gland had androgen deficiency, and correction of testosterone levels of these patients was highly effective in the treatment of chronic prostatitis. Thus, the androgen dependence of the prostate gland and the effect of hypogonadism on the incidence of prostatic parenchymal inflammatory changes allow us to radically revise the approach to the diagnosis and treatment of chronic bacterial prostatitis. The development and implementation of new algorithms in which the diagnosis and subsequent correction of concomitant androgenic are becoming a promising direction for this group of patients.

Management of Chronic Bacterial Prostatitis.

We conducted a review of the literature describing the most up-to-date diagnosis and treatment options of chronic bacterial prostatitis. Recurrence after oral antimicrobial therapy is common, due in part to the rising rates of antimicrobial resistance and inability to completely clear the offending bacteria from the prostate following prostatitis. Recent literature has described various treatment options for chronic bacterial prostatitis refractory to conventional antimicrobial agents, including the use of alternative agents such as fosfomycin, direct antimicrobial injections into the prostate, surgical removal of infected prostatic tissue, chronic oral antibiotic suppression, and an emerging novel therapy utilizing bacteriophages to target antibiotic resistant bacteria. Management of chronic bacterial prostatitis, especially recurrence after oral antimicrobial treatment, remains challenging. This review highlights an urgent need for further evidence assessing the efficacy and safety of treatment modalities for chronic bacterial prostatitis refractory to conventional oral antimicrobials.

Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

Prostatitis is a common condition which can affect men of all ages; however, it is more frequently experienced in younger men with an initial onset around 40 years of age. The two main presenting clinical features of prostatitis are lower urinary tract symptoms and pelvic pain. Other symptoms might include obstructive or irritative voiding symptoms, ejaculatory pain, and hematospermia. A diagnosis is usually based on the man's history, physical examination, urinalysis, and the two-or four-glass test (also known as obtaining urine specimens before, during, and after prostatic massage). Further investigations may also be performed when considering the differential diagnosis. Prostatitis can result in a significant reduction in quality of life (QOL) and pain can be associated with sexual dysfunction in men. Prostatitis can be classified as four distinct types, namely, type I acute prostatitis, type II chronic bacterial prostatitis, type III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and type IV asymptomatic prostatitis. It is unclear whether type III can be linked in all cases to prostatic involvement therefore the alternate denomination CPPS is used in clinical practice. Furthermore, CP/CPPS is further subclassified as type IIIa (inflammatory), and type IIIb (noninflammatory) which is dependent on the presence of inflammatory cells in prostatic secretions. CP/CPPS is considered when pelvic pain is present for at least three of the preceding 6 months with no other identifiable causes determined. There are several hypothesized causes of CP/CPPS which include: neuropsychological factors, infection, inflammation/autoimmunity, and dyssynergia voiding associated with bladder neck hypertrophy. Given the wide range of potential causes of CP/CPPS, there are many pharmacological interventions available in clinical practice to manage this complex condition. It is important to critically summarize evidence-based recommendations to inform the clinical management of men affected by CP/CPPS (Franco et al., 2019).