Chronic Prostatitis Syndrome Research Articles

Chronic prostatitis and related psychological problems. Which came first: The chicken or the egg? A systematic review

A spectrum of psychological problems is commonly found in CP/CPPS patients, though it is not yet clear whether, a priori, psychological dysfunctions are the cause of these pain syndromes, or whether these pain conditions are themselves causing psychological disturbances. In this article we present the current perspective on the impact of psychological problems in chronic prostatitis syndromes and we discuss the implications thereof from a clinical perspective. A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, EMBASE, and other libraries using the key words "prostatitis syndromes", "chronic bacterial prostatitis", "chronic pelvic pain", in various combinations with the terms "psychological issues", "depression" "anxiety", "stress", "unhappiness", "cognitive status" and "personality". Two independent reviewers performed data extraction. We included clinical studies with available information on chronic prostatitis and related psychological conditions. We considered full-text written papers. We excluded reviews and case reports. In order to reduce the risk of bias we analyzed only studies including patients with confirmed CBP or CP/CPPS. Bibliographic information in the selected publications was checked for relevant records not included in the initial search. Database search allowed us to retrieve 638 studies to which we added to 16 additional studies retrieved by hand-searching. After screening, 34 relevant papers were identified for thorough review. Most studies included patients with chronic pelvic pain and prostatitis-like symptoms, whereas a smaller number of studies included patients with methodologically con- firmed CP/CPPS including studies with a microbiologically confirmed diagnosis of CBP. The psychosocial factors examined in the selected studies include pain, catastrophizing, stress, personality factors and social aspects. Comorbid psychiatric disorders evidenced in the studies included depression, anxiety and trauma-related disorders, somatization disorders, and substance abuse. Some studies investigated the association of pain with each individual psychological disturbance, while others examined the impact of pain in association with the overall quality of life. Sample size, study design and diagnostic measures varied among studies. Despite limitations and variations in sample size, study design and diagnostic measures in all included studies, a relation between chronic prostatitis and psychological problems is a consistent finding. The existing evidence does not permit to definitely conclude whether psychological problems are a risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease.

Study on the Application Value of the Content of Prostatic Exosomal Protein in the Treatment of Chronic Prostatitis.

To evaluate the application value of urinary prostatic exosomal protein (PSEP) in the treatment of chronic prostatitis (CP). We evaluated 174 patients with chronic prostatitis (44 cases of NIH-II, 65 cases of NIH-IIIa, and 65 cases of NIH-IIIb) who had obvious symptoms of chronic prostatitis syndrome and met the diagnostic criteria of National Institutes of Health Prostatitis from May 2018 to February 2021. They were also evaluated according to the clinical treatment's effect after six weeks of treatment. Urine samples of CP patients were collected before treatment and after six weeks of treatment, and the level of PSEP in the urine samples of all patients, before and after treatment, was detected by the ELISA method to evaluate the application value of PSEP in the end of CP curative effect. After six weeks of treatment, the total CPSI score of CP patients decreased significantly, compared to patients before treatment. After six weeks of treatment, the PSEP content in the patients' urine was compared to before treatment. The PSEP levels of CP subgroups decreased significantly (p < 0.05): NIH-II group (1.55 ± 1.39 ng/mL vs. 3.09 ± 2.66 ng/mL); NIH-IIIa group (1.68 ± 1.06 ng/mL vs. 3.34 ± 2.69 ng/mL); and NIH-IIIb group (1.57 ± 1.17 ng/mL vs. 3.14 ± 2.81 ng/mL). The concentration of PSEP in the urine of CP patients has a good application value for evaluating clinical treatment's effect on chronic prostatitis, and its concentration level may affect the development and outcome of prostatitis.

The role of the microbiome in urological diseases

The use of modern molecular technologies in the last decade has given us new insights into the complex interactions of the human microbiome in health and in the pathogenesis of diseases. Among other things, the sterility concept of the urinary tract has been discarded and the goal is now to identify the different microbial signatures associated with various diseases. Dysbalances of the microbiome are increasingly suspected of causing negative effects on various malignant and benign diseases. Recently, such associations have also been shown for prostate carcinoma, renal cell carcinoma and urinary bladder carcinoma. This may lead to the discovery of new potential biomarkers for the diagnosis and as a therapeutic target of the diseases mentioned. For the diagnosis of some benign diseases such as interstitial cystitis, urge incontinence and chronic prostatitis or chronic pelvic pain syndrome, microbial involvement was previously considered an exclusion criterion. However, current studies show that the individual patient's microbiome can have an influence on the development and severity of the respective disease.

Management of Chronic Nonbacterial Prostatitis and Chronic Pelvic Pain Syndrome in the Adult Male Patient with Comorbid Conditions.

Faith community nurses often counsel patients regarding illness management and are in a unique position to provide support to those facing multiple illnesses. When faced with multiple illnesses, men with urologic problems commonly do not mention them at routine exams, yet older patients might ask a trusted faith community nurse about urological concerns such as prostatitis. The National Institutes of Health developed a new classification structure for prostatitis in the 1990s, combining two types of prostate conditions into a new category. Due to disease complexity, treatments combining both pharmacological and nonpharmacological interventions are shown to be effective in relieving symptoms.

The association of Boswellia resin extract and propolis derived polyphenols can improve quality of life in patients affected by prostatitis-like symptoms.

Chronic prostatitis syndrome is a bothering and poorly understood condition. Many patients report genitourinary pain and Lower Urinary Tract Symptoms as a main complaint. Many different pharmacological or behavioural therapies are prescribed in daily clinical practice, but efficacy data are still lacking. The aim of our study was to test the efficacy and safety of a transrectal delivered association of Boswellia resin extract and propolis derived polyphenols for the relief of prostatitis - like symptoms. Patients affected by chronic/recurrent prostatitis - like symptoms were prospectively enrolled in our study from December, 2016 to December, 2018. Patients were screened at baseline through clinical examination and validated questionnaires administration: Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF). Inclusion criteria were: age ≥ 18; prostatitis symptoms persisting for at least 3 of the last 6 months; CPSI pain domain score ≥ 5; previous negative Meares-Stamey test. Treatment consisted on the administration of 1 suppository containing Boswellia resin extract and propolis derived polyphenols, once a day for 20 days. The primary endpoint of the study was the improvement of quality of life after treatment, defined by a reduction of ≥ 2 points, or ≥ 25%, of mean CPSI pain domain score, compared to baseline. Secondary endpoints were the improvement of post-treatment CPSI total score and the analysis of treatment - related adverse events. All patients were re-evaluated 1 month after treatment. 40 patients were enrolled in our study. Median age (Inter - Quartile Range IQR) was 51.5 (41.5-63.2) years. Mean baseline CPSI scores were: 22.15 (total score), 9.67 (pain domain), 5.15 (micturition domain) and 7.35 (quality of life domain), respectively. No significant adverse events were reported. At 1 month follow-up, CPSI scores appeared modified as follows: 16.40 (total score, p = 0.001); 6.92 (pain domain; p = 0.001; 4.02 (micturition domain, p = 0.09); 5.45 (quality of life domain, p = 0.002). Mean CPSI pain domain score reduction was -2.75 points (-28.5%). Mean CPSI total score reduction was -5.75 points (-26%). The association of Boswellia resin extract and propolis derived polyphenols can reduce genitourinary pain and then improve quality of life of men affected by bothersome prostatitis - like symptoms.

Interleukin-6 in the ejaculate in normal and pathological conditions of the male reproductive system

The study of immune mechanisms in inflammatory diseases of the male reproductive system, androgen deficiency and male infertility continues. The relationship of the content of a particular component of seminal plasma with the indicators of ejaculate fertility – concentration, mobility and morphological features of spermatozoa was revealed. A prominent representative of the group of proinflammatory cytokines is interleukin-6 (IL-6), whose main functions are activation of the immune response in the acute phase of the systemic inflammatory response, stimulation of the expression of adhesive molecules on endothelial cells and leukocyte chemotaxis, activation of T - and B - lymphocyte proliferation, and stimulation of the granulocyte growth of hematopoiesis. In the male reproductive system, IL-6 is produced by Sertoli cells; it is found in the tissues of the testicles, in the ejaculate. It was found that an increase in the level of IL-6 is observed in some pathological conditions of the male reproductive system. An increase in the concentration of IL-6 in the seminal plasma is associated with the development of inflammatory processes in the organs of the male sexual system - it may indicate acute and chronic prostatitis, non-specific urethritis, and chronic pelvic pain syndrome. The fact of active production of IL-6 in the ejaculate in patients with leukocytospermia was revealed. In the case of viscous sperm syndrome, the level of IL-6 in the ejaculate also increases, presumably due to a reaction to the occurrence of oxidative stress in the male reproductive system. There was a negative relationship between the level of IL-6 in the ejaculate and spermatogenesis indicators – the concentration of spermatozoa, the progressive mobility of spermatozoa in men from infertile couples.

The effect of sensation of transmission along meridian acupuncture for chronic nonbacterial prostatitis

ObjectiveTo investigate the short-term efficacy difference between sensation of transmission along meridian acupuncture and non- sensation of transmission along meridian acupuncture in the treatment of chronic nonbacterial prostatitis. MethodsA randomized, controlled, and single-blind clinical study was performed to collect 63 patients with chronic nonbacterial prostatitis who met the inclusion criteria and were randomly assigned to a transmission sensation group (31 patients) and a non-transmission sensation group (32 patients). The two groups of patients took the same acupuncture points. When they were lying down on their backs, Guānyuán (关元 CV4), Zhōngjí (中极 CV3) and Dàhè (大赫 KI12) were taken. When they were lying down on their stomachs, Shènshū (肾俞 BL 23), Cìliáo (次髎 BL32) and Huìyáng (会阳 BL35) were taken. Among them, the transmission sensation group was treated with transmission sensation along meridian to apply deep needling to the lower abdomen and lumbosacral acupuncture points with lifting, thrusting, and twirling method, so that the needling sensation was transmitted to the bladder, perineum and urethra. The non-transmission sensation group was treated with non-transmission sensation along meridian, and the acupuncture points were treated with conventional acupuncture until the patient felt soreness and distending etc. and the arrival of qi. Both groups of patients were treated with electro-acupuncture during acupuncture, and the sparse-dense wave (sparse wave 4 Hz, dense wave 20 Hz), and the needle retention continued for 20 min. All patients were treated for 3 times with once every other day, and the treatment lasted for one week. The CV4, CV3 and KI12 were used in the first and third treatments, and the BL23, BL32 and BL35 were used in the second treatment. The National Institute of Health chronic prostatitis syndrome index (NIH-CPSI) and Hamilton Anxiety Rating Scale (HAMA) were observed, and the clinical efficacies of the patient were observed. ResultsAfter treatment, the NIHCPSI scores (18.29±1.25, 21.56±1.28) and HAMA scores (10.29±1.16, 11.25±1.14) in the transmission sensation group and non-transmission sensation group were all lower than the pre-treatment NIHCPSI score (24.90±1.45, 24.94±1.25) and HAMA (14.10 ± 1.53, 14.47 ± 1.22) in the transmission sensation group and non-transmission sensation group, the differences were statistically significant (all P < 0.05). The difference value between the pre-treatment and post-treatment NIHCPSI scores of the transmission sensation group (6.61±0.97) was higher than that of the non-transmission sensation group (3.48±0.59), and the difference was statistically significant (P<0.05). The difference value between the pre-treatment and post-treatment HAMA scores of the transmission sensation group (3.81±0.81) was higher than that of the non-transmission sensation group (2.77±0.54). The total effective rate of the transmission sensation group (35.48%) was higher than that of the non-transmission sensation group (12.50%), and the difference was statistically significant (P<0.05). ConclusionsBoth the method of transmission sensation along meridian and the method of non-transmission sensation along meridian can effectively relieve the clinical symptoms and anxiety symptoms of patients with chronic nonbacterial prostatitis, improve the quality of life, and the method of transmission sensation along meridian had a more advantageous effect.

Effect of Essential Oil on Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Pilot Randomized Controlled Trial.

To evaluate the efficacy and safety of essential oil treatment for type III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A randomized controlled trial was conducted from December 2014 to October 2015. Seventy type III CP/CPPS patients were assigned to the essential oil group (35 cases) or almond placebo oil control group (35 cases) by a random number table. The oil was smeared by self-massage on the suprapubic and sacral region once a day for 4 weeks. The National Institutes of Health Chronic Prostatitis Syndrome Index (NIH-CPSI) and expressed prostatic secretions (EPS) were examined. The primary outcome was NIH-CPSI pain domain. The secondary outcomes included other NIH-CPSI domains and laboratory examinations of EPS. Adverse events were also observed. Sixty-six subjects completed the full 4-week treatment. There was no significant difference between almond oil control and essential oil groups in terms of the total score of NIH-CPSI, pain, quality of life and urination domain scores of NIH-CPSI and EPS examinations (P>0.05). In the essential oil group, pain between rectum and testicles (perineum) in the domain of pain or discomfort was significantly reduced at week 2 and week 4 compared with almond oil control group (P<0.01). No serious adverse events occurred. The essential oil may reduce the pain or discomfort in the perineum region in patients with CP/CPPS. (Registration No. ChiCTR-IPR-14005448).

Studying clinical of efficiency α-adrenoblockator tamsulozinum at men at of the chronic abacterial prostatitis or chronic pelvic pain syndrome

Цель исследования: оценивание эффективности терапии хронического абактериального простатита/синдрома хронической тазовой боли (ХАП/СХТБ) препаратом Тамсин Форте. Материалы и методы. В динамике обследованы и пролечены 34 пациента по поводу ХАП/СХТБ. Для монотерапии был использован препарат Тамсин Форте (тамсулозин), который относится к высокоселективным α 1 -адреноблокаторам длительного действия. Возраст обследованных пациентов составил от 24 до 42 лет. Продолжительность заболевания – от 2 до 4 лет. Всем пациентам было проведено стандартное урологическое обследование. Результаты. Применение монотерапии препаратом Тамсин Форте обеспечило быстрый клинический эффект. Болевые ощущения ликвидированы по окончании трехмесячного курса лечения у 32 (94,1%) из 34 обследованных, дизурические явления купированы у 31 (91,2%). У 7 (87,5%) из 8 больных отмечали улучшение эректильной функции, преждевременная эякуляция купирована у 9 (81,8%) из 11 пациентов. После лечения препаратом Тамсин Форте достоверно увеличилась максимальная скорость мочеиспускания. Заключение. Препарат Тамсин Форте достаточно эффективен при использовании в виде монотерапии у больных с ХАП, сопровождающимся СХТБ, как по оценке врача (94,2%), так и по оценке пациентов (91,2%). Полученные результаты позволяют рекомендовать препарат Тамсин Форте для использования в андрологической практике.

Effect of thermobalancing therapy on chronic prostatitis and chronic pelvic pain syndrome

Background: Type-III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common type of prostatitis. Patients and methods: We ascertained the effect of ‘thermobalancing’ therapy (TT; using Dr Allen’s therapeutic device (DATD)) on CP/CPPS. We measured National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores, prostatic volume (PV), and maximum urinary flow rate (Qmax) in one group of 45 patients who underwent TT and a control group that did not have TT, and compared these parameters between groups. Results: Baseline evaluation (pretreatment) of both groups showed no significant difference with regard to age, NIH-CPSI score, PV or Qmax. Pain score decreased in both groups but, in the treatment group, the difference between scores was considerably higher (8.72:1) than that of the non-treatment group. TT decreased quality of life (QoL) significantly whereas, in the control group, it decreased QoL slightly. TT reduced PV significantly whereas, in the control group, PV increased. TT increased Qmax significantly in CP/CPPS patients whereas, in the control group, TT did not elicit a significant change in Qmax. Conclusions: Six-month TT with DATD: (a) reduces CP/CPPS symptoms and improves QoL; (b) reduces PV; (c) increases Qmax. TT could be effective treatment for CP/CPPS.

Microbiological etiology of bacterial prostatitis in general hospital and primary care clinic in Korea

Purpose:The National Institutes of Health classification of prostatitis reported the proportion of chronic bacterial prostatitis, especially category II, at 3% to 10%. Because of the polymerase chain reaction (PCR) diagnosis technique, chronic prostatitis syndrome (CPS) with a known bacterial origin has increased recently. In this study, we evaluated the proportion of chronic bacterial prostatitis in a general hospital and a primary care clinic (PCC) in addition to the distribution of the microorganism in chronic bacterial prostatitis in Korea.Methods:Two hundred and ninety-three patients were enrolled in this study. One hundred and five patients in the general hospital and 188 patients in the PCC were enrolled in the study. Using a questionnaire, all patients were checked for symptoms of urinalysis, expressed prostate secretion (EPS), EPS or V3 culture and PCR of EPS or VB3 for Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genetalia, and Trichomatis vaginalis.Results:In routine EPS or VB3 culture, 12 of 105 patients (11.4%) in the general hospital showed positive culture, but 77 of 188 patients (40.9%) in the PCC showed a positive culture. Escherichia coli, Streptococcus faecalis, Staphylococcus epidermidis, Staphylococcus hemolyticus, Staphylococcus aureus, and Pseudomonas were isolated in routine culture. In the PCR diagnosis, 37 of 105 patients (35.2%) in the general hospital were PCR positive, and 65 of 188 patients (34.5%) in the PCC were PCR positive. In the general hospital, C. trachomatis was the most common (49%), followed by U. urealyticum (24%), M. genetalia (16%), M. hominis (10%), and T. vaginalis (2%). In the PCC, U. urealyticum was the most common (45%), followed by C. trachomatis (34%), M. hominis (13%), M. genetalia (7%) and T. vaginalis (1%). The proportions of chronic bacterial prostatitis were 46.6% (49/105) and 67.5% (127/188) in the general hospital and PCC, respectively.Conclusions:The total portion of chronic bacterial prostatitis was 59.3% (174/293). Culture-positive patients in the PCC were significantly higher than in the general hospital, but the number of PCR positive patients in the PCC was the same as in the general hospital.

Semen quality and associated reproductive indicators in middle-aged males: the role of non-malignant prostate conditions and genital tract inflammation

To compare the associations between non-malignant prostate conditions, genital tract inflammation, and reproductive function in middle-aged men. Three-hundred and eighty-two voluntary male subjects who underwent the screening for prostate health were recruited for the study. Semen quality and associated reproductive indicators, seminal inflammation, and prostate-related pathologies were evaluated. Sperm motility and prostate-related parameters were significantly impaired in patients with chronic prostatitis syndromes and lower urinary tract symptoms in comparison with controls. Elevated seminal markers of inflammation were in positive association with body mass index, prostate-specific antigen, and estradiol level in serum while in negative association with semen volume, total sperm count, and sperm motility. According to WHO reference limits, speculative cutoff values for WBC and IL-6 in semen to detect reduced sperm parameters were 0.342M/mL and 56.8ng/L, respectively. According to our data, one of the possible pathways for impaired reproductive quality in male subjects >45years could be related to infection and inflammation in the genital tract with subsequent (partial) obstruction and damage of prostate and other male accessory glands.

Prostatitis: Diagnostik und Therapie

The prostatitis syndrome is a frequent and complex disease. During the last 40 years the scientific perception has shifted between sometimes success and sometimes disappointment. Whereas acute prostatitis is most frequently considered an infectious disease, in only about 10% of cases with a chronic prostatitis syndrome can pathogens be identified. The bacterial spectrum is similar to that of complicated urinary tract infections with mainly Gram-negative pathogens. In some studies atypical pathogens, such as Chlamydia trachomatis and mycoplasmas, can be found in a considerable proportion. In most cases, however, a multifactorial aetiology is discussed. This has lead to a phenotyping directed multimodal treatment approach, considering the main symptoms. In prostatitis of microbial origin antibiotics, particulary fluorquinolones, are still the therapy of first choice. In the other cases multimodal treatment strategies are used considering evidence-based monotherapeutic studies. The evidence for multimodal combination treatment is still sparse.

Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome

• Our traditional approach to managing the chronic prostatitis (CP) syndromes has not been very successful for many of our patients. • Our developing understanding of CP/chronic pelvic pain syndrome (CP/CPPS) as a heterogeneous syndrome rather than a homogenous disease has allowed us to develop treatment strategies based on individual patient characteristics. • By considering each patient as a unique individual and tailoring treatments to a specific patient's clinical 'phenotype' we improve our therapeutic outcomes.

Phenotypic differences between coagulase‐negative staphylococci isolated from seminal fluid of healthy men and men suffering from chronic prostatitis syndrome

Chronic prostatitis syndrome (CPS) is a common urologic condition that many clinicians find difficult to diagnose and treat effectively. The most common causative agents of CPS among Gram-positive bacteria are coagulase-negative staphylococci (CNS). We compared phenotypic properties among CNS isolated from semen of healthy men and patients with CPS. A significantly higher proportion of CPS strains demonstrated inhibition of lysozyme and platelet microbicidal protein. Identifying these phenotypic characteristics in clinical laboratories would be helpful to differentiate which staphylococcal bacteriospermia case should be treated and which should not.

Associating Serenoa Repens, Urtica Dioica and Pinus Pinaster. Safety and Efficacy in the Treatment of Lower Urinary Tract Symptoms. Prospective Study on 320 Patients

Introduction Serenoa repens (saw palmetto) has been employed for the treatment of lower urinary tract symptoms (LUTS) for several years. Its mechanism of action is believed to be due to antiandrogenic, antiproliferative and antinflammatory properties. An association of Serenoa with the nettle “Urtica dioica” showing antiproliferative activity and the pine “Pinus pinaster” derivative, showing antinflammatory action, has been proposed in recent years. Such an action is hoped to act not only by reducing LUTS but also by preventing the development of prostate cancer. Material and Methods During the years 2007 and 2008, 320 patients suffering from LUTS were treated with an association of Serenoa repens 320 mg, Urtica dioica 120 mg and Pinus pinaster 5 mg, named IPBTRE. This treatment was administered to all patients for a minimal duration of 30 days to a maximum of a year, either alone or in association with antibiotics or alpha-blockers, if needed. Outcome analysis was based on evaluation of symptoms, prostate volume and maximum flow rate (Qmax). Results From a careful analysis of the data collected in our database, the following observations can be made: ages varied between 19 and 78 years. The patients were affected by BPH in 46% of cases, chronic prostatitis syndrome in 43%, chronic genital-pelvic pain in 7% and other conditions in 4%, the absolute numbers being 147, 138, 22 and 7 patients, respectively. No untoward side effect was reported in any case. Variations in symptom score could be fully evaluated only in 80 of 320 patients (25%), of whom 68 (85%) reported a significant benefit, with special reference to an improvement of pain, urgency, strangury and nocturia. Data on variations in prostate volume, as measured by digital rectal examination, were available in 84 (26.5%) patients. No significant change was observed. Qmax after treatment was measured in 83 (26%) patients. It did not show significant changes from the initial values. Discussion The association tested in our study appeared to be safe and well tolerated. No changes in flow rate and prostate volume were observed, but a marked reduction of LUTS was observed in 85% of evaluable cases, especially with regard to pain and irritative symptoms. Whether or not such an association may display a prevention of prostate cancer, may be investigated in additional studies.

Microflora of the seminal fluid of healthy men and men suffering from chronic prostatitis syndrome

Chronic prostatitis syndrome (CPS) is a common urologic condition that many clinicians find difficult to diagnose and treat effectively. The information about the composition of the flora of the seminal fluid in healthy men and patients with CPS is limited. The aim of this study was to define the microbial communities present in the seminal fluid of healthy men and patients with CPS and at in vitro detection of decomplementary activity (DCA) phenotypes of isolates along with their comparison with isolates from patients with or without CPS. The bacteriological study was carried out to 48 healthy men and 60 men with CPS. Culture specimens were spread on various selective media. Bacterial DCA was tested by measuring the decrease in complement activity (CH(50)) under the influence of culture supernatants. The most common isolates in both groups were coryneforms, lactobacilli, coagulase-negative staphylococci, micrococci and streptococci. Enterobacteriaceae, enterococci and Staphylococcus aureus were isolated only from the CPS group. The organisms from seminal fluid of healthy men exerted DCA at 3.56 +/- 2.15; 2.47 +/- 1.23 and 4.36 +/- 2.2 anti-CH(50) for staphylococci, micrococci and diphtheroids respectively. The DCA of staphylococci, coryneforms, Enterobacteriaceae, enterococci and micrococci from CPS group were 12.8 +/- 2.1 (p < 0.05), 4.4 +/- 3.6 (p > 0.05), 16.8 +/- 2.1, 7.2 +/- 1.9 and 11.6 +/- 3.3 (p < 0.05) anti-CH(50) respectively. The data obtained in this study testify the microecological disorders in microbiota of seminal fluid in CPS.

Phenotypic differences between coryneform bacteria isolated from seminal fluid of healthy men and men with chronic prostatitis syndrome

We compared the potential phenotypic properties of coryneform bacteria associated with chronic prostatitis syndrome (CPS), such as secretory inhibitor of lysozyme (SIL) and secretory inhibitor of platelet microbicidal protein (SIPMP). A total of 110 clinical isolates of coryneform bacteria isolated from the seminal fluid of healthy men and men with CPS were tested. SIPMP production was tested by inhibiting platelet microbicidal protein (PMP) bioactivity against Bacillus subtilis, and was expressed as percentage of inhibition of PMP bactericidal activity. SIL production was tested by inhibiting lysozyme activity against Micrococcus lysodeikticus and was expressed in microgram per millilitre of inactivated lysozyme. A significantly higher proportion of CPS strains (58.7% vs. 19.2 %) was SIPMP-positive compared with non-CPS strains (P < 0.01). Of the CPS strains tested, 77.8% were SIL-positive compared with 34% of the non-CPS isolates (P < 0.05). These results suggest that the diagnosis of CPS should not rely solely on classical parameters, for example, the identification and counting of microorganisms, but the functional significance of these parameters must be estimated, possibly by the concentration of different bacterial substrains, detection of opportunistic microorganisms with pathogenic properties, such as pronounced resistance to the cationic antimicrobial peptides, and/or the ability to inhibit the antimicrobial host defence factors.

Comparison of Clinical Symptoms Scored According to the National Institutes of Health Chronic Prostatitis Symptoms Index and Assessment of Antimicrobial Treatment in Patients with Chronic Prostatitis Syndrome

We examined a total of 194 patients over 18 years of age with chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnor-malities. the following data were obtained for each patient: clinical history - the severity of chronic prostatitis symptoms scored by a Croatian translation of the NIH CPSI questionnaire, clinical status including digitorectal examination, urethral swab specimens, and selective samples of urine and expressed prostatic secretion, according to the 4-glass localization test (meares and Stamey localization technique).Patients were treated orally with antimicrobial agents in doses and duration according to clinical practice in Croatia. An infectious etiology was determined in 169 (87%) patients. Chlamydia trachomatis was the causative pathogen in 38 (20%) Tri-chomonas vaginalis in 35 (18%) Enterococcusin 36 (19%) and Escherichia coli in 35 (18%) patients. in the remaining 25 patients the following causative pathogens were found: Ureaplasma urealyticum, Proteus mirabilis, Klebsiella pneumoniae, Streptococcus agalactiae and Pseudomonas aeruginosa. Comparison of symptoms scores and effect on quality of life has shown that the most severe clinical presentation of disease was recorded in patients with chronic bacterial prostatitis caused by E. coli and Enterococcus(p<0.001). Clinical success was paralleled by bacteriological eradication in chronic bacterial prostatitis caused by C. trachomatis, Enterococcus and E. coli (kappa >0.2<0.5), but not in inflammatory chronic pelvic pain syndrome caused by T. vaginalis.

The Significance of Chlamydia trachomatisin Urethritis and Prostatitis – Differences in Therapeutic Approach – Croatian Experience

We examined a total of 1014 patients over 18 years of age; 252 with urethritis and 762 with chronic prostatitis syndrome. The mean age of patients with urethritis was 32.7 and with prostatitis syndrome 37.6 years. Clinical symptoms of urethritis were present from a few days to several months. In patients with chronic prostatitis syndrome, symptoms were present for at least 3 months. Chlamydia trachomatis alone was confirmed in 26 (10%) and in combination with Ureaplasma urealyticum in 6 (2%) patients with urethritis. in 171 (68%) patients with urethritis neither C. trachomatis nor U. urealyticum or Mycoplasma hominis were found. C. trachomatis alone was confirmed in 70 (9%), and in combination with other microorganisms in 7 (1%) patients with chronic prostatitis syndrome. In Croatia, the frequency of chronic chlamydial prostatitis has not significantly changed in the last 10 years, while the frequency of infections among adolescents decreased. the recommended regimen for acute chlamydial urethritis in Croatia is azithromycin 1.0 g as a single dose, and a total dose of 4-4.5 g azithromycin for chronic chlamydial prostatitis.