Inflammatory Prostatitis Research Articles

Inflammatory Prostatitis Plus IBS-D Subtype and Correlation with Immunomodulating Agent Imbalance in Seminal Plasma: Novel Combined Treatment.

We recently demonstrated the effectiveness of long-term treatment with rifaximin and the probiotic DSF (De Simone formulation) in improving urogenital and gastrointestinal symptoms in patients with both chronic inflammatory prostatitis (IIIa prostatitis) and diarrhea-predominant irritable bowel syndrome (IBS-D), relative to patients with IBS-D alone. Because the low-grade inflammation of the intestine and prostate may be one of the reasons for co-developing both IIIa prostatitis and IBS-D, we designed the present study to once again evaluate the efficacy of combined rifaximin and DSF treatment in patients affected by IIIa prostatitis plus IBS-D, but we also measured seminal plasma pro-inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines before and after treatment. Methods: We consecutively enrolled 124 patients with IIIa prostatitis and IBS-D (diagnosed using the Rome III criteria). Patients were randomized into two groups: group A (n = 64) was treated with rifaximin (seven days per month for three months) followed by DSF, and group B (n = 60) was treated with a placebo. By the end of the intervention, 68.7% and 62.5% of patients from group A reported improved NIH-CPSI (National Institute of Health's Chronic Prostatitis Symptom Index) and IBS-SSS (Irritable Bowel Syndrome Severity Scoring System) scores, respectively, compared to only 3.3% and 5% of the placebo group. Group A patients also had significantly lower mean seminal plasma levels of IL-6 (11.3 vs. 32.4 pg/mL) and significantly higher mean levels of IL-10 (7.9 vs. 4.4 pg/mL) relative to baseline, whereas the levels of IL-6 and IL-10 did not change in the placebo group. Conclusions: The combined treatment with rifaximin and DSF appears to represent the optimal approach for addressing a syndrome such as irritable bowel syndrome (IBS-D plus), which frequently co-occurs with prostatitis (IIIa prostatitis). This approach is particularly beneficial in cases where the symptoms are not always clearly delineated, the etiology is multifactorial, and the diagnosis is multilevel.

Imaging of Non-malignant Conditions of the Prostate and Seminal Vesicles: A Comprehensive Review

AbstractNon-malignant conditions of the prostate and seminal vesicles are much more common in imaging practice than prostate cancer. They include benign prostatic hyperplasia, infective and inflammatory prostatitis, prostatic and periprostatic cysts, and benign tumors. The advances in magnetic resonance imaging (MRI) of the prostate gland have dramatically improved the ability to identify these entities, many of them being identified incidentally in patients evaluated for other indications. Good knowledge of these conditions can aid in precise diagnosis and avoid interpretation pitfalls. In this article, we present non-malignant conditions of the prostate gland using several imaging modalities, including transrectal ultrasound, MRI, and computed tomography. We also present the pathological correlation for benign tumors.

Canonical and truncated transglutaminase-2 regulate mucin-1 expression and androgen independency in prostate cancer cell lines

Androgen independency is associated with poor prostate cancer (PCa) survival. Here we report that silencing of transglutaminase-2 (TG2) expression by CRISPR-Cas9 is associated with upregulation of androgen receptor (AR) transcription in PCa cell lines. Knockout of TG2 reversed the migratory potential and anchorage independency of PC3 and DU145 cells and revealed a reduced level of mucin-1 (MUC1) RNA transcript through unbiased multi-omics profiling, which was restored by selective add-back of the truncated TG2 isoform (TGM2_v2). Silencing of AR resulted into increased MUC1 in TG2KO PC3 cells showing that TG2 affects transcriptional regulation of MUC1 via repressing AR expression. Treatment of PC3 WT cell line with TG2 inhibitor ZDON led to a significant increase in AR expression and decrease in MUC1. ZDON also blocked the formation of MUC1-multimers labelled with TG amine-donor substrates in reducing conditions, revealing for the first time a role for TG2, which we show to be externalised via extracellular vesicles, in MUC1 stabilisation via calcium-dependent transamidation. A specific antibody towards TGM2_v2 revealed its restricted nuclear location compared to the canonical long form of TG2 (TGM2_v1), which is predominantly cytosolic, suggesting that this form contributes to the previously suggested TG2-mediated NF-κB activation and AR transcriptional repression. As TGM2_v2 transcription was increased in biopsies of early-stage prostate adenocarcinoma (PRAD) patients compared to subjects presenting inflammatory prostatitis, and total TG2 protein expression significantly increased in PRAD versus normal tissue, the role of TG2 and its truncated form as a prostate malignancy marker is suggested. In conclusion, this investigation has provided the first unbiased discovery of a novel pathway mediated by TG2 via MUC1, which is shown to contribute to androgen insensitivity and malignancy of PCa cells and be upregulated in PCa biopsies, with potential relevance to cancer immune evasion.

Prostatic Inflammation's Effects on Individuals with Benign Prostate Hyperplasia's Clinical Consequences

Objective: In order to ascertain the impact of silent inflammatory prostatitis on the clinical results of individuals receiving trans urethral prostate resection owing to benign prostatic hyperplasia. Study Design: Retrospective study Place and Duration: This retrospective study was conducted at Liaquat National Hospital Karachi in the period from April, 2022 to September, 2022. Methods: Total 330 patients were presented in this study. In this study, individuals over 45 years without a history of urologic surgery who presented to a urology clinic with lower urinary tract symptoms related to benign prostatic hyperplasia were included. Pathological outcomes and clinical indicators were evaluated before and one year after surgery. Mean Standard deviation was used to present data and categorical variables were assessed by frequencies and percentages. Results: Mean age of the patients was 61.3±10.42 years. Among 330 cases, 200 (60.6%) patients were had benign prostatic hyperplasia and 130 (39.4%) cases had both prostatic inflammation (category-IV) and benign prostatic hyperplasia. Before TURP, mean prostate volume in BP patients was 55.7±8.11 m3 and in BPH/PI patients was 55.3±10.6 m3 and after TURP mean prostate volume in BP patients was 23.2±1.20 m3 and in BPH/PI group 23.4±8.17 m3. We found that people with prostate inflammation had lower Qmax values and a higher preoperative prostate score compared to those who had no signs of inflammation before to prostate transurethral resection. Conclusion: In this study, we came to the conclusion that in individuals with benign prostatic hyperplasia, prostate inflammation without symptoms might worsen lower urinary tract symptoms and the rate of urine flow. Keywords: Benign Prostatic Hyperplasia (BPH), Prostate Pathology, Prostatic Inflammation

Prostatic Inflammation's Effects on Individuals with Benign Prostate Hyperplasia's Clinical Consequences

Objective: In order to ascertain the impact of silent inflammatory prostatitis on the clinical results of individuals receiving trans urethral prostate resection owing to benign prostatic hyperplasia. Study Design: Retrospective study Place and Duration: This retrospective study was conducted at Liaquat National Hospital Karachi in the period from April, 2022 to September, 2022. Methods: Total 330 patients were presented in this study. In this study, individuals over 45 years without a history of urologic surgery who presented to a urology clinic with lower urinary tract symptoms related to benign prostatic hyperplasia were included. Pathological outcomes and clinical indicators were evaluated before and one year after surgery. Mean Standard deviation was used to present data and categorical variables were assessed by frequencies and percentages. Results: Mean age of the patients was 61.3±10.42 years. Among 330 cases, 200 (60.6%) patients were had benign prostatic hyperplasia and 130 (39.4%) cases had both prostatic inflammation (category-IV) and benign prostatic hyperplasia. Before TURP, mean prostate volume in BP patients was 55.7±8.11 m3 and in BPH/PI patients was 55.3±10.6 m3 and after TURP mean prostate volume in BP patients was 23.2±1.20 m3 and in BPH/PI group 23.4±8.17 m3. We found that people with prostate inflammation had lower Qmax values and a higher preoperative prostate score compared to those who had no signs of inflammation before to prostate transurethral resection. Conclusion: In this study, we came to the conclusion that in individuals with benign prostatic hyperplasia, prostate inflammation without symptoms might worsen lower urinary tract symptoms and the rate of urine flow. Keywords: Benign Prostatic Hyperplasia (BPH), Prostate Pathology, Prostatic Inflammation

Establishment and application of a CRISPR-Cas12a-based RPA-LFS and fluorescence for the detection of Trichomonas vaginalis

BackgroundInfection with Trichomonas vaginalis can lead to cervicitis, urethritis, pelvic inflammatory disease, prostatitis and perinatal complications and increased risk of HIV transmission. Here, we used an RPA-based CRISPR-Cas12a assay system in combination with a lateral flow strip (LFS) (referred to as RPA-CRISPR-Cas12a) to establish a highly sensitive and field-ready assay and evaluated its ability to detect clinical samples.MethodsWe developed a one-pot CRISPR-Cas12a combined with RPA-based field detection technology for T. vaginalis, chose actin as the target gene to design crRNA and designed RPA primers based on the crRNA binding site. The specificity of the method was demonstrated by detecting genomes from nine pathogens. To improve the usability and visualize the RPA-CRISPR-Cas12a assay results, both fluorescence detection and LFS readouts were devised.ResultsThe RPA-CRISPR-Cas12a assay platform was completed within 60 min and had a maximum detection limit of 1 copy/µl and no cross-reactivity with Candida albicans, Mycoplasma hominis, Neisseria gonorrhoeae, Escherichia coli, Cryptosporidium parvum, G. duodenalis or Toxoplasma gondii after specificity validation. Thirty human vaginal secretions were tested by RPA-CRISPR-Cas12a assays, and the results were read by a fluorescent reporter and LFS biosensors and then compared to the results from nested PCR detection of these samples. Both RPA-CRISPR-Cas12a assays showed 26.7% (8/30) T. vaginalis-positive samples and a consistency of 100% (8/8). The RPA-CRISPR-Cas12a assays had a higher sensitivity than nested PCR (only seven T. vaginalis-positive samples were detected).ConclusionsThe T. vaginalis RPA-CRISPR-Cas12a assay platform in this study can be used for large-scale field testing and on-site tests without the need for trained technicians or costly ancillary equipment.Graphical abstract

Appropriateness of Empirical Antibiotic Therapy for Cervicitis and Urethritis Prescribed in the Emergency Department.

Sexually transmitted infections are a prevalent global health care problem. Treatment guidelines have recently been updated as a result of antimicrobial resistance and public health trends. The aim of the study was to assess the appropriateness of empirical antibiotic therapy prescribed for cervicitis and urethritis in the emergency department. We designed a retrospective observational cohort study. We included adult patients with suspected cervicitis or urethritis who attended the emergency department of a tertiary hospital in 2020. We excluded patients with suspected pelvic inflammatory disease, pregnancy or prostatitis and those requiring admission to hospital. Appropriateness of empirical antibiotic therapy was evaluated taking into account 4 aspects: indication, dosing, duration of therapy, and route of administration. Data were obtained from the electronic medical record, the electronic prescription program, and the discharge summary. The study population comprised 176 patients; mean age was 28.9 years (SD = 7.7), and 90.9% were men. The most prescribed treatment was the combination of ceftriaxone and azithromycin (83.0%). Treatment was inappropriate in 71.6% of patients. A total of 159 drug errors were recorded. The most frequent cause was undertreatment (36.4%) related to underdosing (46.5%), particularly with regard to ceftriaxone. The percentage of errors was 11.9% for indication, 84.9% for dosing, 3.1% for duration, and 0% for route of administration. A high percentage of patients who attended the emergency department for suspected cervicitis or urethritis received an inappropriate empirical antibiotic regimen. The main reason was undertreatment due to underdosing.

Brief analysis on main indications and compatibility rules of Ciliao (BL 32) based on data mining

Based on the data mining technology, the main indications and compatibility rules of Ciliao (BL 32) were analyzed and summarized. The relevant literature was retrieved from the databases of CNKI, Wanfang, VIP, Cochrane Library, SinoMed, Scopus, Web of Science, EMbase and PubMed, from the date of establishment to September 8, 2021. Using the software of SPSS Modeler 18.0 and Gephi0.9.2, the included literature was analyzed by data mining. A total of 218 articles were included, of them, there were 36 articles using single-acupoint prescriptions and 182 articles using compound prescriptions. Acupuncture was the most frequently used intervention of Ciliao (BL 32), followed by electroacupuncture. Dysmenorrhea and labor analgesia were the dominant indications of single-acupoint prescriptions of Ciliao (BL 32), and 9 diseases i.e. dysmenorrhea, urinary incontinence, urinary retention, chronic pelvic inflammatory disease, chronic prostatitis and lumbar disc herniation were the dominant indications of compound prescriptions. The main indications of Ciliao (BL 32) involved diseases of reproductive system, urinary system and waist. There were 92 acupoints in compatibility with Ciliao (BL 32), which were main belonged to the bladder meridian, the conception vessel and the spleen meridian, the most frequently used acupoints were Sanyinjiao (SP 6), Guanyuan (CV 4), Shenshu (BL 23) and Zhongji (CV 3).

Effects of inflammatory prostatitis on the development and progression of benign prostatic hyperplasia: A literature review.

Benign prostatic hyperplasia is a major disease that affects the quality of life of middle-aged and older men. Although >70% of men aged >70years have pathological benign prostatic hyperplasia, its pathogenesis and progression remain unclear. In this article, we reviewed the scientific literature on this condition and examined the development of lower urinary tract symptoms. Clinically, the weight of the prostate is not always proportional to the severity of the symptoms, and many factors can influence the progression of benign prostatic hyperplasia. Other than androgens, chronic inflammation can play an essential role in its development and the induction of symptoms, especially in symptomatic hyperplasia, because inflammatory cell infiltration is frequently observed in the prostate. Inflammation-induced changes in the prostate environment lead to changes in gene expression and subsequent chronicity of inflammation. It has been suggested that chronic asymptomatic prostatitis might be associated with changes in prostate structure and subsequent symptoms. In animal studies, the administration of anti-inflammatory drugs in rats with chronic prostatitis prevented the infiltration of inflammatory cells and increased the gland-to-stroma ratio. It is hoped that future research on the molecular biology of asymptomatic prostatitis might help to develop new therapeutic strategies for lower urinary tract symptoms associated with symptomatic prostatitis. Our conclusions provide a comprehensive insight into the prevalence and development of benign prostate hyperplasia and the treatment methods that can be used to treat it.

I-wave Transcutaneous Thermotherapy for The Treatment of Benign Prostate Hyperthrophy and Pelvic Dysfunction In men

I-wave heat therapy produces microwave-like energy using a high-frequency electromagnetic field to achieve an optimal hyperthermia effect on the targeted organs. One of the advantages of this non-invasive and effective method is that it uses the body's natural response to the application of heat to produce a desired therapeutic effect. This innovative, non-invasive and very promising method, which also requires no anesthesia, is performed in the practitioner's office on an outpatient basis. Regarding urological indications, it is Benign Prostate Hypertrophy and inflammatory prostatitis including pelvic dysfunction that will be mainly treated. However, many other indications are applicable and some are under evaluation. In this paper, we present a review of one of these techniques concerning the principle of i-wave external thermotherapy. In a separate article we will present our patient group and the first clinical results in Switzerland.

I-wave Transcutaneous Thermotherapy for the Treatment of Benign Prostate Hypertrophy and Pelvic Dysfunction in Men

I-wave heat therapy produces microwave-like energy using a high-frequency electromagnetic field to achieve an optimal hyperthermia effect on the targeted organs. One of the advantages of this non-invasive and effective method is that it uses the body’s natural response to the application of heat to produce a desired therapeutic effect. This innovative, non-invasive and very promising method, which also requires no anesthesia, is performed in the practitioner’s office on an outpatient basis. Regarding urological indications, it is Benign Prostate Hypertrophy and inflammatory prostatitis including pelvic dysfunction that will be mainly treated. However, many other indications are applicable and some are under evaluation. In this paper, we present a review of one of these techniques concerning the principle of i-wave external thermotherapy. In a separate article we will present our patient group and the first clinical results in Switzerland.

Prediction of clinically significant prostate cancer after negative prostate biopsy: The current value of microscopic findings

ObjectiveTo assess the current ability of atypical small acinar proliferation (ASAP), multifocal high-grade prostatic intraepithelial neoplasia (mHGPIN), HGPIN with atypia (PINATYP) and other non-malignant lesions to predict clinically significant prostate cancer (csPCa) in repeat prostate biopsies. MethodsThis retrospective study analyzed 377 repeat prostate biopsies, carried out between 2.014 and 2.017, and excluding those with previous PCa or 5-alpha reductase inhibitors treatment. ASAP, mHGPIN, PINATYP, prostatic atrophy, prostatic hyperplastic atrophy, proliferative inflammatory atrophy (PIA), chronic prostatitis, acute prostatitis, or granulomatous prostatitis, were prospectively reported after 12-core transrectal ultrasound (TRUS) systematic negative previous biopsies. 3T-multiparametric magnetic resonance imaging (mpMRI) was performed previous repeat biopsies. At least 2-core TRUS targeted biopsies of Prostate Imaging-Reporting and Data Systemv2 lesions ≥3, and/or 12-core TRUS systematic biopsy were performed in repeat prostate biopsies. The main outcome measurements were csPCa detection, which was defined when the International Society of Uro-Pathology group grade >1 and avoided biopsies. After logistic regression analysis the most efficient model was selected, nomogram was designed with internal validation, and clinical utility was analyzed. ResultsNormal benign tissue alone was present in less than 2% of previous negative biopsies. mHGPIN (39.7%), ASAP (4.3%) and PINATYP (3.7%) failed to predict csPCa risk in repeat biopsies. The finding of PIA (38.2%) associated with a decreased the risk of csPCa with an Odd ratio of 0.54 (95% confidence interval: 0.31–0.95), P= 0.031. The area under the curve, to predict csPCa, of mpMRI was 0.736, increasing up to 0.860 (95% confidence internal:0.82–0.90) when PSA density, age, digital rectal examination, and differential PSA between biopsies and PIA finding were integrated in a predictive model. At 6% threshold, more than 20% of repeat prostate biopsies were saved without missing csPCa. ConclusionCurrently, mHGPIN in negative prostate biopsy seems not able to predict the risk of future csPCa. The low incidence of ASAP and PINATYP, in our series, did not allow us to draw conclusions. PIA finding associated with a reduced risk of csPCa, and it could be integrated in a useful based-mpMRI predictive nomogram.

Differentially Enhancing Effects of Long-term Treatment with Serrazyme, Boswellia and Pine on Seminal Bacterial Detection in Patients with Chronic Bacterial or Inflammatory Prostatitis, Probably Related to Several Degrees of Bacterial Adherence.

Prostatitis is a recurrent urinary infection in males and is often difficult to cure. The aim of the study was to examine whether anti-inflammatory effects of enhanced drainage of prostatic secretions, obtained through two months treatment with a proteolytic enzyme mucoactive (PEM) compound (Serrazyme and other constituents), influenced qualitative or quantitative expressions of bacterial growth in seminal cultures. 450 patients with prostatitis syndromes were randomized either to PEM therapy (intervention group) or to no treatment group. All patients were followed at the end of a 2-month PEM continuous treatment period (T2) and further two months after withdrawal (T4). After treatment, 15 out of 107 (14.1%) patients with Chronic Bacterial Prostatitis (CBP) showed negative seminal cultures, while in patients with cat NIH-IIIA prostatitis seminal cultures became positive in 33.3% cases with low bacteriospermia. After two months from withdrawal, although among CBP patients the total number of isolates and colony forming units (CFU) counts showed not significant changes compared to matched-values observed at T2, microbial parameters varied significantly among inflammatory prostatitis patients. The results of the present study showed that 2 months of treatment with PEM, decreasing bacterial adherence and inflammatory prostatitis, reveals a subgroup of apparent inflammation associated with infection that microbial biofilms likely mask in inflammatory prostatitis patients.

Classification and treatment of prostatitis: a review of literature

Prostatitis is one of the most common urinary tract diseases in men of all ages and is often challenging to manage. They can be classified based of the course of illness, presentation, and their etiology, and the investigation and treatment depend on how type of prostatitis. In this study we aim to look through the literature to find the various types of prostatitis and understand the respective methods of management. We did a systematic search for prostatitis using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar. google.com). The terms used in the search were: prostatitis, urinary tract diseases in men, classification of prostatitis, management of prostatitis. Prostatitis is a common disease and is considered to be the third most common urological disease in men. It has been categorized into four groups: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Treatment can be challenging, but mainly consists of use of fluoroquinolones.

Chronic Pelvic Pain: Neurogenic or Non-Neurogenic? Warm Detection Threshold Testing Supports a Diagnosis of Pudendal Neuropathy

Chronic pelvic pain (CPP) in men is rarely considered to have a neurogenic (neuropathic) basis. Separation of neurogenic from non-neurogenic pain is possible using clinical examination and neurophysiologic tests. A definite diagnosis of neuropathic pain can be made. We aim to demonstrate that definite pudendal neuropathic abnormalities can be supported by a quantitative sensory test (QST) called the warm temperature threshold detection (WDT) test in men with CPP. This is a retrospective review of 25 consecutive, unrecruited men evaluated in a private clinical practice beginning on January 1, 2010. The techniques of examination and neurophysiological testing have been standard since 2003. A private practice that is a referral center because of its focus on CPP of a neuropathic basis. Pinprick sensation was evaluated at 6 sites in the pudendal nerve territory (3 branches on each side). A WDT was performed at each nerve branch using a Physitemp NTE-2C Thermoprobe and Controller. This used a stepping algorithm from a neutral baseline of 31.5°C. Quantitative and subjective "qualitative responses" were recorded. Our preferred symptom score to evaluate pain level at consultation is the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). The results become the benchmark for comparison of responses following future treatments (not discussed). When possible, microscopy was used to evaluate prostate secretions for inflammatory prostatitis except in 2 men with CPP who had undergone previous radical prostatectomy for cancer. Observations were made of the skin in the pudendal territory. Our specific evaluation for neuropathy also sought evidence of multiple additional neuropathic pelvic pain generators. The WDT was abnormal in all men (88% quantitative), and pinprick sensation was abnormal in 92% of the men. The combination of tests provided a diagnosis of pudendal neuropathy in all patients, resulting in an accurate and timely explanation of the neurogenic basis of their CPP symptoms. The NIH-CPSI scores ranged from 10 to 35 (median 25). Four of 15 men had inflammatory prostatitis in addition to pudendal neuropathy. There is selection bias because the men were either self-referred, suspecting their diagnosis from internet searches, or were referred by physicians who were aware of the focus of this clinical practice. The warm temperature testing used established normal values for the men. The NIH-CPSI does not evaluate sexual or bowel symptoms. Sensitivity or specificity values for the tests could not be obtained. A possible neuropathic basis for CPP in men can be suspected from symptoms and history of activities. A probable diagnosis of neuropathy can be determined using a pinprick sensory evaluation in the pudendal territory. A definite diagnosis of pudendal neuropathy can be made using WDT. The combination of these 2 examinations demonstrated pudendal neuropathy in 100% of this cohort.The institutional review board deemed this study met criteria for exemption. Chronic pelvic pain, pudendal neuropathy, quantitative sensory testing, warm temperature detection threshold test, neuropathic pelvic pain, definite diagnosis of neuropathy, chronic prostatitis.

Pathological lesions and global DNA methylation in rat prostate under streptozotocin-induced diabetes and melatonin supplementation.

Chronic hyperglycemia increases production of reactive oxygen species, which favors carcinogenesis. The association between diabetes and prostate cancer is controversial. Melatonin has antioxidant, anti-inflammatory, and antiproliferative properties. We investigated whether low doses of melatonin prevent the tissue alterations caused by diabetes and alter prostate histology of healthy rats. We also investigated whether experimental diabetes promoted the development of pathological lesions in the ventral prostate of rats. Melatonin was provided in drinking water (10 μg/kg/day) from age 5 weeks until the end of experiment. Diabetes was induced at 13 weeks by administration of streptozotocin (40 mg/kg, ip). Rats were euthanized at 14 or 21 weeks. Histological and stereological analyses were carried out and the incidence and density of malignant and pre-malignant lesions were assessed. Immunohistochemical assays of α-actin, cell proliferation (PCNA), Bcl-2, glutathione S-transferase (GSTPI), and DNA methylation (5-methylcytidine) were performed. Melatonin did not elicit conspicuous changes in the prostate of healthy animals; in diabetic animals there was a higher incidence of atrophy (93%), microinvasive carcinoma (10%), proliferative inflammatory atrophy, PIA (13%), prostatitis (26%), and prostate intraepithelial neoplasia, PIN (20%) associated with an increase of 40% in global DNA methylation. Melatonin attenuated epithelial and smooth muscle cell (smc) atrophy, especially at short-term diabetes-and normalized incidence of PIN (11%), inflammatory cells infiltrates, prostatitis (0%) and PIA (0%) at long-term diabetes. MLT was effective in preventing inflammatory disorders and PIN under diabetic condition. Although MLT has antioxidant action, it did not influence DNA methylation and not avoid carcinogenesis at low doses.

195 Intraprostatic Injection of Botulinum Toxin-A in Patients with Refractory Chronic Pelvic Pain Syndrome: The Transurethral vs. Transrectal Approach

To evaluate the outcome of an intraprostatic injection of botulinum toxin-A (BTX-A) in men with refractory chronic prostatitis-associated chronic pelvic-pain syndrome (CP/CPPS) and to compare the efficacy of the transurethral and transrectal routes. In an uncontrolled randomised clinical trial conducted in men with refractory CP/CPPS, the patients were classified into two groups according to the route of BTX-A injection; transurethral (group 1, 28 patients) and transrectal ultrasonography-guided (group 2, 35 patients). The chronic prostatitis symptom index (CPSI), maximum urinary flow rate (Qmax) and white blood cell (WBC) count in expressed prostatic secretion (EPS) were measured before and at 3, 6 and 12 months after the injection. A significant clinical improvement (SCI, defined as a reduction of 4 points or a 25% decrease in total CPSI score) was correlated with patient age, prostate volume and symptom duration. In group 1, the pain and quality-of-life domain scores improved, but statistically significantly only at 6 months. The voiding score improved at all follow-up visits. In group 2 there was a significant improvement in all the CPSI domain scores at all follow-up visits, except for pain, which was insignificantly improved by 12 months. The SCI ratings in groups 1 and 2 were 36%, 79% and 57%, and 49%, 89% and 74% in group 2 at the three follow-up visits, respectively. The Qmax was significantly improved in both groups during the follow-up (except at 12 months in group 1). There was a significant reduction in the mean WBC count in the EPS in patients with inflammatory prostatitis. Both prostate volume and symptom duration were significantly associated with a lower SCI rating.

The effect of prostatic inflammation on clinical outcomes in patients with benign prostate hyperplasia.

BackgroundTo investigate the effect of asymptomatic inflammatory prostatitis on clinical outcomes of patients undergoing trans urethral resection of prostate due to benign prostatic hyperplasia.Materials and methodsA total of 514 patients were enrolled in the study. Clinical parameters and pathological results were compared before and one year after surgery.ResultsOf the patients 310 were diagnosed with purely benign prostatic hyperplasia and the others were diagnosed with both prostatic inflamation (cathegory IV) and benign prostatic hyperplasia. No statistical significance was observed between two groups among the parameters including age, prostate volume and post voiding residue (P > 0.05). Patients with prostate inflammation presented higher preoperative International Prostate Symptom Score and lower Qmax values when compared to those without inflammation before trans urethral resection of prostate.ConclusionAsymptomatic prostate inflammation can lead to worsen lower urinary tract symptoms and urinary flow rate in patients with benign prostatic hyperplasia. Furthermore, the improvement of the complaints after surgery was worse in patients with asymptomatic prostate inflammation. Further well designed prospective-randomised studies are needed to support our findings.

Elevated Adiponectin in Expressed Prostatic Secretion is a Novel Indicator of Inflammatory Prostatitis.

Prostatitis is a common urologic disease with a high prevalence and a significant negative impact on the quality of life. There is a lack of clear understanding of the pathogenesis of prostatitis, there are no rapid diagnostic methods nor effective treatment methods. The present study explored the cytokine profiles in expressed prostatic secretions of prostatitis in the hope of obtaining specific diagnostic biomarkers for prostatitis. Cytokine antibody arrays, ELISA, and immunohistochemical staining were used to detect the levels and origin of cytokines in expressed prostatic secretions. The diagnostic value of adiponectin as an inflammatory indicator for sub-classification of prostatitis type III were evaluated. The results showed that adiponectin levels in prostatitis type IIIa (577.72 ± 558.86 ng/mL) were higher than in prostatitis type IIIb (124.82 (75.81, 241.04) ng/mL) and healthy controls (76.08 (23.34, 204.81) ng/mL), and that the adiponectin levels in prostatitis type IV (207.10 (128.02, 454.31) ng/mL) had a significant correlation with the white blood cell count in expressed prostatic secretion. Our results indicate that adiponectin had a moderate diagnostic value as an inflammatory indicator for sub-classification of prostatitis type III. It suggests that adiponectin plays an important role in the pathogenesis of inflammatory prostatitis and could be developed as a rapid laboratory test indicating inflammation in prostatitis.

Symptom Severity Following Rifaximin and the Probiotic VSL#3 in Patients with Chronic Pelvic Pain Syndrome (Due to Inflammatory Prostatitis) Plus Irritable Bowel Syndrome.

This study investigated the effects of long-term treatment with rifaximin and the probiotic VSL#3 on uro-genital and gastrointestinal symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) plus diarrhoea-predominant irritable bowel syndrome (D-IBS) compared with patients with D-IBS alone. Eighty-five patients with CP/CPPS (45 with subtype IIIa and 40 with IIIb) plus D-IBS according to the Rome III criteria and an aged-matched control-group of patients with D-IBS alone (n = 75) received rifaximin and VSL#3. The primary endpoints were the response rates of IBS and CP/CPPS symptoms, assessed respectively through Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) and The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and performed at the start of therapy (V0) and three months after (V3). In IIIa prostatitis patients, the total NIH-CPSI scores significantly (p < 0.05) decreased from a baseline mean value of 21.2 to 14.5 at V3 , as did all subscales, and in the IIIb the total NIH-CPSI score also significantly decreased (from 17.4 to 15.1). Patients with IBS alone showed no significant differences in NIH-CPSI score. At V3, significantly greater improvement in the IBS-SSS and responder rate were found in IIIa patients. Our results were explained through a better individual response at V3 in IIIa prostatitis of urinary and gastrointestinal symptoms, while mean leukocyte counts on expressed prostate secretion (EPS) after prostate massage significantly lowered only in IIIa cases.