Prostatitis Patients Research Articles

Urovirulence determinants in Escherichia coli strains causing prostatitis.

To define the urovirulence properties of Escherichia coli strains producing prostatitis, E. coli strains isolated from men with acute (7 strains) or chronic (23) prostatitis were compared with E. coli isolates from women with pyelonephritis (30), acute cystitis (60), or complicated urinary tract infection (UTI; 30). Strains from prostatitis patients were significantly more likely to express hemolysin than were strains causing complicated UTI (73% vs. 43%; P = .02) and more often demonstrated hybridization with the cytotoxic necrotizing factor-1 (CNF-1) probe (63%) than did strains from women (44%-48%). P fimbrial expression was highest among pyelonephritis (73%) and prostatitis strains (53%) and lowest among E. coli from women with complicated UTI (23%) and cystitis (30%; P < .05, prostatitis strains vs. either of the latter 2 groups). Results suggest that E. coli strains producing prostatitis generally possess urovirulence profiles similar to those of strains from women with acute uncomplicated pyelonephritis and that hemolysin and CNF-1 are especially prevalent in prostatitis strains.

Ciprofloxacin treatment in chronic prostatitis.

Objective: To investigate the effectiveness of ciprofloxacin in the treatment of chronic bacterial prostatitis due to various microorganisms. Methods: Patients with chronic prostatitis symptoms were evaluated by culture of their expressed prostatic secretion and fractionated urine samples according to the four-glass localization test of Meares and Stamey. Patients with an isolated microbial agent were treated with ciprofloxacin 500 mg twice a day for 4 weeks and re-evaluated 1 week and 6 months after the treatment. Results: Sixteen of the 68 (23.5%) evaluated patients were diagnosed as having chronic prostatitis with an isolated microbial agent. Ureaplasma urealyticum was the most common microorganism related to chronic prostatitis. Eradication of the previously isolated microbial agent was found in 11 of the 16 patients at the first-week evaluation. At the 6-month control evaluation no growth was observed on the cultures of seven of the 16 (43.8%) patients, which was accepted as successful treatment. Conclusions: U. urealyticum can be the responsible agent in some chronic prostatitis patients. Ciprofloxacin may be a treatment option in chronic prostatitis.

Psychological and physical factors involved in chronic idiopathic prostatitis

Idiopathic prostatitis is a common, often chronic condition in which psychological factors are suspected to play a role. Men with chronic prostatitis ( n = 51) and a control group of 34 men without any chronic pain condition, equivalent on demographic characteristics, were compared on psychological and perineal muscle tension measures. Prostate-specific antigen and expressed prostatic secretion cell counts were also measured. Chronic prostatitis patients were consistently more elevated than controls on hypochondriasis, depression, and hysteria (MMPI), and on somaticization and depression (Brief Symptom Inventory), and were less elevated on masculine/instrumentality (Personal Attributes Questionnaire) scales. A cluster analysis of MMPI profiles revealed that 57% of the chronic prostatitis patients produced generally unelevated MMPI profiles, whereas the remaining 43% fell into two groups with distinct patterns of distress. The results indicate depression and psychosocial distress are common among chronic prostatitis patients, calling for careful evaluation and attention to psychological symptoms.

Transurethral Microwave Thermotherapy for Nonbacterial Prostatitis: A Randomized Double-Blind Sham Controlled Study Using New Prostatitis Specific Assessment Questionnaires

Purpose We investigated the effectiveness and durability of transurethral microwave thermotherapy in the treatment of chronic nonbacterial prostatitis using 2 new prostatitis specific assessments in a randomized, double-blind, sham controlled trial. Materials and Methods Patients with nonbacterial prostatitis were randomly assigned to receive either transurethral microwave thermotherapy or sham therapy. Patients were assessed using a symptom severity index and symptom frequency questionnaire. These 2 new prostatitis symptom assessment tools were validated by applying them to 30 similar patients without prostatitis. All nonresponders received transurethral microwave thermotherapy at 3 months and were reassessed at 6 months. Long-term followup of the responder group averaged 21 months. Results The symptom severity index and symptom frequency questionnaire were confirmed to be valid for symptom assessment in prostatitis patients. The transurethral microwave thermotherapy group benefited from therapy compared to the sham group. Of the sham group 50 percent had a favorable response after subsequent transurethral microwave thermotherapy. The 7 responders in the treatment group continued to improve during the subsequent 21 months. Conclusions Transurethral microwave thermotherapy appears to be an effective, safe and durable treatment for some patients with nonbacterial prostatitis unresponsive to traditional therapy.

Sickness Impact of Chronic Nonbacterial Prostatitis and its Correlates

Purpose There is evidence that many patients experiencing chronic idiopathic prostatitis or prostadynia not only have recurrent physical symptoms but also display a range of psychological symptoms, such as depression or anxiety, suggesting that the symptoms of chronic prostatitis may seriously impact on quality of life and functioning. We investigated the degree of sickness impact of chronic prostatis, and the differential importance of physical and psychological symptoms in predicting sickness impact. Materials and Methods The sickness impact profile as well as several symptom measures were administered to 39 patients with chronic prostatitis. Multiple regression analyses were performed to evaluate what proportion of the variance in quality of life or functional status was explained by physical and psychological symptoms. Results The sickness impact profile mean total score of chronic prostatitis patients was within the range of scores reported in the literature for patients suffering myocardial infarction, angina or Crohn's disease. Pain was the only physical symptom that significantly contributed towards explaining variance in sickness impact. Psychological symptoms added significantly to the amount of predicted variance. Conclusions The results indicate a need for careful evaluation and attention to sickness related dysfunction in patients with chronic prostatitis.

Autoantibodies to Prostate Specific Antigen in Patients with Benign Prostatic Hyperplasia

Purpose We tested for a possible autoimmune process in benign prostatic hyperplasia (BPH). Materials and Methods Titers of IgC antibodies to prostate specific antigen (PSA) were measured in the sera of 85 BPH patients, 20 controls and 17 chronic prostatitis patients by enzyme-linked immunosorbent assay. Results The mean anti-PSA titers in the BPH group were significantly higher than in the controls and prostatitis group (p less than 0.0005). Accordingly, 59 percent of BPH patients could be defined as responders to PSA compared to none among the controls (p less than 0.0005). Conclusions Circulating autoantibodies to PSA were shown to exist in the sera of BPH patients. This observation suggests that autoimmune processes may have a role in BPH.

Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia.

The relationship between the serum values of prostate specific antigen (PSA) and the extent of histological prostatitis was investigated in 42 patients undergoing transurethral resection of the prostate for benign hyperplasia (BPH) without clinical evidence of prostatitis. Histological prostatitis was divided into three groups: acute, chronic-active, and chronic-inactive inflammation. The extent of histological prostatitis was expressed as the number of prostatic acinar and ductal glands with inflammatory infiltrate per total number of glands (%). The serum PSA values significantly correlated with the extent of acute and chronic-active prostatitis (correlation coefficient r = 0.765 and 0.656, P < 0.01). A relationship between PSA values and the extent of chronic-inactive prostatitis was not found. In the immunohistochemical study, prostatic epithelial cells with acute and chronic-active inflammation showed negative staining for PSA antigen. These results indicate that histological acute and chronic-active prostatitis is considered an important factor for inducing the high increase in serum PSA values via the leak phenomenon.

Reduced semen quality caused by chronic abacterial prostatitis: an enigma or reality?

To investigate whether there is an inter-relationship between chronic abacterial prostatitis and potential infertility. As part of the eligibility studies for hyperthermia treatment for chronic abacterial prostatitis patients, a large number of chronic prostatitis patients were referred to us from peripheral outpatient clinics. Sperm analysis was a routine portion of the eligibility studies. To exclude bacterial prostatitis, urine cultures, expressed prostatic secretion, and semen cultures were performed. The patient population was not differentiated on the basis of those suffering from either nonbacterial prostatitis or prostatodynia according to the commonly accepted classification. The control group was the laboratory normal standard group. Normal human volunteers in an academic and clinical research environment. The first group includes 86 patients suffering from long-standing (1 to 20 years) chronic abacterial prostatitis, according to the commonly accepted classification, with a mean age of 39.9 +/- 9.5 years. The second group includes 101 normal fertile men with a mean age of 31.4 +/- 5.5 years. The routine semen analysis performed included biochemical tests of seminal plasma, bacteriology, and light microscopy. The original hypothesis was based on a reduction in semen quality in these patients caused by chronic abacterial prostatitis. Measurements for sperm motility parameters, morphology characteristics, prostate markers, and white blood cells (WBC) were designed accordingly. Statistical comparisons of the two groups showed that several sperm motility parameters, morphology characteristics, prostate markers, and WBC are outside of the normal value ranges in the chronic abacterial prostatitis group. In addition, there is a correlation between the duration of the disease and two important sperm analysis variables: increased prostatic markers and appearance of sperm morphological defects. From the results obtained, the high incidence of secondary infertility in these patients may be explained.

Ureaplasma urealyticum in the Urogenital Tract of Patients with Chronic Prostatitis or Related Symptomatology

To elucidate the role of Ureaplasma urealyticum as a causative organism in chronic prostatitis we investigated its incidence in the urogenital tract in 131 chronic prostatitis patients and 120 prostatodynia patients; the presence of common bacteria or Chlamydia trachomatis was also recorded. According to the 4-glass localisation test, U. urealyticum (> or = 10(3) ccu/ml) was isolated from the prostates of 16 prostatitis patients and 2 prostatodynia patients; 5 of these prostatitis patients (but neither of the prostatodynia patients) had other bacteria in specimens after prostatic massage. Thus U. urealyticum was the sole organism isolated from the prostates of 11 prostatitis and 2 prostatodynia patients, which suggests that it is an aetiological agent in some cases of chronic non-bacterial prostatitis.

Personality variables involved in chronic prostatitis

Psychologic factors have been considered to play an important role in the etiology of chronic prostatitis. Earlier studies are often based on a psychoanalytical perspective and seldomly used quantitative approaches. In the present study quantitative tests are used to investigate personality variables which are suggested in the literature as underlying chronic prostatitis. A group of 50 chronic prostatitis patients was compared with a group of 50 patients seen for a vasectomy. Psychologic measures were taken by means of a personality inventory (NVM, Dutch short form of the MMPI), a symptom checklist (SLC-90), and a depression inventory (IDD). Results showed statistically significant differences between the groups, with the chronic prostatitis patients scoring consistently higher on the measures than vasectomy patients. However, these differences in scores were not of a great magnitude and minor compared with differences in scores from psychiatric patients. Discriminant analysis suggested somatization and depression to be the key variables to distinguish chronic prostatitis patients from vasectomy patients. Overall, it seemed unfounded to label chronic prostatitis patients “neurotic” or “psychopathologic,” and it was impossible to conclude that there are personality variables that specifically identify the chronic prostatitis patients.

Antimicrobial Treatment for Chronic Prostatitis as a Means of Defining the Role of &lt;i&gt;Ureaplasma urealyticum&lt;/i&gt;

A study was conducted to assess the clinical and microbiological effects of antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum. Significant U. urealyticum cells were considered to be isolated from the prostates of 18 of 143 prostatitis patients. These patients with ureaplasma-associated prostatitis were randomly treated with either ofloxacin or minocycline for 2 weeks; 4 patients were excluded due to voluntary withdrawal. U. urealyticum was eradicated in all the patients. Symptoms were resolved in 10 patients, and leukocytes in expressed prostatic secretion were cleared in 4 patients; both drug treatments revealed similar results. Even if we exclude 3 patients with significant coexistent Staphylococcus epidermidis cells before treatment, 3 of 11 patients evaluated showed complete resolution of symptoms and clearance of leukocytes in expressed prostatic fluid. These results suggest that U. urealyticum is a causative organism in some patients with chronic prostatitis.

Digital rectal examination-associated alterations in serum prostate-specific antigen.

The effect of digital rectal examination (DRE) on measurement of serum prostate-specific antigen was investigated during a prostate cancer screening program of 2,736 ambulatory men. Serum samples were collected before and after DRE and values compared using the nonparametric Wilcoxon signed rank test. Small, yet statistically significant, increases were found associated with DRE. The magnitude of these increases, however, was of minor clinical importance. Patients who exhibited the largest increases with initial values greater than the upper limit of normal (4 micrograms/L) were found to have either benign prostatic hyperplasia, prostatitis, or prostatic carcinoma. The benign prostatic hyperplasia patients showed relatively low initial prostate-specific antigen values with similarly small increases related to DRE, whereas the prostatitis and cancer patients exhibited both higher initial prostate-specific antigen values and larger increases associated with DRE. Finally, patients with increases in prostate-specific antigen from less than 4 micrograms/L to greater than or equal to 4 micrograms/L comprised less than 2% of the reference range population, the majority of whom had post-DRE measurements of less than 5 micrograms/L. Thus, DRE does not appear to be a significant factor in falsely elevating prostate-specific antigen levels and should be of limited concern to the clinician obtaining serum samples after DRE.

The survival rate of macrophages in prostatic fluid from nonbacterial prostatitis patients.

The survival rate of macrophages in prostatic fluid from nonbacterial prostatitis patients.

Study of Macrophages in Prostatic Fluid from Nonbacterial Prostatitis Patients

Relationship between activation of macrophages in prostatic fluid and stage of nonbacterial prostatitis was studied by observing the rate of adherence of leukocytes, percentage of macrophages among adherent leukocytes and presence of spreading of macrophages. As a result, it was found that macrophages in the early stage of NBP were more activated than macrophages in the chronic stage.

The Response of Seven Prostatic Fluid Components to Prostatic Disease

282 human prostatic fluid samples have been investigated for their pH value, zinc, and citrate concentration and their acid phosphatase, leucine aminopeptidase, diamine oxidase, and beta-glucuronidase activities. The results have been analysed in terms of the clinical status of the patients. Significant differences between patient categories were found with all but diamine oxidase and beta-glucuronidase. These differences were mainly found between men with apparently healthy prostates and prostatitis patients; the pH being raised and the acid phosphatase, leucine aminopeptidase, zinc and citrate being reduced. The diagnostic value of these parameters was evaluated, each could be used to classify correctly 90% of patients from these 2 groups. Zinc, citrate and leucine aminopeptidase showed no age relationship and were better than acid phosphatase and pH in discriminating between BPH and prostatitis. Evidence was also found for a return of normal secretory function sometime after an episode of prostatitis. Zinc and citrate are likely to be the most useful parameters for clinical evaluation.

The response of seven prostatic fluid components to prostatic disease.

282 human prostatic fluid samples have been investigated for their pH value, zinc, and citrate concentration and their acid phosphatase, leucine aminopeptidase, diamine oxidase, and beta-glucuronidase activities. The results have been analysed in terms of the clinical status of the patients. Significant differences between patient categories were found with all but diamine oxidase and beta-glucuronidase. These differences were mainly found between men with apparently healthy prostates and prostatitis patients; the pH being raised and the acid phosphatase, leucine aminopeptidase, zinc and citrate being reduced. The diagnostic value of these parameters was evaluated, each could be used to classify correctly 90% of patients from these 2 groups. Zinc, citrate and leucine aminopeptidase showed no age relationship and were better than acid phosphatase and pH in discriminating between BPH and prostatitis. Evidence was also found for a return of normal secretory function sometime after an episode of prostatitis. Zinc and citrate are likely to be the most useful parameters for clinical evaluation.

Longitudinal study of macrophages in prostatic fluid from nonbacterial prostatitis patients

Longitudinal study of percentage of macrophages among leukocytes in prostatic fluid from 10 patients with nonbacterial prostatitis did not show correlation between percentage of macrophages and severity of clinical symptoms.

Disc electrophoresis of prostatic fluid. Relative mobility and molecular weight of some enzymes and proteins

Prostatic fluid from 20 healthy men and 7 patients with prostatitis was studied by acrylamide disc electrophoresis, along with seminal plasma from 7 healthy individuals and homogenates of prostate gland, ductus deferons, seminal vesicles, seminal fluid and sperms of two healthy individuals killed in an accident. Proteins and multiple molecular forms of lactate and malate dehydrogenases, alkaline and acid phosphatases, transaminases, esterases, leucine aminopeptidase, peroxidase, and α-amylase were localized in the gels and their relative mobility determined. Fifteen protein bands are characteristic for prostatic fluid. In prostatitis patients some differences were observed in the above proteins and enzymes. Molecular weight determination of 9 characteristic proteins and 10 enzyme forms from prostatic fluid showed it to be a complex mixture containing both low and high molecular weight proteins.

Bacteriological and serological study of chronic prostatitis patients.

Bacteriological and serological study of chronic prostatitis patients.