Prostatitis | Health and Prostate

Archive for the ‘Prostatitis’ Category

Radiographic Examination

Posted by admin on June 21st, 2011 No Comments

Radiographic examination of patients with chronic bacterial prostatitis and prostatitis inflammatory syndromes is usually unnecessary and findings are nondiagnostic. While patients with tuberculosis prostatitis and granulomatous prostatitis may undergo radiographic examination with diagnostic findings, the majority of patients can be evaluated and treated without imaging studies. In patients who have chronic bacterial prostatitis and are undergoing transrectal ultrasound for elevated prostate-specific antigen levels, lesions may be identified, including prostatic calcifications, hypoechoic lesions in the peripheral zone, periprostatic venous engorgement, and abnormalities in size, symmetry, and consistency of the seminal vesicles. Hypoechoic lesions are frequently multifocal, often occurring in the peripheral zone and usually without changes in the overlying prostatic capsule. Prostatic calcifications are a more common abnormality in imaging studies of patients with recurrent chronic bacterial prostatitis. These calcifications are visible on transrectal ultrasound as multifocal or unifocal, with Read more [...]

Posted in Prostatitis

Chronic Bacterial Prostatitis in the Elderly

Posted by admin on May 5th, 2011 No Comments

Chronic bacterial prostatitis is now recognized as an important cause of relapses of urinary tract infection in elderly men. It is most commonly caused by E. coli, but Klebsiella-Enterobacter, P. mirabilis, and enterococci are also common causes. S. epidermidis, S. aureus, and diphtheroids have been frequent isolates in some series. Many individuals with chronic infection of the prostate are totally asymptomatic. However, some have perineal discomfort, low back pain, or dysuria. Symptoms of acute urinary tract infection may periodically appear. In fact, chronic bacterial prostatitis is probably the most common cause of relapsing urinary tract infection in men. Fever, if present, tends to be low grade unless pyelonephritis occurs. Rectal examination and intravenous pyelograms are unremarkable unless the patient also has an enlarged prostate from benign prostatic hypertrophy or carcinoma. Because of the focal nature of chronic bacterial prostatitis, needle biopsy of the prostate gland for culture of tissue is unreliable. Demonstration of leukocytes in prostatic fluid is not specific for bacterial Read more [...]

Posted in Prostatitis

Diagnosis and Treatment of Prostatitis. Part 5

Posted by admin on May 4th, 2011 No Comments

Nonbacterial Prostatitis Nonbacterial prostatitis (NBP) is the most common type of prostatitis, and occurs eight times more frequently than bacterial prostatitis. Nonbacterial prostatitis presents with the same signs and symptoms as bacterial prostatitis; however, prostatic fluid cultures are negative for presence of bacteria. Inflammation is evident upon prostatic fluid analysis, and can be identified by a minimum of 10 to 15 white blood cells per high power field on microscopic examination. Although controversial, implicated pathogens include Chlamydia trachomatis, Ureaplasma urealyticum, and Trichomonas vaginalis. Minocycline 100 mg twice daily, doxycycline 100 mg twice daily, or erythromycin 500 mg four times daily have been utilized in order to eradicate the suspected pathogens. Erythromycin’s antimicrobial activity is significantly enhanced in the presence of the alkaline pH in prostatic fluid, thus, it achieves high cure rates of prostatic infections. Treatment duration is approximately 2 to 4 weeks. Prolonged therapy after treatment failure is not indicated, since nonbacterial prostatitis Read more [...]

Posted in Prostatitis

Research and Treatments Ahead for Prostatitis

Posted by admin on January 8th, 2010 No Comments

Every year, men make over two million visits to the doctor because of prostatitis, a condition that causes chronic pelvic pain, urinary problems and often pain during ejaculation. While experts still don't know for sure what causes this disease, or how to cure it, great strides have been made in the past few years. "It's really unknown whether [the cause] is a small microbial agent such as a bacterium or virus, cytokines or autoimmune factors, toxins in the urine or some kind of oxidative stress. But there's evidence of all of these, particularly psychological and immunological [factors]," according to Dr. Mark Samuel Litwin of the University of California at Los Angeles. Dr. Litwin addressed an audience of urologists at the annual meeting of the American Urological Association in Atlanta last week. Litwin pointed out that "there is a tremendous psychological burden associated with this chronic condition." Prostatitis can affect men of any age, but is most common among those between 35 and 50. In the past, men with prostatitis were usually treated with antibiotics because it was assumed Read more [...]

Posted in Prostatitis

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 3

Posted by admin on December 6th, 2009 No Comments

Results Of the 40 patients who received trimethoprim-sulfamethoxazole for 6 weeks, 9 were classed as failures. These either had no response or relapsed during therapy or relapsed after therapy with unchanged severity of symptoms. Eleven were considered improved on the basis of continued symptomatic improvement or because of a good initial response followed by relapse with symptoms less severe than before treatment. Included in the "improved" group are two patients who initially relapsed but who have since remained asymptomatic on long-term therapy. The 20 patients who have had continued satisfactory relief of symptoms are classified as having good results. Discussion An earlier controlled study compared the results of treatment with sulfamethoxazole with those from the use of trimethoprim-sulfamethoxazole. Only after 6 weeks of treatment was a significant response obtained and this influenced the choice of 6 weeks as the treatment period. A longer period of treatment (12 weeks) produced better results when trimethoprim-sulfamethoxazole (TMP-SMX) was used after a course of Read more [...]

Posted in Prostatitis

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 2

Posted by admin on December 6th, 2009 No Comments

Treatment Antibiotic therapy with appropriate agents, even in well documented infections, rarely proved successful in the past because the diffusion of most antibacterial drugs from plasma into prostatic fluid provided too low a concentration to be effective. Of many drugs tested for diffusion across the prostatic epithelium only the basic macrolides (erythromycin and oleandomycin) achieved significant concentrations in the prostatic fluid. These drugs are ineffective against the common gram-negative organisms cultured from prostatic fluid. Trimethoprim has been shown in both dogs and man to reach higher concentrations in the prostatic fluid than in serum at the normal pH of prostatic fluid. The concentrations attained in the diseased prostate may be lower, since in prostatitis the prostatic fluid pH may be elevated, but are probably still effective. When trimethoprim is combined with a sulfonamide, synergistic antibacterial activity results, with both a bactericidal effect and delayed emergence of resistant strains. Because of a similar half-life, sulfamethoxazole has been used in Read more [...]

Posted in Prostatitis

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 1

Posted by admin on December 6th, 2009 No Comments

Chronic prostatitis is a common condition occurring in younger men which presents problems of diagnosis and treatment. In some patients a bacterial population of known pathogens can be identified in the prostatic fluid. In many others proof of bacterial etiology is lacking. There has therefore been an acceptance of two common forms of the disease, namely chronic bacterial prostatitis and a condition that has been variously termed chronic abacterial prostatitis, nonspecific prostatitis, prostatosis and prostatic neurosis. Despite the refinements of methods of collection and bacteriologic processing of prostatic fluid, certainty of bacterial recovery cannot be assumed. The sample obtained may fail to include fluid from all parts of the gland or, in particular, from the inflamed parts of the gland. The inconsistency of recovery of bacteria from known cases of bacterial prostatitis lends support to this thesis and suggests that the segregation of chronic prostatitis into bacterial and nonbacterial groups is by no means certain. Where episodes of recurrent genitourinary infection such as Read more [...]

Posted in Prostatitis

Diagnosis and Treatment of Prostatitis. Part 4

Posted by admin on December 2nd, 2009 No Comments

Antimicrobial Regimens for the Treatment of Acute and Chronic Bacterial Prostatitis Drug class Dose* and Route Common Side Effects Comments Trimethoprim/ sulfamethoxazole 160 mg TMP–800 mg SMX PO BID Nausea, vomiting, diarrhea, photosensitivity May be used for suppressive therapy as one single-strength tablet given once a day Fluoroquinolones ofloxacin 200 mg–400 mg PO BID Nausea, vomiting, dizziness, insomnia, photosensitivity Drug-drug interactions with theophylline, caffeine, warfarin and other drugs metabolized by the cytochrome p450 system. Drug-nutrient interactions with di– and trivalent cations (e.g., Mg, Al, Ca, Fe, Zn, and Cr) norfloxacin 400 mg PO BID ciprofloxacin 250 mg–500 mg PO BID Aminopenicillins ampicillin 2 gm IV Q6h Diarrhea, rash, hypersensitivity reactions Contraindicated in patients with a history of penicillin anaphylaxis amoxicillin 500 mg PO Q8h Aminoglycosides gentamicin 1 mg/kg–2 mg/kg Q8h Nephrotoxicity, vestibular and auditory toxicity Serum concentrations need to be Read more [...]

Posted in Prostatitis

Diagnosis and Treatment of Prostatitis. Part 3

Posted by admin on December 2nd, 2009 No Comments

Chronic Bacterial Prostatitis Chronic bacterial prostatitis (CBP) occurs when acute bacterial prostatitis is treated inadequately due to resistance, relapse, short-course therapy or because the ductal anatomy of the peripheral zone of the prostate may have blocked drainage of secretions from the prostate. Rarely will some patients be found who have not had a previous bout of acute prostatitis. The most common clinical feature of chronic bacterial prostatitis is recurrent urinary tract infections. Subsequently, patients will complain of obstructive and irritative urinary symptoms. Physical exam reveals a palpable, tender prostate. However, patients often present asymptomatic, with a normal prostate gland exam. Localizing bacteria from the prostate is paramount in order to diagnose chronic bacterial prostatitis. The Stamy–Meares test is a collection of segmented urine samples from the urethra, bladder, and prostate; it is considered the gold standard for diagnosis. The patient voids and collects the first 5–10 mL of urinary stream (VB1), then collects a midstream specimen of 10–20 mL (VB2), Read more [...]

Posted in Prostatitis

Diagnosis and Treatment of Prostatitis. Part 2

Posted by admin on December 1st, 2009 No Comments

Acute Bacterial Prostatitis Acute bacterial prostatitis (ABP) is the least common of the prostate infections. It is usually accompanied by a urinary tract infection with positive cultures from prostatic secretions. It presents with a sudden onset of fever, chills, and low back and perianal pain. Patients often complain of obstructive (dysuria, nocturia, urgency, frequency, and burning) and irritative (hesitancy, straining, dribbling, weak stream, and incomplete emptying) urinary symptoms. Other constitutional symptoms include generalized malaise, arthralgias and myalgias. Physical examination reveals a warm, tender, swollen and indurated prostate. The diagnosis of acute bacterial prostatitis can be made based on clinical signs and symptoms. Often, urinary cultures are positive and reveal Escherichia coli as the most prevalent pathogen. Other Gram-negative microorganisms from the Enterobacteriaceae class, such as Proteus sp. and Klebsiella sp., may also be present. In patients who present with a recent history of hospitalization and/or broad-spectrum antimicrobial use, a high index of suspicion Read more [...]

Posted in Prostatitis

Archive for the ‘Prostatitis’ Category

Symptoms and Treatment

Drugs. Meds