Health and Prostate

Benign Prostatic Hyperplasia – Prostate Cancer – Prostatitis
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Posts Tagged ‘Nitrofurantoin’

Localization

Posted by admin on June 21st, 2011 No Comments
The localization method is the most accurate and efficient method of distinguishing between urethral, bladder, and prostate sources of inflammation or infection. The localization technique was initially described by Meares and Stamey et al. in 1968 and has become the standard for a thorough and methodic evaluation of prostatitis syndromes. Surprisingly, few primary care physicians and only about 50% of urologists perform localization evaluations on patients. In fact, one study revealed that only 33 to 45% of urologists even cultured urine or prostatic fluid as part of their evaluation. Physicians cite several reasons for not performing this basic and important diagnostic measure: it is cumbersome, perceived to have a low yield, and perceived to possess high false negative and false positive rates with low predictive value. Such a low percentage of physicians utilizing these basic diagnostic measures may impact adversely on treatment outcomes. Localization culture techniques have been described in detail elsewhere and will be briefly described here. The procedure involves analyzing aliquots of Read more [...]
Posted in Prostatitis

Therapy and Prognosis

Posted by admin on June 21st, 2011 No Comments
Antimicrobial Therapy For an antimicrobial agent to be effective against prostatic infection, several properties of the agent must be met. First, the drug must achieve adequate bactericidal levels in both urine and prostate. Most commonly used agents today attain 50- to 100-fold greater urinary concentrations than serum concentration. Second, to enter the prostate under noninflammatory conditions, the agent should be lipid soluble and exist in the nonionized form. Once inside the prostate, the ideal agent should exist as a basic ion to trap itself within the prostate.''' The fluoroquinolones meet most of the above criteria and are the first agents of choice in treating bacterial prostatitis. Some have questioned whether an inflamed prostate represents a similar environment to the uninflamed prostate with respect to pharmacodynamics. To address this question, a group of investigators induced prostatitis in rats and then treated the animals with norfloxacin, followed by assays for intraprostatic norfloxacin levels. The authors found no difference in levels or efficacy of the antimicrobial and concluded 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 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 [...]
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Prostatitis Syndromes. Part 5: Treatment

Posted by admin on November 28th, 2009 No Comments
Experiments in animals show that most antimicrobial agents diffuse very poorly into the prostatic tissue and prostatic secretions. Experimentally, a notable exception was trimethoprim. Trimethoprim diffuses easily into prostatic secretion because of its favorable pharmacokinetics, which includes the pH of the prostatic fluid and tissue as well as the specific negative logarithm of the ionization constant of the drug. Trime-thoprim-sulphamethoxazole or trimethoprim alone have been the antimicrobial agents with the best documented record of success in treating chronic bacterial prostatitis. Theoretically, erythromycin and minocycline also achieve therapeutic levels in the secretions. However, these drugs are characterized by a high incidence of adverse side effects, and neither is really suitable for long-term use. The only antibiotic approved for chronic bacterial prostatitis is carbenicillin. Studies have not confirmed that this is the most appropriate drug for this disease. The new quinolones offer theoretical efficacy in that they do diffuse very freely into the prostatic secretion Read more [...]
Posted in Prostatitis

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