Alpha-blockers for the treatment of prostatitis-like syndromes

Prostatitis is a common medical diagnosis. The etiology of this symptomatic syndrome can be an acute or chronic bacterial infection, a noninfectious initiator (the most common cause), or iatrogenic heat or radiation; the syndrome may coexist with benign prostatic hyperplasia. Alpha-blockers have a role in the treatment of the prostatitis syndromes. In Category I, acute bacterial prostatitis, alpha-blockers have been shown to possibly ameliorate obstructive and irritative voiding symptoms. In Category II, chronic bacterial prostatitis, alpha-blockers seem to reduce the risk of clinical and bacteriological recurrence. In Category III, chronic pelvic pain syndrome, alpha-blockers improve symptoms and quality of life. Alpha-blockers also seem to ameliorate the symptoms and reduce the risk of acute urinary retention in patients who suffer from either heat- or radiation-induced prostatic inflammation. Alpha-blockers improve lower urinary tract symptoms, including pain, in patients who are diagnosed with both prostatitis and benign prostatic hyperplasia. Evidence has proven there is definitely a role for alpha-blockers in the management of the prostatitis syndromes.     

A severely symptomatic case of anaerobic chronic bacterial prostatitis successfully resolved with moxifloxacin therapy

It has been demonstrated that patients showing symptoms of chronic bacterial prostatitis but culture-negative prostate-specific specimens can benefit from administration of antibacterial agents. This suggests that organisms that are not isolated in the routine practice may be responsible for prostate infection in an undefined fraction of subjects. Anaerobic bacteria have been proposed to play a pathogenic role in CBP, on the basis of studies describing clinical remission after eradication of pathogens like Peptostreptococcus spp or Bacterioides spp from prostatic secretions of symptomatic patients, or the significant association between prostatic infection by anaerobes and the presence of inflammation markers in prostatic secretions.In this paper, we report in detail a case of severely symptomatic chronic prostatitis in a patient with evidence of infection by Peptostreptococcus. We also report for the first time that treatment with the 3rd generation fluoroquinolone moxifloxacin was successful in eradicating the pathogen and in causing dramatic resolution of signs and symptoms of chronic bacterial prostatitis.The strict association between eradication of Peptostreptococcus and the rapid disappearance of clinical signs/symptoms points to a causative role of this anaerobe in the chronic bacterial prostatitis case described in this report.     

Distinction des prostatites aiguës récidivantes et chroniques

The E.A.U. (European Association of Urology) published its Guidelines on Urinary and Male Genital Tract Infections in 2001. In the chapter devoted to prostatitis, epididymitis and orchitis, the E.A.U suggests a classification distinguishing prostatitis (usual clinical picture and demonstrated infection) from chronic pelvic pain syndrome (same clinical picture without demonstrable infection). Prostatitis is divided into three categories: acute bacterial prostatitis (type I), chronic bacterial prostatitis (type II) and asymptomatic inflammatory prostatitis (histological prostatitis, type IV). Type I and II prostatitis are considered here. The E.A.U. guidelines do not mention recurrent prostatitis. The authors discuss whether or not recurrent prostatitis should be distinguished from chronic prostatitis by raising three questions: does the literature provide precise data in favour of this distinction? Does this theoretical distinction have any practical consequences? Is this distinction feasible, especially in general practice? The Stanford sesearch team (Stamey and Shortliffe) has provided documented bacteriological data demonstrating recurrence of prostatitis with different bacteria in some cases and persistence of the same pathogen in other cases. The main consequence of these two situations concern treatment (which antibiotics? for how long?) On the basis of personal unpublished data, the authors discuss the feasibility of this distinction in general practice. They show that, in the case of several recurrences of prostatitis per year, it may be difficult to distinguish recurrent prostatitis from chronic prostatitis. They also show that the duration of symptoms is not a sufficiently discriminant factor and that bacteriological findings should be considered. In conclusion, recurrent prostatitis is a particular disease which should be distinguished from chronic prostatitis. The main consequence of this distinction concerns several unresolved questions about the therapy of recurrent prostatitis. In general practice, the distinction may be difficult when only routine bacteriological tests are available. The use of Meares and Stamey’s four glass technique is unusual in this setting, making it difficult to confirm prostatic disinfection.     

Prostatites: mise au point

Prostatitis is frequent and appears to corresponds to a very heterogeneous group of diseases. The diagnosis of acute prostatitis has always been well defined, while that of chronic prostatitis has always been much more difficult. The conventional classification distinguishes acute prostatitis comprising a systemic infectious syndrome, accompanied by alteration of the general state, voiding disorders and especially a painful prostate on digital rectal examination, and chronic prostatitis corresponding to all other diseases associating voiding disorders, perineal or pelvic pain and possible urethral discharge. More recently, a more objective classification, based on bacteriological and histological criteria derived from analysis of urine and prostatic liquid was proposed by the NIH (National Institutes of Health). This classification defines 4 categories: acute bacterial prostatitis (category 1), chronic bacterial prostatitis (category 2), non-bacterial prostatitis (category 3A), prostatodynia (category 3B). Well conducted treatment appears to be very important to prevent recurrence and the development of chronic prostatitis. The presence of an urethral stricture must be excluded. The management of chronic prostatitis is more difficult and requires bacteriological examination. Finally the patient’s androgen status must be verified, as androgen deficiency can promote infection.     

性病后慢性前列腺炎的病原菌及其耐药性研究

目的:探讨本地区性病后慢性前列腺炎的病原菌分布及其对抗生素的耐药性状况.方法:对131例性病后慢性前列腺炎患者的前列腺液细菌培养和药物敏感试验结果进行统计分析.结果:131例性病后慢性前列腺炎患者的前列腺液细菌培养阳性率为86.3%,从113例阳性标本中共分离培养出14种117株细菌,其中以凝固酶阴性表皮葡萄球菌最为常见(45.2%),其构成比显著高于其他病原菌,药物敏感试验结果显示前列腺液分离菌对临床常用的多种抗生素耐药,而对万古霉素、丁胺卡那霉素、呋喃唑酮、多粘菌素B等耐药率相对较低.结论:凝固酶阴性表皮葡萄球菌是性病后慢性前列腺炎的主要病原菌,病原菌检查和药敏试验对临床诊断和治疗性病后慢性前列腺炎具有重要作用.     

Le syndrome douloureux chronique pelvien chez l’homme. Quelle physiopathologie? Quel traitement?

Chronic pelvic pain, in young men or elderly men, has always been a challenge to the medical profession, raising problems of assessment and management. Chronic pelvic pain has a high prevalence, which is underestimated as indicated by the following figures: 4% to 8% of patients consulting chronic pain centres, 15% of patients consulting a urologist for symptoms of chronic prostatitis with alteration of quality of life, 70,000 cases of chronic cystitis per year in the USA. The circumstances of onset are multiple: postoperative, after minor or major trauma or postinfectious, sometimes without any particular aetiology and often in a multifactorial context. The pathophysiology is therefore vague and poorly elucidated, as only about 5% of cases of chronic prostatitis have a bacterial cause. However, any form of stimulation activates pain pathways with neurogenic inflammation followed by central sensitization and modification of neuronal plasticity, and finally chronic refractory pain with organic dysfunction. This mechanism is currently proposed in numerous publications concerning postoperative chronic pelvic pain and refractory cystitis and chronic prostatitis. The pathophysiology of these types of pain is probably therefore neurogenic. In the absence of stimulation, a pudendal nerve tunnel syndrome can be suggested. The treatment of chronic pelvic pain in men can be considered in the following way: aetiological treatment whenever possible, neurogenic medical treatment (tricyclic antidepressants for continuous pain, anticonvulsants for intermittent pain, NMDA receptor antagonists in the case of failure), treatment of organic dysfunction, pudendal nerve analgesic block in the case of suspected tunnel syndrome and global treatment of patient with impaired quality of life. In conclusion, a better pathophysiological approach to these forms of chronic pelvic pain can improve these difficult patients.     

Place de la scintigraphie osseuse dans la maladie de Paget

The clinical and laboratory signs, as well as the imaging and course of Paget's disease of bone, are now well known. This chronic and usually benign disease is characterized by excessive remodelling of bone tissue, associated with an increase, sometimes considerable, of osteoclast resorption and osteoblast formation activities. The bone scan is a fundamental examination to establish initial mapping of the localizations of the disease. This examination has a greater sensitivity than X-rays for the flat bones. Through three clinical cases, we present the bone scan aspect, the various localizations and the diagnosis difficulties of the disease, especially when a context of neoplasm is present.     

广东湛江地区前列腺炎患者病原体检测及临床治疗

目的:对广东湛江地区前列腺炎患者前列腺液病原菌分布及药敏情况进行分析,为临床合理用药和制定最佳治疗方案提供依据。方法:湛江市两间最大三甲医院2009年1月至2013年4月间共308例前列腺炎患者的前列腺液进行细菌学和药敏试验。运用全自动微生物分析仪鉴定细菌,采用K-B法测定药物敏感性。结果:308例前列腺液标本中,共17例(17/308,5.52%)分离出致病菌。这些致病菌以革兰氏阳性菌为主,共13株(13/17,76.47%),其中溶血葡萄球菌检测出6株(6/13,46.15%),全部是耐甲氧西林凝固酶阴性葡萄球菌。革兰氏阴性菌4例(4/17,23.53%),包括大肠埃希菌2株(其中一株产超广谱β-内酰胺酶(ESBLs)),粘膜炎莫拉氏菌1株,肺炎克雷伯菌亚种1株。结论:绝大多数前列腺炎患者属于慢性前列腺炎/慢性骨盆疼痛综合症,无需常规使用抗生素治疗。慢性细菌性前列腺炎致病菌感染以革兰氏阳性菌为主。对前列腺炎患者进行病原学检测及药敏试验是临床合理用药、制定最佳治疗方案的基础。     

Contribution of Pannexin1 to Experimental Autoimmune Encephalomyelitis

Pannexin1 (Panx1) is a plasma membrane channel permeable to relatively large molecules, such as ATP. In the central nervous system (CNS) Panx1 is found in neurons and glia and in the immune system in macrophages and T-cells. We tested the hypothesis that Panx1-mediated ATP release contributes to expression of Experimental Autoimmune Encephalomyelitis (EAE), an animal model for multiple sclerosis, using wild-type (WT) and Panx1 knockout (KO) mice. Panx1 KO mice displayed a delayed onset of clinical signs of EAE and decreased mortality compared to WT mice, but developed as severe symptoms as the surviving WT mice. Spinal cord inflammatory lesions were also reduced in Panx1 KO EAE mice during acute disease. Additionally, pharmacologic inhibition of Panx1 channels with mefloquine (MFQ) reduced severity of acute and chronic EAE when administered before or after onset of clinical signs. ATP release and YoPro uptake were significantly increased in WT mice with EAE as compared to WT non-EAE and reduced in tissues of EAE Panx1 KO mice. Interestingly, we found that the P2X7 receptor was upregulated in the chronic phase of EAE in both WT and Panx1 KO spinal cords. Such increase in receptor expression is likely to counterbalance the decrease in ATP release recorded from Panx1 KO mice and thus contribute to the development of EAE symptoms in these mice. The present study shows that a Panx1 dependent mechanism (ATP release and/or inflammasome activation) contributes to disease progression, and that inhibition of Panx1 using pharmacology or gene disruption delays and attenuates clinical signs of EAE.     

The artificial kidney and related procedures; a report on clinical experience

The Skeggs-Leonards artificial kidney and related methods were applied by the author in about thirty instances in patients with various kinds of renal disease. The treatment brought about clinical improvement of varying degree and appeared to be life-saving in four of five patients with acute renal failure. Treatment with the artificial kidney is indicated for patients with acute renal failure who develop clinical signs of uremia. The artificial kidney should be applied before the patient's condition has become irreversible. Removal of edema fluid is possible with modern artificial kidney equipment and appears to extend the therapeutic possibilities of the procedure. The artificial kidney may be of help in barbiturate and other intoxications. It affords temporary palliation in certain patients with chronic uremia; it may be used to overcome acute exacerbations of chronic renal disease; it may make it possible to operate on uremic patients who otherwise could not withstand operation.     

Diabetes mellitus y trastorno depresivo,un mal binomio

Type 2 diabetes and depressive disorder are 2 chronic diseases highly prevalent in developed countries and with a negative impact on quality of life and life expectancy. In recent years, both conditions have been shown to be strongly associated. Thus, diabetics have an increased risk of suffering depressive disorder, as well as impaired glucose homeostasis, if they experience depression. In diabetic patients, concurrent depression is associated to greater difficulties in disease management and metabolic control, increased risk of developing chronic complications, decreased quality of life, and higher healthcare expenses. As a result, the interest of diabetic scientific societies in this association has increased, and they recommend regular mood assessment in diabetic patients. However, the limited clinical experience available and the conflicting results reported to date make it difficult to draw conclusions.     

Quantitative studies on the role of Ureaplasma urealyticum in non-gonococcal urethritis and chronic prostatitis

Quantitative determinations of U. urealyticum and M. hominis have been performed in 164 men with non-gonococcal urethritis (NGU) and 597 patients with chronic prostatitis. Evidence is provided that U. urealyticum plays an etiologic role in 29.3 percent of patients with non-gonococcal urethritis. Mixed infections of C. trachomatis and U. urealyticum, in high numbers, do occur in 11 percent of NGU cases. A constellation suggesting ureaplasma-associated disease could be observed in 13.7 to 15.2 percent of 597 patients with chronic prostatitis. M. hominis does not appear to be a causative agent of NGU or chronic prostatitis.     

Cholesterol and benign prostate disease

The origins of benign prostatic diseases, such as benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), are poorly understood. Patients suffering from benign prostatic symptoms report a substantially reduced quality of life, and the relationship between benign prostate conditions and prostate cancer is uncertain. Epidemiologic data for BPH and CP/CPPS are limited, however an apparent association between BPH symptoms and cardiovascular disease (CVD) has been consistently reported. The prostate synthesizes and stores large amounts of cholesterol and prostate tissues may be particularly sensitive to perturbations in cholesterol metabolism. Hypercholesterolemia, a major risk factor for CVD, is also a risk factor for BPH. Animal model and clinical trial findings suggest that agents that inhibit cholesterol absorption from the intestine, such as the class of compounds known as polyene macrolides, can reduce prostate gland size and improve lower urinary tract symptoms (LUTS). Observational studies indicate that cholesterol-lowering drugs reduce the risk of aggressive prostate cancer, while prostate cancer cell growth and survival pathways depend in part on cholesterol-sensitive biochemical mechanisms. Here we review the evidence that cholesterol metabolism plays a role in the incidence of benign prostate disease and we highlight possible therapeutic approaches based on this concept.     

性病后慢性前列腺炎病原微生物分析

本文对性病后慢性前列腺炎病原微生物进行了研究。９０例患者前列腺液支原体检出率为２４．４４％（２２／９０）,其中解脲支原体为２２．００％（１８／９０）,人型支原体为４．４４％（４／９０）。另一组２３２例患者进行前列腺液细菌培养鉴定,总检出率为４２．７％（９９／２３２）,以金黄色葡萄球菌为主２４．５％（５７／２３２）,其它菌依次为表皮葡萄球菌７．３％（１７／２３２）,肠球菌４．３％（１０／２３２）,非发酵菌２．６％（６／２３２）,肠杆菌科细菌２．２％（５／２３２）和Ａ群链球菌１．７％（４／２３２）。作者认为,性病后慢性前列腺炎可能为急性尿道炎期,由于治疗不彻底或忽略非特异性性病病原菌的治疗而使条件致病菌上行感染所致。     

引起AECOPD精神神经异常的原因及治疗对策

目的：探讨引起慢性阻塞性肺疾病合并精神神经异常的原因,以制订有针对性的治疗对策。方法：回顾性分析我院自2010年1月到2013年1月期间收治的250例慢性阻塞性肺疾病急性发作期患者的临床资料。结果：32例患者出现精神神经异常症状,占12.80%。其中17例为肺性脑病,占53.13%（17/32）,8例为低渗性脑病,占25.00%（8/32）,5例为药物的不良反应,占15.63%（5/32）,2例为脑梗死,占6.25%（2/32）。所有患者均给予慢性阻塞性肺疾病急性发作的常规治疗方案进行治疗,同时肺性脑病患者给予积极纠正二氧化碳潴留;低渗性脑病患者给予积极纠正电解质紊乱;脑梗死的患者根据情况给予溶栓、脱水、营养脑神经、抗凝、抗血小板聚集等治疗;药物不良反应的患者则给予停止应用相应的药物。经过治疗后,29例症状恢复,占90.63%,3例最终死亡,死亡率为9.38%,其中2例为肺性脑病患者,1例为低渗性脑病患者。结论：对于慢性阻塞性肺疾病急性发作合并精神神经异常的治疗,应根据患者的症状、体征以及辅助检查结果,尽早明确诊断,及时干预,尽快控制病情,防止病情恶化。     

细菌性前列腺炎病原菌及临床耐药情况分析

目的 分析汕头地区慢性前列腺炎（CP）病原菌的分布及耐药情况,为确定病原菌分布情况和临床治疗提供参考依据。方法 细菌鉴定及药敏试验采用VITEK-60全自动细菌鉴定仪。结果 葡萄球菌是汕头地区CP的主要致病菌（67％）,其中表皮葡萄球菌的检出率最高,为21．58％。葡萄球菌引起的CP对苯唑西林、头孢唑林、氨苄西林-舒巴坦、阿莫西林-克拉维酸和红霉素等基本无效;而肠球菌对青霉素耐药率为0。治疗首选万古霉素、呋喃妥因、克林霉素和利福平等抗生素。结论 该地区CP的致病菌以葡萄球菌为主,其中表皮葡萄球菌已成为CP的主要病原菌。为减少浪费、提高疗效,建议根据药敏结果选择抗生素。     

Evaluation of specific antigen and prostatic acid phosphatase specificity. Study of false values

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1305 subjects without malignant prostatic pathology by double antibody RIA I125 to evaluate their specificity. When we set a second upper normal limit of 10 ng/ml for PSA and 2.5 ng/ml for PAP there was a significant increase of specificity. There were 2 and 3.7% false positive results in non-prostatic benign pathologies, 1.8 and 7.9% in non-prostatic malignant, 3.5 and 4.7% in non-complicated benign prostatic hypertrophy (BPH) and 3.3% for both in chronic prostatitis. In patients with complicated BPH and acute prostatitis the results were 64.8 and 24% for PSA and 20 and 16% for PAP. In conclusion, PSA is more specific than PAP in patients without acute inflammatory pathology of the prostate; the high rate of false positive values in the latter excludes its usefulness in these patients as diagnostic tumoral markers.     

5-alpha-Reductase Inhibitors Prevent the Progression of Benign Prostatic Hyperplasia

Lower urinary tract symptoms (LUTS) associated with clinical benign prostatic hyperplasia (BPH) are a common occurrence in aging men, causing bother and interference with daily activities and affecting disease-specific quality of life. There is increasing evidence to suggest that, in many patients, the signs and symptoms of BPH are progressive. Progression can be measured as continued growth of the prostate gland; worsening of symptoms, bother, or quality of life; deterioration of urinary flow rate; episodes of acute urinary retention (AUR); and need for prostate-related surgery. Furthermore, it has become clear that the risk of disease progression increases with age as well as with increasing prostate volume and serum prostate-specific antigen (PSA) level. The 5-alpha-reductase inhibitor finasteride has been shown not only to improve symptoms, bother, and quality of life but also to prevent progression to AUR and surgery, with a relative risk reduction of over 50%. As the risk for such progression is higher in patients with larger glands or higher serum PSA values at baseline, it is in those patients that finasteride induces an even greater risk reduction, making it a cost-effective treatment choice for patients with LUTS associated with prostatic enlargement.