Identification of potential causative infectious agents of chronic prostatitis

Analysis of the data on etiology and pathogenesis of inflammatory processes in prostate including acute and chronic prostatitis as well as chronic pelvic pain syndrome is presented. It has been noted that about 50% of men of fertile age had clinical signs of chronic prostatitis at least once in life and that more than 60% of admissions to urologists in outpatient practices are related with clinical signs of chronic prostatitis. An appreciable decrease in quality of life similar to that due to myocardial infarction or Crohn's disease is observed in patients with chronic prostatitis. Prostatitis often has a chronic cyclic course with exacerbation and remission phases. Not rarely the disease has primary chronic course--without an apparent beginning as acute prostatitis. This leads to late diagnostics and difficulties with identification of etiologic factor, which commonly is a conditionally pathogenic microorganisms and mixed infections. Such difficulties can be a reason for inadequate treatment and complications of chronic prostatitis such as abscess, paraprostatitis, impotence, and infertility.     

单纯稳恒强磁铁块外贴治疗附睾炎症性结节280 例的临床研究

目的:观察稳恒强磁外贴治疗附睾慢性炎症性结节、囊肿的效果,寻找非药物治疗附睾慢性炎症性结节、囊肿的方法.方法:园形强磁铁2块(直径2cm厚0.5cm,2块叠加厚度达1厘米)分别在内裤内外各一块作为固定,内裤向上提使磁块贴附附睾慢性炎症性结节、囊肿位置.在不影响工作生活的情况下持续粘贴,不能持续者则改用每天晚上睡觉时粘贴.结果:280例经彩超检测为附睾炎症性肿大结节、囊肿病人,持续外贴治疗24小时至72小时后,280例病人会阴及下腹部不适、痛疼症状均明显缓解;持续外贴治疗1周症状消失的有145例,症状基本消失的有35例;持续2-3周则症状全部消失.附睾增大变硬者经2周治疗局部触诊变软缩小,彩超提示结节变小.217例结节、囊肿患者中持续3至4周治疗肿物消失,彩超报告提示为正常附睾声像的有150例,67例大小较前明显变小,有效率达100％.结论:稳恒强磁外贴治疗附睾炎症性肿大结节、囊肿完全有效,是一种安全有效简便、无痛苦、易操作、价廉的值得推广的非药物治疗方法.     

Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis

OBJECTIVE: To study the role of fine needle aspiration cytology (FNAC) and ancillary studies in the diagnosis of tubercular epididymitis or epididymo-orchitis. STUDY DESIGN: Forty patients with tubercular epididymitis or epididymoorchitis diagnosed on FNAC underwent a detailed clinical workup, imaging and microbiologic studies before being started on antitubercular treatment (ATT). One patient underwent orchiectomy. RESULTS: Clinically, the disease presented in patients of all ages usually as a scrotal swelling or rarely as a scrotal sinus (3) or abscess (3) or as part of disseminated tuberculosis (2). Three patients gave a history of previous tuberculosis. Scrotal sonography confirmed the involvement of the epididymis, testis or spermatic cord in each case. FNAC was diagnostic in 27 aspirates (epithelioid cell granulomas with caseation) but nondiagnostic in the rest. Tubercular etiology was confirmed directly by detection of acid-fast bacilli (AFB) on FNA smears in 24 (60%) patients and urine samples in 11 and indirectly in 9 patients with negative AFB by using a combination of a positive Mantoux test (5 of 9), presence of caseating granulomas on FNA smears (7 of 9) and therapeutic response to ATT (9 of 9). CONCLUSION: FNA as a minimally invasive technique plays a prime role in the diagnosis of tubercular epididymitis and epididymoorchitis. It provides adequate material for cytologic and microbiologic examination and helps to avoid unnecesary orchiectomy.     

The use of ampicillin/sulbactam (Unasyn) in treating inflammatory urological diseases

Unasyn is a combination of ampicillin, a bactericidal antibiotic, and sulbactam, an inhibitor of beta-lactamases. It was used in treatment of 36 patients with urogenital infections. The combination was administered intravenously and in the main intramuscularly. The treatment course amounted to 7-10 days. The average daily dose was 6 to 9 g. 22 patients with acute nonocclusive pyelonephritis were treated with the combination and its clinical and bacteriological efficacy was stated in 95 per cent of the cases. An excellent clinical effect of the combination was observed in 6 patients with acute epididymitis. A clinical improvement was also observed in the treatment of the patients with acute prostatitis and chronic renal infections. Unasyn proved to be a highly efficient antibacterial combination with regard to gram-positive flora and colon bacilli as representatives of gram-negative organisms. Satisfactory results were also stated in the treatment of infections caused by Proteus spp. Complete elimination of the pathogen was achieved in 57.7 per cent of the cases. No adverse reactions to Unasyn except pain in the site of the injection were recorded.     

Lower urinary tract injuries following blunt trauma: a review of contemporary management

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.     

Epididymo-orchitis; the significance of the condition in industrial surgery

Epididymo-orchitis, caused by direct trauma, is an uncommon condition, and the history and symptoms are quite different from those of the considerably more common so-called indirect epididymo-orchitis that is ascribed to trauma or strains, and which in symptomatology and clinical course is much like acute, nonspecific, pyogenic epididymitis. The author is convinced that the indirect trauma of muscular strain or minor injuries does not cause epididymitis; it is probable that slight trauma of that sort merely draws attention to an already existing inflammatory process that has made the scrotal area more sensitive than usual.     

The role of the urologist in treating patients with hormone-refractory prostate cancer

Objectives: To ascertain what percentage of urologists' oncology practice is dedicated to the care of prostate cancer patients and to determine urologists' attitudes towards the treatment of patients with metastatic and hormone-refractory prostate cancer (HRPC). An additional objective is to determine urologists' interest in administering various types of chemotherapy in HRPC patients.Materials and Methods: The American Urological Association (AUA) directory of practicing urologists was obtained, and 3000 randomly selected members of the AUA, as well as the complete list of 168 Society of Urologic Oncology (SUO) members, were chosen for the mailing of a 16-item questionnaire. The urologists were asked about how many of their patients have prostate cancer, how many have metastatic disease, and how many have HRPC and are currently receiving intravenous (IV) chemotherapy. In addition, the urologists were queried regarding their level of interest in learning about chemotherapy options as well as learning how to administer chemotherapy.Results: A total of 654 survey questionnaires were completed and returned for tabulation, resulting in a 21% effective response rate. Sixty-four percent of the responding urologists' cancer patients had prostate cancer, 21% had metastatic disease, and 19% had HRPC; only 4% of the urologists currently administer IV chemotherapy themselves. When asked to describe their interest in learning how to deliver and be reimbursed for IV chemotherapy, 26% expressed an extremely low level of interest, 23% a low level of interest, 31% a high level of interest, and 17% an extremely high level of interest. The results of other questions are presented and correlated with the number of years the urologists have been in practice and other demographic data.Conclusions: The management of prostate cancer comprises a major portion of urologists' practices. Almost one half (48%) of the urologists in this survey were interested in administering and being reimbursed for IV chemotherapy. Several chemotherapy regimens have been shown to improve quality of life in patients with HRPC, yet only about 30% of these patients were referred for chemotherapy. If more urologists were able to deliver these drugs, then the number of patients referred for chemotherapy would likely increase, as would accrual to important clinical trials in HRPC. The results of this survey suggest that methods to implement the training and reimbursement of urologists in the use of chemotherapy regimens should be investigated.     

Preliminary Report on the Development of a Diffusion-in-Gel Method for the Diagnosis of Ram Epididymitis

A simple gel-diffusion technique is described for the diagnosis of ram epididymitis caused by Brucella ovis. The results are shown to be very similar to those obtained by the complement-fixation test, which is currently the standard method of diagnosis. The method is suitable for use in the field and is expected to facilitate the control of ram epididymitis in areas where laboratory facilities are not available.     

The acutely painful scrotum in children: review of 113 consecutive cases

A young boy who presents with an acutely painful scrotum can be a diagnostic challenge to his physician. It is important to differentiate the various causes of this symptom and to institute prompt management. Failure to do so could jeopardize the patient''s future fertility. In a review of 113 consecutive cases of a painful scrotum at a children''s hospital, torsion of the testicle was found in 51 patients (45%). Torsion of the appendix testis was found in 40 patients (35%) and acute epididymitis, once considered rare in children, was diagnosed in 17 (15%). The importance of prompt diagnosis of torsion is emphasized. The clinical diagnosis of the acutely painful scrotum is notoriously difficult, and in this series of cases surgical exploration was required in 92%. Only 2 of the 17 cases of epididymitis were associated with a bacterial urinary tract infection.     

Perplexing problem of persistently painful prostatitis

Chronic prostatitis has been a perplexing problem for urologists for decades. This review explores the perils and pitfalls urologists encounter with epidemiology, etiology, classification, diagnosis, and treatment of this syndrome. The major question involves the problem of developing rational treatment plans for patients with a medical condition associated with genitourinary pain, variable voiding, and sexual dysfunction but no obvious and accepted etiology. Exciting, innovative, ongoing research does offer some solutions and management strategies that urologists can even now incorporate into their practice while waiting for the fundamental questions to be answered.     

Incontinence in a child with a duplex kidney: case report

Persistent incontinence after toilet training in young girls and urinary tract infections or epididymitis in prepubertal boys should raise suspicion of an ectopic ureter. This often occurs in the context of duplication of kidney structures or other parenchymal abnormalities. The presence or absence of reflux affects surgical treatment, which may consist of ureteral reimplantation, ureteroureterostomy, and/or upper pole nephrectomy.     

Medical and minimally invasive treatment of urinary incontinence

Newer agents and procedures give urologists more options in treating patients who have urinary incontinence related to such etiologies as an ineffective sphincter, detrusor hypersensitivity, obstruction, or a combination of these. Abolition of the involuntary contractions characteristic of detrusor instability can be accomplished pharmacologically or surgically. First-line anticholinergic agents are tolterodine and oxybutynin XL, given orally. Alternatively, intravesical administration provides a high concentration of drug, such as capsaicin or resiniferatoxin, at the detrusor muscle level. However, this commits the patient to intermittent self-catheterization. Surgery is reserved for those who have failed prolonged trials of conservative therapies. For patients with intractable urge incontinence, urologists have the new technique of sacral nerve stimulation.     

Another look at cryoprostatectomy

The early 1960s witnessed a marked advancement in cryogenic research and its clinical application to surgery. Cooper's development of a closed controllable method for destruction of tissue by cryosurgery was at the forefront. In 1964, Gonder et al. (3) modified this apparatus and popularized its use in the treatment of the common problem of the obstructing prostate gland. However, this potential panacea soon presented the urologists with unexpected serious complicaions. Prolonged sloughing of the necrotized prostate, accidental freezing of rectum, bladder, external urethral sphincter occurred which were unacceptable and rarely encountered with conventional methods of prostatectomy. At this point in time, most urologists in the United States abandoned this procedure. However, others persisted and modified this technique with more precise methods of control monitoring and utilized a small resection of thawing prostate at the time of cryoprostatectomy. During this transition phase, the indications were justifiably narrowed to (i) poor-risk patients, (ii) those with hematological problems, (iii) treatment of large inoperable prostate carcinomas. Our experience with the last 100 cases of combined cryotransurethral prostatectomy encourages another look at this procedure. The utilization of this method, however, must be restricted to a select group of patients and should be carried out by only those urologists properly trained in this surgical modality.     

Immunotherapy for advanced prostate cancer

The absence of curative therapies for advanced or recurrent forms of prostate cancer mandates continued development of novel, more effective treatment regimens. Due to recent advances in basic and translational research, therapeutic vaccines and monoclonal antibody-based therapies are steadily gaining ground as promising treatment modalities against prostate cancer. Several immunotherapeutic products have recently been investigated in later-phase trials and have reported evidence for clinical benefit while maintaining an excellent quality of life for participants. The cumulative clinical results available to date indicate that immune-based therapies will likely play a role in the treatment of patients with prostate and other malignancies. The objective of this article is to increase awareness of contemporary immunologic therapies and clinical trials of new biologic reagents against prostate cancer. We also seek to encourage urologists to actively participate in clinical trials and evaluate the potential of immunotherapeutic drugs for impacting standards of care.     

Proton Beam Therapy for Localized Prostate Cancer 101: Basics,Controversies, and Facts

Proton beam therapy for prostate cancer has become a source of controversy in the urologic community, and the rapid dissemination and marketing of this technology has led to many patients inquiring about this therapy. Yet the complexity of the technology, the cost, and the conflicting messages in the literature have left many urologists ill equipped to counsel their patients regarding this option. This article reviews the basic science of the proton beam, examines the reasons for both the hype and the controversy surrounding this therapy, and, most importantly, examines the literature so that every urologist is able to comfortably discuss this option with inquiring patients.Key words: Prostate cancer, Proton beam therapy, External beam radiation therapy, Intensity modulated radiation therapyProton beam therapy (PBT) has become a source of controversy in the urologic community. It is not uncommon to hear mixed messages regarding the issue, from zealous advocates to cost-conscious skeptics, leaving many urologists unsure what to tell their patients with prostate cancer. What is clear, however, is that the technology is disseminating across the nation, and as our patients turn to the internet to learn more about their diagnosis, they are going to encounter increasingly more information about PBT, both scientific and promotional in nature. Hence, it is necessary for every urologist to understand the basics of PBT to help guide our patients through treatment options. This article reviews and compares the basic science of conventional external beam radiation therapy (EBRT) with PBT, examines the reasons for both the hype and the controversy surrounding this therapy, and, most importantly, examines the literature so that all urologists are adequately equipped to counsel their patients on this subject.     

Mycoplasmosis: Experimental and Spontaneous Infections of the Genital Tract of Bulls

A strain of M. bovigenitalium was isolated from semen of a bull (K) with chronic seminal vesiculitis. Using this strain a vesiculitis of the same type as found in bull K, characterized by simultaneous acute and chronic lesions, was induced experimentally in 2 bulls by direct inoculation into the vesicular glands. In the acute phase a marked infiltration of eosinophils was found in the interstitial tissues and alveoli whereas in the chronic phase fibrosis, lymphoid and epithelial hyperplasia were seen. Degeneration of vascular walls and connective tissue was common. On inoculation into the testis of 3 bulls a chronic epididymitis and ampullitis were produced. The histological changes were of the same type as found in the vesicular glands of the 3 bulls with vesiculitis. By indirect hemagglutination a specific and significant increase in serum antibody could be demonstrated. As the titers were low and the maximum titers were reached early, it will probably not often be possible to make an etiological diagnosis on the basis of serological evidence. A comparative experiment employing the type strain (PG 11) of M. bovigenitalium was performed. A rise in antibody titer was seen, but neither clinical nor histological changes could be demonstrated.     

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.     

Isolation and characterization of Histophilus somni (Haemophilus somnus) in semen samples of rams with epididymitis

Histophilus somni (Haemophilus somnus) has been reported as the cause of epididymitis in rams. This bacterium has also been found in the preputial mucosa of rams without epididymitis lesions. H. somni is a bacterium that is difficult to characterize, since it is a pleomorphic Gram-negative bacilli of characteristics similar to Actinobacillus seminis, which is also found in ram epididymitis lesions. The objective of this work was to determine if H. somni (H. somnus) is involved in cases of sheep epididymitis. A clinical examination was performed in 160 rams, extracting semen by electro-ejaculation of 28 of them, which had epididymal lesions. The penis was exteriorized in order to avoid prepuce contamination. The semen samples were cultivated in chocolate agar in a 10% CO₂ environment. Two strains were isolated in pure culture with a colony morphology and microscopy similar to H. somni (H. somnus). These were identified using the API 20 E system, using as a control the reference strain of H. somnus (2336ATCC). One of the isolates (129H) resulted identical to the reference strain and the other (827) presented differences in the arginine decarboxylase, H₂S, catalase and inositol reactions, although these differences have been reported (in strains isolated from different geographic origins, animal species and anatomical region). To characterize the isolates, an electrophoretic analysis of total proteins was performed (PAGE–SDS) finding identical profiles between the reference strain of H. somnus and isolate 129H and similar in relation to isolate 827. The amplification of a fragment of approximately 407 bp was observed in the 129H isolate and the ATCC strain, but not in 827. In other samples, isolations were made of Brucella ovis, Corynebacterium spp., Staphylococcus and other pleomorphic Gram-negative bacilli similar to A. seminis. Therefore, it has been confirmed that H. somni is present in the reproductive tract of rams and it could be involved in the presentation of ovine epididymitis. It is important that we underline that this is the first report of H. somni isolation in Mexico from ram semen samples.     

Radiotherapy after Radical Prostatectomy: Treatment Recommendations Differ between Urologists and Radiation Oncologists

Purpose

There is no consensus on optimal use of radiotherapy following radical prostatectomy. The purpose of this study was to describe opinions of urologists and radiation oncologists regarding adjuvant and salvage radiotherapy following radical prostatectomy.

Methods

Urologists and genitourinary radiation oncologists were solicited to participate in an online survey. Respondent characteristics included demographics, training, practice setting, patient volume/experience, and access to radiotherapy. Participant practice patterns and attitudes towards use of adjuvant and salvage radiotherapy in standardized clinical scenarios were assessed.

Results

One hundred and forty-six staff physicians participated in the survey (104 urologists and 42 genitourinary radiation oncologists). Overall, high Gleason score (Gleason 7 vs. 6, RR 1.37 95% CI 1.19-1.56, p<0.0001 and Gleason 8-10 vs. 6, RR 1.56 95% CI 1.37-1.78, p<0.0001), positive surgical margin (RR 1.43 95% CI 1.26-1.62, p<0.0001), and extraprostatic tumour extension (RR 1.16 95% CI 1.05-1.28, p<0.002) conferred an increased probability of recommending adjuvant radiotherapy. Radiation oncologists were more likely to recommend adjuvant radiotherapy across all clinical scenarios (RR 1.48, 95% CI 1.39, 1.60, p <0.001). Major differences were found for patients with Gleason 6 and isolated positive surgical margin (radiotherapy selected by 21% of urologists vs. 70% of radiation oncologists), and patients with extraprostatic extension and negative surgical margins (radiotherapy selected by 18% of urologist vs. 57% of radiation oncologists).

Conclusions

Urologists and radiation oncologists frequently disagree about recommendation for post-prostatectomy adjuvant radiotherapy. Since clinical equipoise exists between adjuvant versus early salvage post-operative radiotherapy, support of clinical trials comparing these approaches is strongly encouraged.     

Review of the treatment options for chronic constipation

Constipation is a common gastrointestinal motility disorder that is often chronic, negatively affects patients' daily lives, and is associated with high healthcare costs. There is a considerable range of treatment modalities available for patients with constipation; however, the clinical evidence supporting their use varies widely. Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches, but data on the effectiveness of these measures are limited. The clinical benefits of various traditional pharmacologic agents (many of which are available over the counter, such as laxatives and fiber supplements) remain unclear. Although these modalities may benefit some patients with temporary constipation, their efficacy in patients for whom constipation is chronic is less well defined. Some studies suggest benefit with psyllium, polyethylene glycol, and lactulose; however, the use of other agents, such as calcium polycarbophil, methylcellulose, bran, magnesium hydroxide, and stimulant laxatives, is not supported by strong clinical evidence. More recently, newer agents have been approved for the treatment of patients with chronic constipation on the basis of comprehensive clinical investigation programs. Tegaserod, with its well-established clinical profile, and lubiprostone, the latest addition to the treatment armamentarium, represent the new generation of therapies for chronic constipation. This article reviews the efficacy and safety of traditional therapies used in the management of the multiple symptoms associated with chronic constipation and discusses recently approved and emerging therapies for this disorder.