Prostatitis Category II: Chronic bacterial prostatitis: Difference between revisions

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==Category II: Chronic bacterial prostatitis==


===Signs and symptoms===
==Category II: Chronic Bacterial Prostatitis==
Chronic bacterial prostatitis is a relatively rare condition (<5% of patients with prostate-related non-BPH LUTS) that usually presents with an intermittent [[UTI]]-type picture and that is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Dr. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were [[E-coli]]."<ref name="rare">{{cite journal | author=Schneider, H., Ludwig, M., Hossain, H. M., Diemer, T. & Weidner, W.| title=The 2001 Giessen Cohort Study on patients with prostatitis syndrome – an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis| journal=Andrologia| year=2003| volume=35| issue=5| page=258-262| url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14535851&itool=pubmed_docsum}}</ref> Symptoms may be completely absent until there is also [[bladder infection]], and the most troublesome problem is usually recurrent [[cystitis]].<ref name="haber">{{cite journal | author=Habermacher GM, Chason JT, Schaeffer AJ.| title=Prostatitis/chronic pelvic pain syndrome| journal=Annu Rev Med.| year=2006| volume=57| page=195-206| url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16409145&dopt=citation}}</ref>
===Signs and Symptoms===
 
Chronic bacterial prostatitis is a relatively rare condition (<5% of patients with prostate-related non-BPH LUTS) that usually presents with an intermittent [[UTI]]-type picture and that is defined as recurrent [[urinary tract infection]]s in men originating from a chronic infection in the prostate. Dr. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were [[E-coli]]."<ref name="rare">{{cite journal | author=Schneider, H., Ludwig, M., Hossain, H. M., Diemer, T. & Weidner, W.| title=The 2001 Giessen Cohort Study on patients with prostatitis syndrome – an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis| journal=Andrologia| year=2003| volume=35| issue=5| page=258-262| url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14535851&itool=pubmed_docsum}}</ref> Symptoms may be completely absent until there is also [[bladder infection]], and the most troublesome problem is usually recurrent [[cystitis]].<ref name="haber">{{cite journal | author=Habermacher GM, Chason JT, Schaeffer AJ.| title=Prostatitis/chronic pelvic pain syndrome| journal=Annu Rev Med.| year=2006| volume=57| page=195-206| url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16409145&dopt=citation}}</ref>
Main symptoms of chronic prostitis;


Main symptoms of chronic prostitis:
*Frequent urination with an accompanied burning sensation ([[dysuria]]).
*Frequent urination with an accompanied burning sensation ([[dysuria]]).
*[[Blood]] or [[pus]] in the urine.
*[[Blood]] or [[pus]] in the urine.
*Lower back pain.
*Lower [[back pain]].
*[[Premature ejaculation]] or loss of potency.
*[[Premature ejaculation]] or loss of potency.
*The desire to urinate more at night ([[nocturia]]).
*The desire to urinate more at night ([[nocturia]]).
===Diagnosis===
===Diagnosis===
In chronic bacterial prostatitis there are [[bacteria]] in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a [[rectal exam]] and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. [[Prostate specific antigen]] levels may be elevated, although there is no malignancy.
In chronic bacterial prostatitis there are [[bacteria]] in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a [[rectal exam]] and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. [[Prostate specific antigen]] levels may be elevated, although there is no malignancy.
===Treatment===


===Treatment of Chronic Bacterial Prostatitis===
{| style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Chronic Prostatitis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg po bid x 4 weeks'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg po q24h x 4 weeks '''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] DS 1 tab PO bid x 1–3 months'''''
|-
|}
|}


Treatment requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well ([[beta-lactam|&beta;-lactam]]s and [[nitrofurantoin]] are ineffective). These include [[quinolone]]s ([[ciprofloxacin]], [[levofloxacin]]), [[Sulfonamide (medicine)|sulfas]] ([[trimethoprim-sulfamethoxazole|Bactrim, Septra]]) and [[macrolide]]s ([[erythromycin]], [[clarithromycin]]). Persistent infections may be helped in 80% of patients by the use of [[alpha blocker]]s ([[tamsulosin]] ([[Flomax]]), [[alfuzosin]]), or long term low dose antibiotic therapy.<ref>{{cite journal |author=Shoskes D, Hakim L, Ghoniem G, Jackson C |title=Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome |journal=J Urol |volume=169 |issue=4 |pages=1406-10 |year=2003 |id=PMID 12629373}}</ref> Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.
Treatment requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well ([[beta-lactam|&beta;-lactam]]s and [[nitrofurantoin]] are ineffective). These include [[quinolone]]s ([[ciprofloxacin]], [[levofloxacin]]), [[Sulfonamide (medicine)|sulfas]] ([[trimethoprim-sulfamethoxazole|Bactrim, Septra]]) and [[macrolide]]s ([[erythromycin]], [[clarithromycin]]). Persistent infections may be helped in 80% of patients by the use of [[alpha blocker]]s ([[tamsulosin]] ([[Flomax]]), [[alfuzosin]]), or long term low dose antibiotic therapy.<ref>{{cite journal |author=Shoskes D, Hakim L, Ghoniem G, Jackson C |title=Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome |journal=J Urol |volume=169 |issue=4 |pages=1406-10 |year=2003 |id=PMID 12629373}}</ref> Recurrent infections may be caused by inefficient urination ([[benign prostatic hypertrophy]], [[neurogenic bladder]]), prostatic stones or a structural abnormality that acts as a reservoir for infection.


The addition of [[prostate massage]] to courses of antibiotics was previously proposed as being beneficial.<ref>{{cite journal |author=Nickel J, Downey J, Feliciano A, Hennenfent B |title=Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience |journal=Tech Urol |volume=5 |issue=3 |pages=146-51 |year=1999 |id=PMID 10527258}}</ref><ref>{{cite journal |author= |title=Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis |journal=Prostate Cancer Prostatic Dis |volume=2 |issue=3 |pages=159-162 |year=1999 |id=PMID 12496826}}</ref>
The addition of [[prostate massage]] to courses of antibiotics was previously proposed as being beneficial.<ref>{{cite journal |author=Nickel J, Downey J, Feliciano A, Hennenfent B |title=Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience |journal=Tech Urol |volume=5 |issue=3 |pages=146-51 |year=1999 |id=PMID 10527258}}</ref><ref>{{cite journal |author= |title=Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis |journal=Prostate Cancer Prostatic Dis |volume=2 |issue=3 |pages=159-162 |year=1999 |id=PMID 12496826}}</ref>
It is though not without some risk,<ref name="massage9">{{cite journal | author=Buse S, Warzinek T, Hobi C, Ackerman D.| title=Prostate massage with unwanted consequences. Case report| journal=Urologe A. | year=2003| volume=42| issue=1| page=78-79| url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=14655640&dopt=citation}}</ref><ref>{{cite journal |author=Sengoku A, Yamashita M, Umezu K |title=[A case of Fournier's gangrene: was it triggered by prostatic massage?] |journal=Hinyokika Kiyo |volume=36 |issue=9 |pages=1097-100 |year=1990 |id=PMID 2239620}}</ref> and, in more recent trials, was not shown to improve outcome compared to antibiotics alone.<ref>{{cite journal |author=Ateya A, Fayez A, Hani R, Zohdy W, Gabbar M, Shamloul R |title=Evaluation of prostatic massage in treatment of chronic prostatitis |journal=Urology |volume=67 |issue=4 |pages=674-8 |year=2006 |id=PMID 16566972}}</ref>
It is though not without some risk,<ref name="massage9">{{cite journal | author=Buse S, Warzinek T, Hobi C, Ackerman D.| title=Prostate massage with unwanted consequences. Case report| journal=Urologe A. | year=2003| volume=42| issue=1| page=78-79| url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=14655640&dopt=citation}}</ref><ref>{{cite journal |author=Sengoku A, Yamashita M, Umezu K |title=[A case of Fournier's gangrene: was it triggered by prostatic massage?] |journal=Hinyokika Kiyo |volume=36 |issue=9 |pages=1097-100 |year=1990 |id=PMID 2239620}}</ref> and in more recent trials, was not shown to improve outcome compared to antibiotics alone.<ref>{{cite journal |author=Ateya A, Fayez A, Hani R, Zohdy W, Gabbar M, Shamloul R |title=Evaluation of prostatic massage in treatment of chronic prostatitis |journal=Urology |volume=67 |issue=4 |pages=674-8 |year=2006 |id=PMID 16566972}}</ref>


===Prognosis===
===Prognosis===
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 23:50, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Category II: Chronic Bacterial Prostatitis

Signs and Symptoms

Chronic bacterial prostatitis is a relatively rare condition (<5% of patients with prostate-related non-BPH LUTS) that usually presents with an intermittent UTI-type picture and that is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Dr. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were E-coli."[1] Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.[2]

Main symptoms of chronic prostitis:

Diagnosis

In chronic bacterial prostatitis there are bacteria in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. Prostate specific antigen levels may be elevated, although there is no malignancy.

Treatment

Chronic Prostatitis
Preferred Regimen
▸ Ciprofloxacin 500 mg po bid x 4 weeks
OR
▸ Levofloxacin 750 mg po q24h x 4 weeks
Alternative Regimen
▸ TMP-SMX DS 1 tab PO bid x 1–3 months

Treatment requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well (β-lactams and nitrofurantoin are ineffective). These include quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may be helped in 80% of patients by the use of alpha blockers (tamsulosin (Flomax), alfuzosin), or long term low dose antibiotic therapy.[3] Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.

The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial.[4][5] It is though not without some risk,[6][7] and in more recent trials, was not shown to improve outcome compared to antibiotics alone.[8]

Prognosis

Over time, the relapse rate is high, exceeding 50%. A 2007 study showed that repeated courses of combination antibiotics may eradicate infection in 83.9% of patents with clinical remission extending throughout a follow-up period of 30 months for 94% of these patients.[9]

References

  1. ↑ Schneider, H., Ludwig, M., Hossain, H. M., Diemer, T. & Weidner, W. (2003). "The 2001 Giessen Cohort Study on patients with prostatitis syndrome – an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis". Andrologia. 35 (5): 258-262.
  2. ↑ Habermacher GM, Chason JT, Schaeffer AJ. (2006). "Prostatitis/chronic pelvic pain syndrome". Annu Rev Med. 57: 195-206.
  3. ↑ Shoskes D, Hakim L, Ghoniem G, Jackson C (2003). "Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome". J Urol. 169 (4): 1406–10. PMID 12629373.
  4. ↑ Nickel J, Downey J, Feliciano A, Hennenfent B (1999). "Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience". Tech Urol. 5 (3): 146–51. PMID 10527258.
  5. ↑ "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer Prostatic Dis. 2 (3): 159–162. 1999. PMID 12496826.
  6. ↑ Buse S, Warzinek T, Hobi C, Ackerman D. (2003). "Prostate massage with unwanted consequences. Case report". Urologe A. 42 (1): 78-79.
  7. ↑ Sengoku A, Yamashita M, Umezu K (1990). "[A case of Fournier's gangrene: was it triggered by prostatic massage?]". Hinyokika Kiyo. 36 (9): 1097–100. PMID 2239620.
  8. ↑ Ateya A, Fayez A, Hani R, Zohdy W, Gabbar M, Shamloul R (2006). "Evaluation of prostatic massage in treatment of chronic prostatitis". Urology. 67 (4): 674–8. PMID 16566972.
  9. ↑ Magri V; et al. (2007 May). &dopt=citation "Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis" Check |url= value (help). Int J Antimicrob Agents. 29 (5): 549-556. Check date values in: |year= (help)

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