Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte I / Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte I

La Sociedad Argentina de Infectología y otras sociedades científicas han actualizado estas recomendaciones utilizando, además de información internacional, la de un estudio multicéntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes también se las debe investigar sistemáticamente; los antibióticos de elección son nitrofurantoína, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprima-sulfametoxazol. Ante procedimientos que impliquen lesión con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos según sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervención. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 días, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crónicas, si bien su tratamiento de elección hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertas dudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.

The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.

Role of native thiol, total thiol and dynamic Disulphide in diagnosis of patient with prostate cancer and prostatitis

ABSTRACT Background: Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis. Materials and Methods: Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method. Results: NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8μmoL / L, 150.3 ± 45.3μmoL / L, 15.9 ± 7μmoL / L, 78.8 ± 7μmoL / L, 10.5 ± 3.5μmoL / L, 13.8 ± 5.8μmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5μmoL / L, 147.5 ± 50.1μmoL / L, 15.5 ± 8.7μmoL / L, 79.7 ± 9μmoL / L, 10.1 ± 4.5μmoL / L, 13.5 ± 7.2μmoL / L in patients with prostatitis and as 144.1 ± 21.2μmoL / L, 191 ± 32.3μmoL / L, 23.4 ± 10.1μmoL / L, 76.1 ± 98.3μmoL / L, 11.9 ± 4.1μmoL / L, 16.4 ± 6.9μmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222). Conclusions: Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

TeleCondutas: prostatite crônica/síndrome da dor pélvica crônica / TeleGuides: chronic prostatitis / chronic pelvic pain syndrome

Sintomas de prostatite são muito comuns na população, ocorrendo com uma prevalência média de 8,2%. Estima-se que 35% a 50% dos homens apresentarão esses sintomas em algum momento de sua vida. Entre as formas de prostatite, a apresentação mais comum é a Prostatite Crônica/ Síndrome da Dor Pélvica Crônica (PC/SDPC). PC/SDPC é uma síndrome clínica definida essencialmente pela presença de dor pélvica crônica não causada por patologias identificáveis. Apesar do termo "prostatite", parcela significativa dos casos não tem sinal de inflamação ("-ite") da próstata. Infecções causadas por Clamídia, Micoplasma ou Ureaplasma geralmente não são responsáveis pela PC/SDPC. Tampouco se sabe em que extensão a próstata é responsável pelos sintomas. Além de prevalente, a PC/SDPC prejudica a qualidade de vida dos homens e tem importante impacto econômico. Está frequentemente associada a dor genital, dor ejaculatória, dor abdominal, sintomas do trato urinário inferior e disfunção erétil. Ansiedade e medo de doenças graves são achados comuns em pacientes com PC/SDPC e podem contribuir com os sintomas. Múltiplas consultas, investigações e procedimentos também são riscos aos quais esses pacientes estão sujeitos. Pouca atenção tem sido dada à essa condição, o que resulta em literatura relativamente escassa sobre o assunto. Considerando a diversidade e severidade dos sintomas, assim como as comorbidades sistêmicas que frequentemente estão associadas (como síndrome do intestino irritável e fibromialgia), abordagens terapêuticas uniformes e monoterápicas raramente funcionam. Não surpreende que a PC/SDPC seja uma condição associada a significativa frustração, tanto nos pacientes quanto nos médicos. É necessário, portanto, que o diagnóstico e tratamento adequado seja feito na Atenção Primária à Saúde (APS), em vistas a melhorar a qualidade de vida do paciente e evitar encaminhamentos desnecessários ao urologista. Esta guia apresenta informação que orienta a conduta para casos de prostatite crônica/síndrome da dor pélvica crônica no contexto da Atenção Primária à Saúde, incluindo: Classificação, Sinais e Sintomas, Diagnóstico, Tratamento, Encaminhamento para serviço especializado, Referências, Anexo.

Multiparametric Magnetic Resonance Imaging Characteristics of Prostate Tuberculosis

OBJECTIVE: To describe the multiparametric magnetic resonance imaging (MRI) appearance of prostate tuberculosis. MATERIALS AND METHODS: Six patients with prostate tuberculosis were analyzed retrospectively. The mean age of the patients was 60.5 years (range, 48-67 years). The mean prostate specific antigen concentration was 6.62 ng/mL (range, 0.54-14.57 ng/mL). All patients underwent a multiparametric MRI examination. RESULTS: The histopathological results were obtained from biopsies in four men and from transurethral resection of the prostate in two men after the MRI examination. Nodular (33%, 2/6 patients) and diffuse lesions (67%, 4/6 patients) were seen on MRI. The nodular lesions were featured by extremely low signal intensity (similar to that of muscle) on T2-weighted imaging (T2WI). The T2WI signal intensity of the diffuse lesions was low but higher than that of muscle, which showed high signal intensity on diffusion weighted imaging and low signal intensity on an apparent diffusion coefficient map. MR spectroscopic imaging of this type showed a normal-like spectrum. Abscesses were found in one patient with the nodular type and in one with the diffuse type. CONCLUSION: The appearance of prostate tuberculosis on MRI can be separated into multiple nodular and diffuse types. Multiparametric MRI may offer useful information for diagnosing prostate tuberculosis.

Body mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health

PURPOSE: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. MATERIALS AND METHODS: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. RESULTS: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. CONCLUSIONS: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.

Multiphase Contrast-Enhanced Magnetic Resonance Imaging Features of Bacillus Calmette-Guerin-Induced Granulomatous Prostatitis in Five Patients

OBJECTIVE: To evaluate the multiphase contrast-enhanced magnetic resonance (MR) imaging features of Bacillus Calmette-Guerin (BCG)-induced granulomatous prostatitis (GP). MATERIALS AND METHODS: Magnetic resonance images obtained from five patients with histopathologically proven BCG-induced GP were retrospectively analyzed for tumor location, size, signal intensity on T2-weighted images (T2WI) and diffusion-weighted images (DWI), apparent diffusion coefficient (ADC) value, and appearance on gadolinium-enhanced multiphase images. MR imaging findings were compared with histopathological findings. RESULTS: Bacillus Calmette-Guerin-induced GP (size range, 9-40 mm; mean, 21.2 mm) were identified in the peripheral zone in all patients. The T2WI showed lower signal intensity compared with the normal peripheral zone. The DWIs demonstrated high signal intensity and low ADC values (range, 0.44-0.68 x 10(-3) mm2/sec; mean, 0.56 x 10(-3) mm2/sec), which corresponded to GP. Gadolinium-enhanced multiphase MR imaging performed in five patients showed early and prolonged ring enhancement in all cases of GP. Granulomatous tissues with central caseation necrosis were identified histologically, which corresponded to ring enhancement and a central low intensity area on gadolinium-enhanced MR imaging. The findings on T2WI, DWI, and gadolinium-enhanced images became gradually obscured with time. CONCLUSION: Bacillus Calmette-Guerin-induced GP demonstrates early and prolonged ring enhancement on gadolinium-enhanced MR imaging which might be a key finding to differentiate it from prostate cancer.

Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience.

Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I), 34 BPH patients (group II) and 40 chronic prostatitis patients (group III). Serum total PSA (tPSA) and free PSA (fPSA) were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049). Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035). Difference was significant for f/t PSA ratio in group I and II (P < 0.00) and group II and III (P < 0.000).Group I and III were with comparable levels (P < 0.807). Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.

Cultural Adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) - to Brazilian Spoken Portuguese: NIH-CPSI (Braz)

Objectives To create a Brazilian version of the National Institutes of Health – Chronic Prostatitis Symptom Index (NIH-CPSI) using a cross-cultural adaptation process. Materials and Methods The nine items of the NIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. Results All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called NIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). Conclusions NIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients. .

Biexponential Apparent Diffusion Coefficients Values in the Prostate: Comparison among Normal Tissue, Prostate Cancer, Benign Prostatic Hyperplasia and Prostatitis

OBJECTIVE: To investigate the biexponential apparent diffusion parameters of diverse prostate tissues and compare them with monoexponential apparent diffusion coefficient (ADC) value in the efficacy to discriminate prostate cancer from benign lesions. MATERIALS AND METHODS: Eleven healthy volunteers and 61 patients underwent a conventional (b-factors 0, 1000 s/mm2) and a 10 b-factor (0 to 3000 s/mm2) diffusion-weighted imaging (DWI). The monoexponential ADC value and biexponential parameters of fast ADC (ADCf), fraction of ADCf (f), slow ADC (ADCs) value for 29 prostate cancer, 28 benign prostatic hyperplasia (BPH), 24 prostatitis lesions and normal tissue were calculated and compared. Receiver operating characteristic analysis was performed to determine the sensitivity, specificity and optimal cut-off points. RESULTS: Prostate cancer had lower ADC, ADCf, f, and ADCs than all other tissues (p 0.05), but the AUC of f and ADCs in differentiating cancer from BPH (0.73 and 0.81) and prostatitis (0.88 and 0.91) were significantly lower than ADC (all p < 0.05). CONCLUSION: The biexponential DWI appears to provide additional parameters for tissue characterization in prostate, and ADCf helps to yield comparable accuracy with ADC in differentiating cancer from benign lesions.

PCR for Diagnosis of Male Trichomonas vaginalis Infection with Chronic Prostatitis and Urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

Impact of infection on the secretory capacity of the male accessory glands

INTRODUCTION: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT) on the male accessory gland function are controversial. MATERIAL AND METHODS: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38), chronic epididymitis (n = 12), and chronic urethritis (n = 21). RESULTS: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20), Klebsiella (n = 2), Proteus spp. (n = 1), Enterococcus (n = 20), Staphylococcus spp. (n = 1), M. tuberculosis (n = 2), N. gonorrhea (n = 8), Chlamydia tr. (n = 16) and, Ureaplasma urealyticum (n = 1). The infection group had significantly (p < 0.05) lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non-infected men. CONCLUSION: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate. These findings were associated with an infectious related significant increase of semen pH. None of the semen parameters evaluated can be suggested as a diagnostic tool for infection.

Semen and urine culture in the diagnosis of chronic bacterial prostatitis

OBJECTIVE: To assess the diagnostic accuracy of semen and urine culture in the diagnosis of chronic bacterial prostatitis (CBP). MATERIALS AND METHODS: In 70 consecutive men suspected of having chronic bacterial prostatitis along with 17 asymptomatic controls, we obtained urine and semen cultures followed 1 week later by the Meares and Stamey test, our reference standard. The interpretation of each of the cultures was blind to the results of other tests. RESULTS: 139 men were referred for evaluation of chronic bacterial prostatitis and 70 received all tests. Additionally, 17 control men volunteered to participate. The Meares and Stamey Test was positive in 69 (79 percent) patients. The semen culture had a sensitivity of 45 percent and a specificity of 94 percent. The likelihood ratio associated with a positive semen culture was 8.1 (95 percent confidence interval (CI) 1.2 to 55.3); the likelihood ratio associated with a negative semen culture was 0.6 (95 percent CI 0.5 to 0.7). The urine culture had a sensitivity of 4 percent and a specificity of 100 percent. The likelihood ratio of a positive urine culture was infinity and of a negative urine culture was 0.96 (95 percent CI 0.9 to 1). CONCLUSIONS: While a positive semen culture in a symptomatic patient may suffice to select and start antibiotic treatment against chronic bacterial prostatitis, a negative culture does not rule out the condition. Urine cultures alone are not useful for diagnosing CBP. The Meares and Stamey test remains important for the diagnosis of CBP in practice.

value of transrectal ultrasound guided needle biopsy in the diagnosis of non-malignant prostatec conditions

The majority of patients [60-65%] undergoing prostatic needle biopsies because of an elevated serum PSA levels and/or abnormal digital rectal examination will not have adenocarcinoma of their prostates upon pathological examination. Benign prostatic hyperplasia [BPH] and prostatitis are common causes of serum PSA elevation. We selected to evaluate the distribution of malignant and non-malignant conditions in patients undergoing prostatic needle biopsies. For this purpose 408 consecutive patients underwent 12 core transrectal ultrasound [TRUS] guided prostatic needle biopsies were evaluated. None of them had clinical prostatitis. Prostatic volume was estimated during the procedure. Pathologic examination focused on the presence of normal prostate, BPH, Prostatitis and cancer in every core. According to serum PSA levels, patients were classified into four different groups ranging between 0.1 to more than 20 ng/ml. Prostatic volume ranged between 10-178 ml. Prostate cancer was detected in 139 patients [34%] with average volume 36 ml, 89 patients [22%] showed pathologic evidence of chronic prostatitis with average volume 59 ml. BPH changes were elicited in 153 patients [37.5%] with average volume 42 ml while 27 patients [6.5%] were having normal prostates with average volume 51 ml. The incidence of prostate cancer, prostatitis, BPH and normal prostate was 25% 17%, 50% and 8% for group I [[PSA 0.1-4 ng/ml], [n = 94]] this incidence was 30%, 25%, 40 and 5% for group II [PSA 4.1-10 ng/,l], [n = 188]], it was 38%, 19%, 37% and 6% for group III [[PSA 10.1-20 ng/ml]], [n = 100] and it was 50%, 21%, 17% and 12% for group IV patients [[PSA > 20 ng/ml] [n = 22]1 respectively. From the above mentioned results we can conclude that the majority of patients suspected to harbour cancer in their prostates shows no malignancy upon pathologic examination of their biopsies, with BPH being the most common [37.5%] and prostatitis was a significant finding in 22% of patients. Prostate volume was not a crucial factor in predicting the pathologic entity. After excluding prostatitis, the higher the serum PSA level the higher the incidence of prostate cancer

Etude epidemio-clinique et therapeutique de la prostatite chronique sur 80 cas dans les service d'urologie du CHU Gabriel Toure

Au Mali; rares sont les etudes qui ont porte sur les prostatites chroniques. C'est ainsi que du 1 juillet 2003 au 30 septembre 2004; 80 cas de prostatite chronique ont ete etudies. La prostatite chronique a represente 9;28de l'ensemble de pathologie en Urologie et 22;85pour notre etude. L'age de nos patients a varie entre 18 a 56 ans avec une moyenne de 32;46 ans et une classe d'age dominante de 21 a 40 ans. La dysurie a ete le motif de consultation le plus frequent (36;25) et l'asthenie sexuelle (22;5). Les signes les plus rencontres ont ete: - Pour les troubles urinaires; une prostatorrhee et dysurie avec respectivement 97;5et 96;25. - Pour les troubles sexuels; les troubles a l'ejaculation ont ete dominantes (92;5). - Pour les troubles algiques; les douleurs lombaire; testiculaires; abdominale basse sont des maitres symptomes (95; 85et 82).L'ECBU; SPE n'ont pu determiner que quelques cas de germes (11/80 soit 13.75de prostatites chroniques bacteriennes) et la presence de leucocytes (53/80 soit 66;25de prostatites chroniques non bacteriennes et inflammatoires). L'echographie vesicale et prostatique a retrouve un grand nombre de calcifications prostatiques (58;75). Le traitement medical; surtout avec les fluoroquinolones a ete le plus utilise et le massage prostatique a ete effectue chez tous les patients. L'echec medical a ete constate (35)

Prostatitis: diagnostic criteria and classification

Our aim from this prospective study is to determine the prevalence and classification of major types of prostatitis, also determining the commonest etiological agents. We analyzed 54 patients with symptoms suggestive of prostatitis, the patients were presented to the family clinic at Princess Haya Hospital at Aqaba between January-June 2000, and underwent prostatic localization [diagnostic] studies. 54 consecutive patients were analyzed, and according to the currently accepted criteria for the diagnosis of prostatitis; 4 patients were given a diagnosis of acute bacterial postatitis which account for [7%] of all cases, 10 patients diagnosed as chronic bacterial prostatitis with [18%] prevalence, 25 had chronic non-bacterial prostatitis [46%] and 15 given a diagnosis of chronic pelvic pain syndrome [28%]. Bacterial growth was obtained from 14 patients [26%], of which Escherichia coli was grown from 5 [36%], Staphylococcus aureus from 4 [29%], Proteus from 3 [21%], Serratia from one [7%] and Klebsiella from one patient [7%]. The dilemma of diagnosing prostatitis is discussed. Prostatitis is an important diagnosis in urological and primary care practice, this study emphasizes the need for improved diagnosis of prostatitis, also the higher prevalence of Staphylococcus aureus in our patients should prompt researchers to study their patient since cultural, social habits and evulsion of microbial world may have an impact on the etiology of the disease