Chronic prostatitis alters the prostatic microenvironment and accelerates preneoplastic lesions in C57BL/6 mice

BACKGROUND: Chronic prostatitis has been supposed to be associated with preneoplastic lesions and cancer development. The objective of this study was to examine how chronic inflammation results in a prostatic microenvironment and gene mutation in C57BL/6 mice. METHODS: Immune and bacterial prostatitis mouse models were created through abdominal subcutaneous injection of rat prostate extract protein immunization (EAP group) or transurethral instillation of uropathogenic E. coli 1677 (E. coli group). Prostate histology, serum cytokine level, and genome-wide exome (GWE) sequences were examined 1, 3, and 6 months after immunization or injection. RESULT: In the EAP and E. coli groups, immune cell infiltrations were observed in the first and last months of the entire experiment. After 3 months, obvious proliferative inflammatory atrophy (PIA) and prostatic intraepithelial neoplasia (PIN) were observed accompanied with fibrosis hyperplasia in stroma. The decrease in basal cells (Cytokeratin (CK) 5+/p63+) and the accumulation of luminal epithelial cells (CK8+) in the PIA or PIN area indicated that the basal cells were damaged or transformed into different luminal cells. Hic1, Zfp148, and Mfge8 gene mutations were detected in chronic prostatitis somatic cells. CONCLUSION: Chronic prostatitis induced by prostate extract protein immunization or E. coli infection caused a reactive prostatic inflammation microenvironment and resulted in tissue damage, aberrant atrophy, hyperplasia, and somatic genome mutation.

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.

Painful ejaculation; an underestimated sexual possible underlying serious etiology

Painful ejaculation, a previously an underestimated ejaculatory and sexual dysfunction, has gained increased attention being one of the significant sexual dysfunctions associating LUTS of BPH. Other underlying etiopathologic factors are not well studied, To study the underlying etiologic factors responsible for painful ejaculation in a group of patients having this symptom as the main complaint and the efficacy of different treatment modalities. Furthermore we want to test our hypothesis that in suspected cases of genital TB, it is better to search for it in semen rather than in urine. 60 male patients with painful ejaculation were enrolled in this study. Their mean age was 39,4 +/- 8.7 years while the mean duration of their complaint was 15.4 +/- 4.8 months. Patients were subjected to thorough history taking and physical examination including DRE. Patients were extensively investigated by urinalysis, urine culture, Ziehi Neelsen [Z,N.] staining and PCR for acid fast bacilli in both urine and semen ,semen culture, semen culture for TB, TRUS [ +/- biopsy] and/or cystoscopy when indicated in addition to PSA determination in all men above 50 years old. Associated symptoms were premature ejaculation, chronic prostatitis manifestations, ED, cystitis manifestations, infertility, partner dyspareunia or hemospermia in that order of frequency. Significant physical findings included BPH [15], epididymal mass[1], recurrent epididymoorchitis [1] scrotal sinus [1] and prostatic carcinoma [1], UTI was proved by urine culture in 20case with E-coli strains predominantly isolated. Urine PCR for TB was positive in 5 patients [13% sensitivity and 100% specificity] while same test in semen yielded astonishingly high incidence of TB in 40 patients [100% sensitivity and 91% specificity].Semen culture for TB confirmed its presence in 38 out of 40 PCR positive specimens. TRUS findings included calcular prostatitis [7], BPH [15], Prostatic adenocarcinoma [1], pathologic seminal vesicles [15],ejaculatory duct obstruction [3] and prostatic cysts [2]. Treatment of the underlying etiologies produced significant improvement of pain. Alpha blockers improved pain in 93% and 70% of BPH and chronic prostatitis patients respectively. Painful ejaculation may be an important indicator of a serious underlying disease such as prostatic carcinoma. In our locality genitourinary TB is prevalent among this group of patients. We introduce the application of PCR in semen as a highly sensitive and specific test which should be done whenever genitourinary TB is suspected as it showed better sensitivity than same test in urine. Alpha blockers proved effective in relieving painful ejaculation in BPH patients and to less extent in chronic prostatitis patients

In vitro resistance to human platelet microbicidal protein among urethral staphylococcal and enterococcal isolates with its correlation with prostatitis.

The study was carried out to test the in vitro activity of human platelet microbicidal protein (hPMP) on most commonly isolated urethral pathogens and compare the same with clinical isolates from cases of chronic prostatitis (CP). Urethral isolates of Staphylococcus aureus (n=19), coagulase negative staphylococci (n=40) and Enterococcus faecalis (n=16) from patients with or without CP were tested. The hPMP susceptibility of bacterial strains was determined by exposing bacterial cells to serial dilutions of hPMP. A significantly higher proportion of CP-strains of coagulase negative staphylococci (91.3% vs 5.88%) was resistant to hPMP than was that of non-CP strains (P S.aureus studied, 77.8% were considered resistant to the bactericidal action of hPMP. All nine CP-strains of E.faecalis were highly resistant to hPMP. Most non-CP urethral isolates of S.aureus, coagulase negative staphylococci and E.faecalis were susceptible to the bactericidal action of hPMP, while CP isolates of all species were significantly more resistant to hPMP. Data from the present study may have significant implications in understanding the pathogenesis of CP.

Tuberculous prostatitis--a case report.

Tuberculous prostatitis is a rare condition. A 55 years-old man admitted into a surgery unit of Mymensingh Medical College Hospital with features of prostatism. After clinical examination and investigations, it was diagnosed as a case of benign enlargement of prostate (BEP) and surgery was decided to do. During exploration a large cystic cavitation found in prostate and the intact median lobe taken out for histopathological examination, which revealed tuberculous granuloma. The patient had no evidence of past or present pulmonary tuberculosis. He was treated with anti-tubercular chemotherapy and responded well. No such case is found reported in Bangladesh yet in through medline search database. So, the case is reported here.

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

Lomefloxacino vs. trimetoprim/sulfametoxazol en el tratamiento de la prostatitis bacteriana crónica / Lomefloxacine vs. trimethoprim-sulfametoxazole in the treatment of chronic bacterial prostatitis

Se realizó un estudio multicéntrico, prospectivo y comparativo con distribución al azar para comparar la eficacia y la seguridad de lomefloxacino (LMF) con la de trimetoprim/sulfametoxazol (TMP/SMX) en el tratamiento de la prostatitis bacteriana crónica. El estudio se efectuó en tres centros hospitalarios, y abarcó a un total de 30 pacientes adultos del sexo masculino con diagnósticos clínicos y bacteriológico confirmados. Los pacientes se distribuyeron al azar para recibir LMF a la dosis de 400 mg una vez al día (n = 15), o TMP/SMX a la de 160/800 mg dos veces al día (n = 15) durante seis semanas. Se valoraron los aspectos de seguridad y eficacia antes del tratamiento, durante el mismo y una vez terminado éste mediante cultivos de orina pruebas de laboratorio y valoración clínica, incluso hasta dos y cuatro meses después del tratamiento. Se logró erradicación bacteriológica en 92.3 por ciento de los pacientes tratados. con LMF y en 84.6 por ciento de los que recibieron TMP/SMX (p> 0.05). Se logró un buen resultado clínico en 100 por ciento de los pacientes que recibieron LMF o TMP/SMX. Ambas evaluaciones se realizaron cinco a nueve días después de terminar el tratamiento. Los agentes patógenos que con mayor frecuencia se aislaron fueron Escherichia coli (43.3 por ciento), estafilococo coagulasa negativo (20 por ciento), Staphylococcus saprophiticus (13.3 por ciento) y Enterococcus sp. (13.3 por ciento). Los efectos adversos se consideraron leves, y los experimentaron un paciente que recibió LMF y dos que tomaron TMP/SMX

Role of mycoplasma hominis and ureaplasma urealyticum in patients with chronic prostatitis

This study was done to elucidate the role of Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum] in patients with chronic prostatitis. The study was done on two groups. The first group included 50 male patients with chronic prostatitis, the second group included 10 normal subjects as controls. Urine samples before and after prostatic massage and prostatic secretions were collected from all patients and controls. Prostatic secretions were used for preparation of wet and Gram stained films, culture on conventional culture media and to inoculate Mycofast AlI- In trays. Conventional cultures revealed positive growth in 74% of cases. Strept faecalis and Staph epidermides were the commonest organisms isolated. 26% of cases and all the controls revealed no growth. The overall isolation rate of U. urealyticum and M. hominis was 12%. Each of U. urealyticum and M. hominis was detected in 4% of cases and both organisms occured in 4% of cases. All controls were negative for mycoplasmas. Regarding antibiotic susceptibility, all M. hominis and U. urealyticum strains were susceptible to minocycline, tetracycline and ciprofloxacin except one strain of U. urealyticum which was resistant to ciprofloxacine. We concluded that mycoplasmas may be considered as an aetiological agent in chronic prostatitis either solely or in combination with other bacteria. Also, it is concluded that mycofast All-In kit, which is a rapid and easy test, can be used for routine diagnosis of mycoplasma infections

Genitourinary mycoplasma. Mycoplasma prostatitis

Nineteen patients with the initial diagnosis of chronic nonbacterial prostatitis were screened for mycoplasma infection. Expressed prostatic secretion was examined by the "Mycofast" technique. Positive mycoplasma assays were obtained in 68% of patients. Treatment based on an identibiogram provided in the "Mycofast" produced clinical cure in all patients and bacteriological cure was documented in 5 of them. Search for mycoplasma was warranted in all patients with chronic nonbacterial prostatitis. The "Mycofast" is an inexpensive, fast and reliable technique to detect mycoplasma in genitourinary specimens

Aspectos clínicos y microbiológicos en la prostatitis crónica / Clinical and microbiological aspect in the chronic prostatitis

Se evaluaron 163 pacientes con edades comprendidas entre 21 y 66 años diagnóstico clínico y microbiológico de prostatitis crónica siguiendo los criterios de Meares-Staney. En 98 pacientes (60.1%) se diagnosticó prostatitis crónica bacteriana (PCB) y en 65 pacientes (39.9%) prostatitis crónica bacteriana (PCA). Las principales manifestaciones clínicas fueron trastornos urinarios bajos irritativos (TUB) y de la esfera seminal-sexual. El microorganismo más frecuente identificado fue E.coli en 15 pacientes (15.3%), Ureaplasma en 12 pacientes (12.2%), Enterobacter sp en 10 (10.2%) y Proteus mirabilis en 9 pacietes (9.2%). Los microorganismos causantes de ETS se identificaron en 38 casos (38.8%) lo que resulta significativo. El 38.1% de las cepas de Enterobacterias aisladas fue resistente a la combinación Sulfa-Trimetoprin que es el producto más usado en el tratamiento de la prostatitis. No hubo resistencia a la enoxacina ni a ciproxina, productos que pueden ser alternativas en el tratamiento de esta afección

Aspectos microbiológicos de la prostatitis crónica / Microbiological aspect of the chronic prostatitis

En 46 de 216 (21,3%) de pacientes con prostatitis crónica y en 5 de 163 (3.1%) individuos del grupo control, se aislaron microorganismos potencialmente patogénos de las vías uro-genitales (P<5%). Corynebacterium JK fue el organismo más frecuente (12.9%) seguido de E. coli (10.2%), Mycobacterias atípicas (9.7%), C. trachomatis (8.8%), U. urealyticum (6.5%), T. vaginalis (3.7%), M. hominis (3.2%), P. mirabilis (2.8%), Enterobacter sp (0.9%), S. faecalis (0.9%) y C. albicans (0.9%). Se dicutieron aspectos etiopatogénicos y terapéuticos de la prostatitis crónica.