[Management of acute prostatitis, based on a series of 100 cases]. / Prise en charge d'une prostatite aiguë: à propos de 100 cas.

OBJECTIVES: To evaluate the current diagnostic and therapeutic management of acute prostatitis. MATERIAL AND METHODS: The authors report a series of 100 consecutive patients with a diagnosis of acute prostatitis managed between January 1999 and December 2003. They analysed the clinical and laboratory data and imaging findings leading to the diagnosis of acute prostatitis and then the modalities of treatment and follow-up of these patients. RESULTS: The median age was 56.5 years (range: 19-86 years). In 77% of cases, the initial septic syndrome was considered to be severe. Prostatic tenderness was detected on digital rectal examination in 68% of cases. In 76% of cases, the micro-organism responsible was Escherichia coli. 8% of patients had positive blood cultures. All patients presented laboratory signs of inflammatory syndrome, with elevated C Reactive Protein (CRP) in most cases. Renal and bladder ultrasound was performed in 49% of cases and CT was performed in 16% of cases. 92% of patients were treated with fluoroquinolones, as monotherapy in 34% of cases. The duration of prescription ranged from 2 weeks to 6 weeks. No aetiology was detected in 48% of cases, 8% were considered to be iatrogenic and 44% were associated with incomplete bladder emptying. CONCLUSION: Acute prostatitis, rapidly treated by aggressive and adapted antibiotics has a rapidly favourable outcome. Elevation of CRP and the presence of leukocyturia on urine dipsticks are almost constant and, when they are normal, the diagnosis of acute prostatitis should be questioned. Imaging is not required in the absence of diagnostic doubt and any suspicion of progression to abscess. The duration of antibiotic therapy varies from prescriber to prescriber reflecting the various guidelines. Guidelines on this subject are contradictory and further effort is required to achieve homogenization and application of these guidelines.

[Prevalence of osteoporotic fractures in patients treated by androgen blockade for prostate cancer]. / Prévalence des fractures d'allure ostéoporotique chez des patients traités par blocage androgénique pour cancer de prostate.

INTRODUCTION: Endocrine therapy is the standard first-line treatment for metastatic prostate cancer. The use of this treatment modality for a number of years in a large population has demonstrated some of its iatrogenic complications, especially bone complications. Hypogonadism induced by chemical castration can be responsible for osteoporosis that may be complicated by fractures. OBJECTIVE: Evaluation of the prevalence of fractures in nonmetastatic sites. PATIENTS AND METHOD: Retrospective study of 49 patients treated for more than 5 years by endocrine therapy with determination of the fracture rate, mechanisms and fracture sites. RESULTS: Eight patients developed fractures after antiandrogen treatment. Three patients with a traumatic or metastatic fracture were excluded. Five patients (10.2%) were considered to present osteoporotic fractures on the basis of their site (vertebra and neck of femur) or their mechanism (minor trauma). The mean duration of treatment in these patients was 8.1 years. The prevalence of osteoporotic fractures in the general population is estimated to be 2.2 per 1,000 men between the ages of 65 and 80 years and 6.4 per 1,000 men after the age of 80 years. CONCLUSION: The prevalence of osteoporosis induced by endocrine therapy is increasing due to longer patient survival and early introduction of treatment. No prophylactic treatment is currently proposed when starting endocrine therapy.