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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The criteria for clinical evaluation of the efficacy of antimicrobial agents on prostatitis were proposed. Nomenclatural definition, specifications of patients and criteria were as follows. Acute prostatitis: Target infection is acute bacterial prostatitis with no underlying condition in urinary tract. The findings of swelling and tenderness of prostate by rectal examination are essential. The patients are between 16 and 69 years old. They have fever greater than 37 degrees C and pain on micturition. Microscopic examination reveals white blood cells (WBCs) in VB1 or VB2 before treatment greater than or equal to 10 cells/hpf. Viable bacteria in VB1 or VB2 before treatment are greater than or equal to 10(4) bacteria/ml. Period of treatment is for 7 days. To evaluate clinical efficacy, 3 days after administration, changes of symptoms (fever and pain on micturition) are recorded. Seven days after administration, changes of symptoms, microscopic examinations and number of bacteria are recorded. The overall clinical efficacy is graded as "excellent", "moderate" or "poor" by combining changes in the above 3 parameters. Chronic prostatitis: Target infection is chronic bacterial prostatitis with no underlying condition in urinary tract. The patients are between 16 and 69 years old. Microscopic examination reveals WBC in EPS or VB3 before treatment greater than or equal to 10 cells/hpf. Viable bacteria before treatment are greater than or equal to 10(3)/ml (GNR) or greater than or equal to 10(4)/ml (GPC). Treatment period is for 14 days. To evaluate clinical efficacy, after 14 days of administration, changes of symptoms, microscopic examinations and number of bacteria are recorded. The overall clinical efficacy is graded as "excellent", "moderate", or "poor" by combining the changes in the 2 parameters, microscopic examination and number of bacteria.
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PMID:[Proposal of a standard method for clinical evaluation of antimicrobial agents in prostatitis--specifications of patients and criteria for evaluation of clinical efficacy]. 273 52

Prostatitis describes a spectrum of disorders involving inflammation of the prostate gland. This common yet poorly understood condition produces an array of symptoms, the most common of which are urinary obstruction, perineal pain, and ejaculatory complications. Although several theories have been proposed regarding its etiology, the exact mechanism of disease remains elusive. Definitive diagnosis can be hampered by a somewhat cumbersome testing procedure, but symptomology tends to be a reliable guide for treatment. Although treatment with antibiotics often fails, the fluoroquinolones are among the most effective agents for symptom management. Other interventions that may be appropriate include alpha-1-adrenergic blockers, a 5-alpha reductase inhibitor, or surgery. Chronic prostatitis may result in repeated urinary tract infections and chronic pain syndromes.
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PMID:Prostatitis. Work-up and treatment of men with telltale symptoms. 1130 21

We surveyed the prevalence of chronic prostatitis-like symptoms in young men using the National Institutes of Health (NIH) Chronic Prostatitis Symptom Index (CPSI) and determined the clinical validity of the NIH-CPSI among men in the community. Of 29,017 men aged 20 years dwelling in the community, 8,705 men were randomly selected at a 30.0% sampling fraction and a total of 6,940 men (a response rate 79.7%) completed a self-administered questionnaire. Six percent reported having pain or discomfort in more than one area . About 5% did not feel that the bladder emptied fully after urinating more than 1 time in 5 and 10.5% had to urinate again within 2 h more than 1 time in 5. As the scores for pain or discomfort increased, those for urinary symptoms and impact on quality of life increased (P < 0.001; Armitage test). As the scores for urinary symptoms increased, those for pain or discomfort and impact on quality of life also increased (P < 0.001; Armitage test). The community-based prevalence of chronic prostatitis-like symptoms were found to be high in young men as well as in older men. Our findings indicate that men with pain or urinary symptoms experience a negative impact on their quality of life and the NIH-CPSI provides a valid measure for the general population.
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PMID:The prevalence of chronic prostatitis-like symptoms in young men: a community-based survey. 1139 27

Chronic prostatitis is a multifaceted problem affecting men that is both poorly understood and poorly treated. It is inevitable, therefore, that no single treatment will benefit all patients. However, data suggest that some patients' problems can be treated effectively with alpha-blockers. The prostate is rich in alpha-adrenergic receptors, and some urodynamic studies have shown a failure of the bladder neck to relax during voiding. Other studies have demonstrated turbulent flow in the prostate leading to prostatic duct reflux. Because urine is acidic, reflux into the prostatic ducts will cause inflammation and pain. Thus alpha-blockers are an effective treatment for men with prostatitis caused by dysfunctional voiding.
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PMID:Alpha-blockers: an effective treatment for prostatitis? 1208 29

Chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS) causes morbidity, both through symptoms and associated impairment in health-related quality of life, both of which illustrate the importance of patient-centered outcomes. Despite preliminary work by several investigators, research and clinical efforts to provide help for men afflicted with CPPS have been hampered by the absence of a widely accepted, reliable, and valid instrument to measure symptoms and quality-of-life impact. Investigators from the National Institutes of Health (NIH)-funded Chronic Prostatitis Collaborative Research Network (CPCRN) sought to remedy this problem by developing a psychometrically valid index of symptoms and quality-of-life impact in men with chronic prostatitis. This instrument, now validated in English, Spanish, German, and Korean, is known as the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). It contains 13 items that are scored in 3 discrete domains: pain, urinary symptoms, and quality-of-life impact. In early studies, the NIH-CPSI has been shown to be reliable, valid, and responsive to change. Further work is needed to determine whether it performs as well in minority populations, men seeking care in nonreferral centers, and other diverse populations.
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PMID:A review of the development and validation of the National Institutes of Health Chronic Prostatitis Symptom Index. 1252 81

Anti-inflammatory medications have been used for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), given that inflammation and pain are traditionally associated with this condition. The National Institutes of Health (NIH) classification divides category III into (1) category IIIA--patients with white blood cells (WBCs) in their expressed prostatic secretions, post-prostate massage urine (voided bladder urine-3 [VB3]) or semen; and (2) category IIIB--those without WBCs. However, recent studies indicate that the ability of WBC count alone to distinguish men with symptoms from those without appears limited. Other markers of inflammation, such as cytokines, may correlate better with clinical findings. The mechanisms of inflammation continue to be investigated, including contributions from reactive oxygen species, autoimmune response, neurogenic inflammation, and even endocrine dysfunction. There have been few controlled studies of anti-inflammatory therapy for chronic prostatitis. In the only randomized double-blind placebo-controlled trial, the NIH-Chronic Prostatitis Symptom Index (CPSI) total, domain, and pain scores significantly decreased from baseline in all groups, but the difference was not statistically significant. Other medications that have some theoretic anti-inflammatory properties have shown promising early results. Further study of currently available anti-inflammatory medications may be warranted, especially in longer trials, which may allow resolution of the significant placebo effect commonly seen in the short term in men with CPPS. Further discussion is needed to either validate, modify, or abolish the distinction between category IIIA and IIIB in the NIH classification.
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PMID:Inflammation and anti-inflammatory therapy in chronic prostatitis. 1252 89

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition, traditionally treated with antimicrobials, nonsteroidal anti-inflammatory drugs, and alpha-blockers. Pelvic floor tension myalgia is hypothesized to be a contributing factor in CPPS. Biofeedback training for CPPS is based on the principle that maximum muscle contraction prompts maximum muscle relaxation. Similar chronic pain conditions have been treated successfully with biofeedback-assisted techniques of neuromuscular reeducation. Preliminary study by our group has shown biofeedback, pelvic floor reeducation, and bladder training to be helpful in the treatment of CP/CPPS. Overall, 8 of 11 patients had improvement in either pain scores or their chronic prostatitis pain index scores. With no cure for CP/CPPS available, biofeedback and pelvic floor reeducation merit further evaluation in the treatment of this condition.
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PMID:Bladder training biofeedback and pelvic floor myalgia. 1252 95

According to the National Institutes of Health classification system, chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is subdivided into an inflammatory (category IIIa) and a non-inflammatory (category IIIb) form. The difference is based on the presence or absence of white blood cells in expressed prostatic secretions, urine after prostatic massage, or semen. This is the only criterion which allows a differentiation between the IIIa and IIIb forms. The symptoms, i.e. pain and urinary complaints of various degrees, are thought to be similar in both forms. These symptoms can be assessed with the Chronic Prostatitis Symptom Index (CPSI) and the International Prostate Symptom Score (IPSS), which are both available in a validated German translation. One hundred and six patients with CPPS were evaluated with CPSI and IPSS. Urinary symptoms troubled all patients. Men with category IIIa had significantly more urinary symptoms when compared to men with category IIIb. There was no difference between the two groups regarding pain and impact on the quality of life. Although pain is thought to be the hallmark of CPPS, the contribution of urinary troubles to the symptoms must not be underestimated.
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PMID:[Evaluation of symptoms in men with chronic pelvic pain]. 1257 82

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urological diagnosis affecting young and middle aged men. Symptoms of genital or pelvic pain associated with voiding or sexual dysfunction were historically attributed to an inflamed prostate gland. A review of urological and non-urological literature pertaining to CPPS was conducted in order to devise a plausible alternative description of this syndrome. Due to publisher's criteria, only select articles are included and cited for this purpose. Evidence of a bacterial etiology is non-existent, while evidence of prostatic inflammation is conflicting and non-specific. More plausible causes of prostatitis-like symptoms include musculoskeletal pain, pelvic floor muscular dysfunction, myofascial pain syndromes or functional somatic syndromes. Thorough evaluation and appropriate therapy for patients has been seriously hindered by decades of a prostatocentric approach to CP/CPPS. The following article introduces an alternative perspective.
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PMID:Chronic pelvic pain syndrome: a non-prostatocentric perspective. 1281 13

Prostatitis results in >2 million physician office visits annually. Characterized by pelvic pain and voiding symptoms, chronic pelvic pain syndrome (CPPS) is poorly defined. The Chronic Prostatitis Collaborative Research Network (CPCRN) has put forward a uniform set of classifications for chronic prostatitis based on pain being the primary symptom. The CPCRN has also created a valid instrument for measuring symptoms: the Chronic Prostatitis Symptom Index. After nonbacterial prostatitis has been diagnosed, treatment of patients should be individualized. The condition may be caused by bladder, prostate, pelvic side wall, or seminal vesicle pathology. In addition to currently used treatments, several new therapies are being investigated after promising pilot studies. Despite the multiple approaches to management of CPPS, no hard and fast guidelines have been developed. This review provides an overview of assessment techniques and management options for men with CPPS.
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PMID:Etiology and management of chronic pelvic pain syndrome in men. 1501 57


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