Prostatitis Breakthrough (Chronic Nonbacterial Prostatitis)
Chronic prostatitis is a disease with an unknown etiology that affects a large number of men. Standard treatment usually consists of prolonged courses of antibiotics, even though well-designed clinical trials have failed to demonstrate their efficacy. Recent treatment strategies with some evidence of efficacy include: alpha-blockers, anti-inflammatory agents, hormonal manipulation, phytotherapy quercetin, bee Forum Propolis von Prostatitisphysiotherapy and chronic pain therapy.
A stepwise, multimodal approach can be successful for the majority of patients who present with this difficult condition. Chronic prostatitis remains somewhat of an enigma in Urology. Ever since its description in Meares and Stamey and initial attempt at classification 10 years later Drach et Forum Propolis von Prostatitisthis condition has been long on hypotheses and short on hard data.
The last 10 years have, however, seen significant growth in research on prostatitis, resulting in better evidenced-based therapies. Category III prostatitis previously referred to as nonbacterial prostatitis or prostatodynia Forum Propolis von Prostatitis defined by the persistent symptoms of pelvic and genital pain and urinary symptoms without evidence for urinary tract infection.
The issue of Forum Propolis von Prostatitis is controversial, as some men report exacerbation of symptoms Shoskes et al whereas other report reduction Yavascaoglu et al with regular ejaculation. Stress has also been convincingly associated with CPPS. Indeed, in a well designed study, Ullrich et al Ullrich et al reported greater perceived stress during the 6 months after the healthcare visit was Forum Propolis von Prostatitis with greater pain intensity and disability at 12 months.
Based on those findings, stress reduction is frequently advocated. Importantly, stress reduction can assist in reducing the disability and response to pain.
Importantly, there is no difference in culture results of urine and prostatic fluid between men with CPPS and asymptomatic controls. The prostatic tissue is best penetrated by lipophillic drugs that have high pKa. In this group, we find the quinolones, the macrolides and sulfa drugs. From a microbiological stand point, their broad spectrum Chlamydia, mycoplasma and both gram positive and gram negative bacteria also cover most uropathogens. In non-placebo controlled studies, ciprofloxacin, levaquin and lomefloxacin have all proved clinically effective for patients with category II prostatitis chronic bacterial Naber, Busch, and Focht ; Naber and European Lomefloxacin Prostatitis Study Group, ; Wagenlehner et al Unfortunately, neither levaquin nor ciprofloxacin were found more effective than placebo in a randomized controlled trial in men with CPPS Nickel et al a ; Alexander et al Macrolides such as azithromycin or clarithromycin also penetrate the prostate well Giannopoulos et al The observed beneficial effect of antibiotics in some trials could be explained by a placebo effect or through a mechanism of action of the compounds not related to their antimicrobial activity.
Antibiotics such as quinolones and macrolides have potent anti-inflammatory effects independent of their antimicrobial effects. It is also unclear if bacteria in the prostate proliferate in Forum Propolis von Prostatitis environment protected by biofilms, as this may affect the choice of antibiotics Arakawa et al Mechanistically, prostate massage could help drain occluded prostatic duct Forum Propolis von Prostatitis increase penetration Forum Propolis von Prostatitis the gland by antimicrobial agents Hennenfent and Feliciano It could also disrupt bacterial biofilms or massage a neuromuscular trigger point along the pelvic side wall.
Frequent ejaculation achieves similar results Yavascaoglu, Oktay, Simsek et al A subset of these patients will also have ultrasonographic evidence of bladder neck hypertrophy Di Trapani et al with an accompanying obstructive pattern Forum Propolis von Prostatitis uroflowmetry Ghobish Alpha-blockers can also have a direct effect on pain.
It has been demonstrated that prostatic inflammation leads to substance P-mediated changes in the pain perception regions of the spinal cord and that these changes are blocked by tamsulosin Ishigooka et al Importantly, the presence of urinary symptoms does not correlate with improvement in pain in CPPS patients who take alpha blockers.
The effect was only apparent after several months of treatment and disappeared when the treatment was stopped. Results with tamsulosin are mixed, with one study demonstrating a significant effect Nickel et al b and another one no effect Alexander, Propert, Schaeffer et al when comparing against placebo.
The latter negative study used Forum Propolis von Prostatitis shorter treatment duration and included men who may have failed alpha blocker therapy in the Forum Propolis von Prostatitis.
Terazosin was also found to be superior to placebo in another study Cheah et al It may be possible that an initial bacterial infection triggers a dysregulated inflammatory reaction. Nonsteroidal anti-inflammatory drugs have long been used in CP. Unfortunately, the drug used, rofecoxib, has been voluntary withdrawn by its manufacturer. Some phytotherapeutic agents, to be discussed later, may act by preventing inflammation. The influence of androgen on the development of the prostate is well known, together with the effects of androgen deprivation.
In a randomized, placebo controlled study of finasteride used in combination with other therapies, there was some symptom improvement seen Nickel et al a. The effect was small, however, and the authors did not recommend monotherapy with finasteride unless a significant component of BPH was present. Phytotherapeutic agents, to be discussed later, may act through similar mechanisms.
With the introduction of minimally invasive therapy, a surgical option was again explored. Another minimally invasive approach is Forum Propolis von Prostatitis microwave therapy TUMT. Sham controlled studies are required before these therapies can be recommended for routine use.
However, none of those studies are adequately controlled. Phytotherapy is another alternative to allopathic medications. Herbal-based therapies are prevalent and popular in urologic disease, more so in prostatic disorders, with compelling evidence Shoskes Unfortunately, not all studies are adequately controlled.
Extracts of bee pollen are thought to be effective in prostatic conditions from their presumed anti-inflammatory and anti-androgen effects Buck, Rees, and Ebeling ; Buck, Cox, Rees, et al In an open-label study, 90 patients received one tablet of Cernilton N three times a day for 6 months.
However, it was not found to be more effective than placebo. Quercetin, a polyphenolic bioflavonoid, is commonly found in red wine, green tea and onions Hollman Forum Propolis von Prostatitis al ; Hollman and Katan Patients receiving quercetin had a significant improvement over the placebo group.
Using prostaglandin E2 in expressed prostatic secretion as a surrogate marker of prostate inflammation, it was later found that quecertin significantly decreased inflammation in the prostate Shahed and Shoskes Therapies aimed at relaxation of these muscle groups and proper use of pelvic floor muscle may therefore be expected to be beneficial. Unfortunately, not very many large clinical trials have been published, data is available from small trials. Forum Propolis von Prostatitis, many asymptomatic older men have stones detected during transrectal ultrasound.
However, large, central calcifications are often associated with symptoms in younger men Geramoutsos et al Nanobacteria have attracted attention of late with their possible implication in biomineralization Kajander et al Such an approach awaits validation through a placebo-controlled study. Given current data, we favor a complete examination of the patient followed by multimodal therapy. In a treatment naive patient, a 2—4 week course of antibiotics is reasonable, but should not be continued if cultures are negative and there is no improvement in Forum Propolis von Prostatitis.
If cultures are negative, we then use a combination of an alpha blocker tamsulosin, alfusozin and anti-inflammatory phytotherapy quercetin and bee pollen, for instance 1 capsule of Q-Urol Farr Labs, Santa Monica CA twice daily for 6—12 weeks. If not successful, we use neuromuscular therapies such as pelvic muscle physical therapy, amytriptiline or gabapentin.
In the minority of patients who do not improve with these therapies, referral to a pain management specialist is appropriate. National Center for Biotechnology InformationU. Ther Clin Risk Manag. Author information Copyright and License information Disclaimer. All rights reserved. This article has been cited by other articles in PMC.
Abstract Chronic prostatitis is a disease with an unknown etiology that affects a large number of men. Keywords: prostatitis, chronic, treatment, management, CPPS. Introduction Chronic prostatitis remains somewhat of an enigma in Urology. Hormonal manipulation The influence of androgen on the development Forum Propolis von Prostatitis the prostate is well known, together with the effects of androgen deprivation.
Treatment approach Given current data, we favor a complete examination of the patient followed by multimodal therapy.
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