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Nature Reviews. Urology Jan 2014
Review
Topics: Humans; Laser Therapy; Male; Prostate; Prostatectomy; Prostatic Hyperplasia; Prostatism
PubMed: 24296708
DOI: 10.1038/nrurol.2013.288 -
Schweizerische Medizinische... May 1956
Topics: Disease; Humans; Male; Prostate; Prostatic Diseases; Prostatism; Radiography; Urethra
PubMed: 13337235
DOI: No ID Found -
Infectious Diseases (London, England) 2018Infectious complications after transrectal prostate biopsy are rare. Nevertheless, since these are frequent procedures, the burden of infectious complications is high.... (Meta-Analysis)
Meta-Analysis Review
A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis.
BACKGROUND
Infectious complications after transrectal prostate biopsy are rare. Nevertheless, since these are frequent procedures, the burden of infectious complications is high. Considering the increasing antimicrobial resistance, microbiological confirmation is important to guide antimicrobial therapy.
METHODS
We reviewed PubMed for original studies providing concurrent urine and blood culture data in symptomatic patients with transrectal biopsy-related infectious complications. We performed a proportions meta-analysis (with MedCalc) and calculated the pooled yield of urine and blood cultures and the pooled discordance rate between urine and blood cultures.
RESULTS
Our review identified 41 studies, involving 852 patients with infectious complications after transrectal prostate biopsy and sufficient data to calculate discordance. The pooled yield of urine cultures was 64.6% (95% CI: 56.2-72.3%, I 83%), the pooled yield of blood cultures was 43% (95% CI: 36.5-49.7%, I 74%) and the pooled discordance rate was 14% (95% CI: 10.6-17.8%, I 53%). In subgroup analyses the pooled discordance was; 19.6% (95% CI: 11.8-28.9%, I 31%) in 113 patients presenting within 2 calendar days after the biopsy and 11.2% (95% CI: 4.5-20%, I 47%) in 143 patients presenting with fever and symptoms of lower urinary tract symptoms. The statistical and methodological heterogeneity of included studies was high.
CONCLUSION
Obtaining blood cultures is reasonable in all patients presenting with systemic symptoms suggestive of infection after a transrectal prostate biopsy. Blood cultures can provide additional microbiological data in about 1 of 7 patients with post-biopsy infectious complications. Prospective studies are needed to validate these results.
Topics: Biopsy; Blood Culture; Humans; Male; Postoperative Complications; Prostate; Prostatitis
PubMed: 30372643
DOI: 10.1080/23744235.2018.1508882 -
International Urology and Nephrology Mar 2010Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple)... (Review)
Review
Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes--strategies--biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: "diagnostic TURP"; "elevated PSA"; and "prostate biopsy". Furthermore, subsequent reference search was executed on retrieved articles.
Topics: Algorithms; Biopsy; Humans; Male; Prostate; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatism; Severity of Illness Index
PubMed: 19496018
DOI: 10.1007/s11255-009-9596-z -
European Urology Jul 2016Several preclinical reports, randomized controlled trials, systematic reviews, and posthoc analyses corroborate the role of phosphodiesterase type 5 inhibitors (PDE5-Is)... (Review)
Review
CONTEXT
Several preclinical reports, randomized controlled trials, systematic reviews, and posthoc analyses corroborate the role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of men with lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE).
OBJECTIVE
Update of the latest evidence on the mechanisms of action, evaluate the current meta-analyses, and emphasize the results of pooled data analyses of PDE5-Is in LUTS/BPE.
EVIDENCE ACQUISITION
Literature analysis of basic researches on PDE5-Is, systematic literature search in PubMed and Scopus until May 2015 on reviews of trials on PDE5-Is, and collection of pooled data available on tadalafil 5mg.
EVIDENCE SYNTHESIS
Latest evidences on the pathophysiology of LUTS/BPE has provided the rationale for use of PDE5-Is: (1) improvement of LUT oxygenation, (2) smooth muscle relaxation, (3) negative regulation of proliferation and transdifferentiation of LUT stroma, (4) reduction of bladder afferent nerve activity, and (5) down-regulation of prostate inflammation are the proven mechanisms of action of PDE5-Is. Data from eight systematic reviews demonstrated that PDE5-Is allow to improve LUTS (International Prostate Symptom Score mean difference vs placebo: 2.35-4.21) and erectile function (International Index of Erectile Function mean difference vs placebo: 2.25-5.66), with negligible change in flow rate (Qmax mean difference vs placebo: 0.01-1.43). Pooled data analyses revealed that tadalafil 5mg once daily allows the clinically-meaningful improvement of LUTS and nocturnal voiding frequency independent of both erectile dysfunction severity and improvement.
CONCLUSIONS
PDE5-Is are safe and effective in improving both LUTS and erectile function in appropriately selected men with LUTS/BPE. Data on the reduction of disease progression, long-term outcomes, and cost-effectiveness analyses are still lacking.
PATIENT SUMMARY
We reviewed recent literature on phosphodiesterase type 5 inhibitors in men with lower urinary tract symptoms associated with prostatic enlargement. We found evidence to confirm that phosphodiesterase type 5 inhibitors are a valid treatment option for men affected by bothersome urinary symptoms with or without erectile dysfunction.
Topics: Afferent Pathways; Animals; Cell Proliferation; Cell Transdifferentiation; Erectile Dysfunction; Humans; Male; Muscle Relaxation; Muscle, Smooth; Penile Erection; Phosphodiesterase 5 Inhibitors; Prostatism; Prostatitis; Urinary Bladder; Urinary Tract Physiological Phenomena
PubMed: 26806655
DOI: 10.1016/j.eururo.2015.12.048 -
The Journal of Urology Jul 1950
Topics: Black People; Humans; Male; Prostate; Prostatism
PubMed: 15429171
DOI: 10.1016/S0022-5347(17)68610-5 -
Prostate Cancer and Prostatic Diseases Feb 2022According to current studies, COVID-19 might have an impact on semen quality. Therefore, SARS-CoV-2 may affect other traits of male reproductive system, including the...
According to current studies, COVID-19 might have an impact on semen quality. Therefore, SARS-CoV-2 may affect other traits of male reproductive system, including the prostate. Thus, we recruited patients who experienced COVID-19 infection in-between prostate biopsy and radical prostatectomy and compared prostate samples inflammation, measured with IRANI score, to those who did not. Indeed, we recruited 20 patients, aged 69 (62-73) years, finding no difference between the 10 patients with COVID-19 infection and the others in IRANI score and all its sub-scores. Hence, according to our exploratory and limited results, COVID-19 infection might have no gross effect on prostate inflammation.
Topics: COVID-19; Humans; Inflammation; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Prostatitis; SARS-CoV-2; Semen Analysis
PubMed: 35422100
DOI: 10.1038/s41391-022-00542-5 -
Recenti Progressi in Medicina 2005The Prostatic Specific Antigen (PSA) is one of the best tumour markers currently available, and it is widely employed in the diagnosis and follow up of prostate cancer.... (Review)
Review
The Prostatic Specific Antigen (PSA) is one of the best tumour markers currently available, and it is widely employed in the diagnosis and follow up of prostate cancer. Nevertheless, it is not specific for prostatic carcinoma, and an increase in its serum levels can also be related to benign prostatic hyperplasia, inflammation/infection or traumatic manoeuvres on the prostatic gland. Because of its well-known clinical features acute prostatitis does not require PSA evaluation for diagnosis, but other prostatitis (such as category IV NIH prostatitis) can be responsible of an increase in PSA levels without associated symptoms. Category IV prostatitis has a fairly high prevalence, affecting about one third of the adult males. Recently some studies have showed that approximately half of the patients with PSA levels in the grey zone and without symptoms of prostatitis undergo a decrease in PSA levels after a 2-4-week treatment with antibiotics. Thanks to this approach, 20-30% of the patients obtain PSA normalization and consequently avoid prostatic biopsies. In conclusion, the use of antibiotic treatment allows an increase in PSA specificity and a decrease in the number of unnecessary prostatic biopsies. The cost-benefit ratio of this approach has to be verified by means of prospective randomized trials.
Topics: Anti-Bacterial Agents; Biomarkers, Tumor; Biopsy; Humans; Male; Predictive Value of Tests; Prostate; Prostate-Specific Antigen; Prostatitis
PubMed: 16209120
DOI: No ID Found -
The Prostate Mar 2019Trichomonas vaginalis (T. vaginalis) is the most common sexually transmitted parasite. It has been detected in prostatic tissue of patients with prostatitis and reported...
BACKGROUND
Trichomonas vaginalis (T. vaginalis) is the most common sexually transmitted parasite. It has been detected in prostatic tissue of patients with prostatitis and reported to be associated with chronic prostatitis and benign prostatic hyperplasia as well as prostate cancer. Recently, experimental rodent models of prostatitis induced by pathogen infection have been developed. However, there have so far been no reports of prostatitis caused by T. vaginalis infection in animals. Here, we investigated whether infection with T. vaginalis via the rat urethra could cause prostatitis.
METHODS
T. vaginalis was injected into prostate through urethra of rat (Wistar rats), and the rats were killed 1, 2, or 4 weeks later. The presence of T. vaginalis trophozoites in the rat prostates was examined by immunohistochemistry, and pathological changes of the prostate were observed by hematoxylin-eosin staining and evaluated by grading from 0 to 5 for inflammatory cell infiltration, acinar changes, and interstitial fibrosis. Infiltrated mast cells were observed by toluidine blue staining of rat prostate tissue. Chemokine C-C motif ligand 2 (CCL2) levels of the rat prostates were measured by ELISA.
RESULTS
T. vaginalis trophozoites were observed in acini in the prostates of the injected rats. The prostate tissues had higher pathological scores, and 83% (5/6) and 100% (6/6) of the ventral and dorsolateral lobes (nā=ā6), respectively, were inflamed. Infiltration and degranulation of mast cells were observed at higher rates in prostate sections of the T. vaginalis-infected rats. Also, prostate tissues of the injected rats had increased CCL2 levels.
CONCLUSIONS
Injection of T. vaginalis in rats caused prostatitis as revealed by pathologic changes, mast cell infiltration and increased CCL2 production. Therefore, this study provides the first evidence that T. vaginalis infection in rats causes prostatitis.
Topics: Animals; Chemokine CCL2; Male; Prostate; Prostatitis; Rats; Rats, Wistar; Trichomonas Infections; Trichomonas vaginalis
PubMed: 30488471
DOI: 10.1002/pros.23744 -
The Urologic Clinics of North America Nov 1989Transrectal prostatic ultrasound is a minimally invasive, painless investigation that provides objective data on the topography of the prostate. Prostatitis is a... (Comparative Study)
Comparative Study
Transrectal prostatic ultrasound is a minimally invasive, painless investigation that provides objective data on the topography of the prostate. Prostatitis is a condition difficult to diagnose in view of its varied symptomatology and lack of physical signs. The diagnosis currently rests on the finding of excessive numbers of leukocytes in the prostatic secretion obtained during the Stamey localization procedure. Seven ultrasound features having a significant correlation with a diagnosis of prostatitis have been identified: high-density and mid-range echoes, echo-lucent zones, capsular irregularity and thickening, ejaculatory duct echoes, and periurethral-zone irregularity. Ultrasonography confirms the focal nature and frequent peripheral-zone location of inflammatory prostate disease. Follow-up ultrasound studies over a short period showed that the echo-lucent zones may resolve to normal, mid-range, or high-density echoes in conjunction with a fall in the leukocyte count in expressed prostatic secretions. The ability to place a biopsy needle accurately under ultrasound control has enabled histologic assessment of the parenchymal features. The high-density echoes represent corpora amylacea; the mid-range echoes, inflammation, fibrosis, or both; and the echo-lucent zones, inflammation. The low specificity of mid-range and high-density echoes (51.9 and 40.7 per cent) and the low sensitivity (range 30.8 to 62.3 per cent) of the remaining five ultrasound features of prostatitis preclude identification of any one feature as being diagnostic of this condition. A possible exception may be the finding of echo-lucent zones, which may also prove useful in the monitoring of response to treatment. The detection of several signs within an individual's prostate suggests a diagnosis of chronic prostatitis, whereas a normal scan in a patient with symptoms of prostatitis is highly suggestive of prostatodynia.
Topics: Adult; Aged; Chronic Disease; Humans; Male; Middle Aged; Prostate; Prostatitis; Sensitivity and Specificity; Ultrasonography
PubMed: 2683305
DOI: No ID Found