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Gruppo Italiano Biopsia Prostatica S. Nicolich, U. Gardini, G. Rocco AULA. Trinchieri, G. Montanari, M. Urologia Casa di Cura S. Anatomia Patologica Osp. Urologia Ville Turro, Osp. Farmacologia Clinica e Epidemiologia Cons. Mario Negri Sud S. Italian Panel on Prostate Biopsy Summary Objective: To develop evidence-based and consensus-based guidelines, helping physicians to take decisions about diagnostic procedures for men wishing to undergo examination for detection of prostate cancer.
Material and methods: A panel Trattiamo la prostatite multidisciplinary Italian experts in urology, medical oncology, laboratory medicine, radiotherapy, pathology and methodologists for clinical trial Mario Negri Institution grouped together in to address specific questions relating to clinical controversies in prostate cancer diagnosis.
A practitioners feedback survey by means of a questionnaire of 49 items was also conducted in to assess the great variability in all the aspects relating a asap prostata my pearsons biopsy PB. Experts reviewed relevant evidence, using CeVEAS scale, of the literature from to December Medline, Embase, Cochrane library before offering the discussion panel proposed guidelines asap prostata my pearsons a given subset of questions. The asap prostata my pearsons panel, asap prostata my pearsons consisted of presenters and representatives from medical oncology, forensic medicine, radiotherapy, ethics, biochemistry and family practice medicine, took place on February 12, in Bologna.
The panel deliberated to reach consensus on suggested guidelines.
When evidence was insufficient, suggested guidelines represent the opinion of a cross-section of the presenters and discussion panel. Results: Consensus was achieved regarding all the aspects relating PB.
The final paper was approved by the jury, the panel of experts and the Prostatite. A standardized guideline, containing a short version for physicians and a standardized patient information booklet, for nation-wide use was developed.
Antibiotic prophylaxis with a fluoroquinolone, which can be omitted in cases of transperineal TP PB, is mandatory when using a transrectal TR approach.
It is necessary to start the prophylaxis the day before and continued for days after the procedure. Anaesthesia is mandatory in case of TP biopsy and strongly recommended in cases of TR PB 10 cc of periprostatic lidocaine injection rather than intrarectal lidocaine gel. The optimal PB scheme should include more than 6 cores preferably cores weighted more laterally and apically. PB directed only to the hypoechoic lesion or standard sextant biopsy Hodge s scheme are considered obsolete.
PB of the transition zone are mandatory only in cases of re-biopsy. A tru-cut needle with a diameter of 18 Fr. PB after radiotherapy is asap prostata my pearsons routinely indicated as well as biopsy of asap prostata my pearsons vesico-urethral anastomosis after radical prostatectomy in patients with PSA failure. Conclusions: The suggested guidelines represent a reasonable diagnostic approach in patients to be submitted to PB, with the understanding that new data, subsequent findings, or other methodological considerations may lead to future modifications.
Esistono inoltre numerose controversie circa i rischi e i
asap prostata my pearsons di una diagnosi precoce e le terapie da effettuare in molti stadi di malattia.
La biopsia prostatica è il metodo migliore per fare diagnosi di cancro prostatico 2, 3. Ciononostante, esistono ancora dei punti controversi, legati in parte al fatto che in genere questo tipo di neoplasia è multifocale e con tale metodica viene campionata soltanto una piccola parte di tessuto.
Inoltre, nei casi in cui non siano presenti lesioni palpabili o evidenziabili tramite le tecniche di imaging, la biopsia viene condotta alla asap prostata my pearsons.
Negli ultimi anni sono state sviluppate diverse metodiche bioptiche, ma in molti casi continuano a persistere dei dubbi riguardo alle corrette indicazioni e alle metodiche da applicare per l prostatite della biopsia. Per esempio, la biopsia a sestanti con 6 prelievi è la tecnica tradizionale, ma negli ultimi tempi è considerata inadeguata e a tutt oggi non è chiaro quale sia il numero adeguato di prelievi da effettuare nel corso della asap prostata my pearsons 4, 5.
Si tratta di un gruppo multidisciplinare composto asap prostata my pearsons tutte le figure professionali che sono coinvolte nei diversi aspetti della procedura in esame e cioè urologi, oncologi, asap prostata my pearsons, anatomopatologi, medici di laboratorio. Una delle prime iniziative del gruppo è stata la asap prostata my pearsons di una survey indirizzata alle figure professionali coinvolte a vario titolo nell esecuzione della biopsia prostatica.
Dall analisi dei risultati è emersa una notevole variabilità di comportamento tra gli operatori sanitari interessati alla procedura in esame, che coinvolge diversi aspetti relativi alla biopsia prostatica.
Sono state infatti evidenziate controversie per quanto riguarda le modalità di preparazione del paziente, le indicazioni alla biopsia, il numero e la sede dei asap prostata my pearsons bioptici e le caratteristiche del preparato istologico.
Le Conferenze di Consenso sono momenti di verifica e discussione in cui le informazioni disponibili su diversi aspetti di una tecnologia sanitaria vengono esaminate criticamente da un gruppo di esperti la Giuria della Conferenza per definire lo stato dell arte e produrre raccomandazioni per l uso nella asap prostata my pearsons clinica 6.
Questo approccio si differenzia rispetto a quelli elencati in precedenza per la maggiore enfasi che viene data all opinione di esperti. A questo asap prostata my pearsons il gruppo di lavoro sulla biopsia prostatica ha tentato di porre rimedio strutturando in modo più rigoroso la fase preparatoria alla conferenza, con particolare riferimento alla valutazione della letteratura scientifica, adottando i criteri di sistematicità, trasparenza asap prostata my pearsons multidisciplinarietà propri della medicina basata sulle evidenze.
Formulazione dei quesiti In base ai risultati della survey, sono stati identificati gli argomenti per i quali c era maggiore prostatite di 1. In questo modo, i principali aspetti problematici relativi all indicazione e all esecuzione della biopsia prostatica sono stati riassunti in 7 quesiti, che spaziano dall indicazione alla biopsia alla preparazione del paziente, alla modalità di esecuzione della biopsia, alle caratteristiche del referto istologico: 1 Quando eseguire la biopsia prostatica Il asap prostata my pearsons valuterà l appropriatezza dell esecuzione della biopsia prostatica in relazione ai reperti obiettivi e ai risultati degli esami strumentali e di laboratorio esplorazione rettale, eco transrettale, dosaggio del PSA e derivati ecc.
Ricerca e analisi sistematica delle fonti Dopo aver identificato i quesiti, si è passati alla fase di recupero delle evidenze scientifiche disponibili, attraverso una revisione della letteratura scientifica, effettuata da esperti in metodologia della ricerca clinica ed epidemiologia del Consorzio Mario Negri Sud. Per assicurare una valutazione completa ed esaustiva delle evidenze scientifiche seppur limitata agli studi di lingua inglesesi è effettuata asap prostata my pearsons ricerca bibliografica asap prostata my pearsons appropriate strategie di ricerca su diverse banche dati elettroniche, quali MedlineEMBASECochrane Library I issue,e manualmente attraverso le bibliografie delle review recuperate.
Per alcune delle referenze selezionate non è stato possibile recuperare l articolo per intero. Queste referenze sono state elencate nella bibliografia, ma non sono state valutate dai gruppi di lavoro. Costoro, dopo un attenta lettura, si sono incontrati, confrontati sulla base delle evidenze raccolte e hanno preparato un documento finale da consegnare alla giuria. Ogni Prostatite contiene: una breve nota metodologica in cui viene riportata nel dettaglio la strategia asap prostata my pearsons ricerca utilizzata e il numero di articoli eleggibili per ciascun quesito; la descrizione delle evidenze derivanti dalla letteratura esaminata; per ognuna delle asap prostata my pearsons scritte viene indicato il riferimento al livello di prova di efficacia e di forza della asap prostata my pearsons secondo lo schema di classificazione delle raccomandazioni messo a punto dal Centro per la Valutazione dell Efficacia Assistenza Sanitaria CeVEAS 7 vedi appendice 1.
Estimates of cancer incidence and mortality in Europe in Eur. The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. Prostate Biopsy Interpretation. When to biopsy and when to stop biopsying. North Am. Biopsy of the prostate - an ongoing evolution. Migliorare la pratica clinica. Come promuovere ed implementare la pratica clinica. Linee guida per il trattamento del tumore della mammella in provincia di Modena.
Tipo di interventi: saranno inclusi studi in cui la DRE, il PSA totale e suoi derivati misurati per valori di PSA totale compresi tra 2 e 4, tra 4 e 10 sono confrontati con lo standard di riferimento biopsia asap prostata my pearsons.
Tipi di misure di esito: sensibilità numero di cancri persi ; specificità numero di biopsie non necessarierapporto di verosimiglianza, caratteristiche clinicopatologiche dei tumori diagnosticati. Asap prostata my pearsons ; Prayer-Galetti, V. Ficarra, R. Franceschini, G. Liguori, P. Martino, R. Al contrario sono disponibili alcune Guidelines" redatte sulla base dell'esperienza e sul parere di esperti.
Dalle linee guida pubblicate non è possibile identificare valori impotenza cut-off per il PSA totale o i suoi derivati definiti univocamente come normali o patologici.
È confermato invece da tutti questi documenti e dagli atti del Prostate Cancer Consensus Conference che la diagnosi di carcinoma prostatico viene posta solo quando vi è la conferma istologica del tumore. Analizzando i lavori selezionati si evidenzia come le indicazioni alla biopsia prostatica si siano progressivamente modificate nel tempo. Negli anni 70 prostatite presenza di un nodulo prostatico palpabile al reperto rettale era la principale indicazione alla biopsia.
Nel corso dei 20 anni presi in esame si sono modificate le modalità di raccolta ed analisi dei campioni sierologici, la tecnologia delle apparecchiature ecografiche, le modalità di esecuzione delle biopsie ecoguidate e le modalità di raccolta e preparazione dei frustoli bioptici. In particolare l utilizzo di schemi bioptici che, nel corso degli anni, hanno incluso un numero sempre maggiore di prelievi per ogni singola seduta bioptica, ha portato, indipendentemente dagli altri asap prostata my pearsons, ad una progressiva riduzione dei falsi negativi alla prima biopsia e di conseguenza ad un incremento delle diagnosi di carcinoma prostatico.
Dall analisi dei lavori valutati si evidenzia inoltre come si sia asap prostata my pearsons nel tempo la qualità metodologica degli studi. Viene definito reperto rettale anormale un aumento di consistenza della ghiandola prostatica associato o meno ad irregolarità della sua superficie o dei suoi margini. D altro canto il prostatite rettale, da solo, non dispone di un adeguata accuratezza diagnostica e va associato al dosaggio del PSA livello di evidenza III A.
Per quale valore di PSA totale è necessario eseguire la biopsia prostatica? A partire dalla biopsia prostatica viene eseguita per valori di PSA totale superiori a 4.
Asap prostata my pearsons parametro risulta essere asap prostata my pearsons affidabile nel porre indicazione alla biopsia prostatica in casi dubbi? La correzione dei valori del PSA per l età non garantisce un accettabile incremento di sensibilità e specificità livello di evidenza IV C.
PSA ratio Il PSA sierico esiste in varie forme, anche se la maggior parte è complessato asap prostata my pearsons inibitori delle proteasi come l alfaantichimotripsina e solo una Prostatite cronica percentuale è presente in forma libera.
La percentuale di PSA libero è più bassa nei soggetti con car- 4. È stato inoltre dimostrato che la sensibilità e la specificità del asap prostata my pearsons tra PSA libero e PSA totale sono indipendenti dall età dei soggetti sottoposti all indagine. Non esiste comunque Prostatite valore di cut off per la PSA ratio generalmente accettato livello di evidenza III B e vi è una tendenza a correlarlo all età dei soggetti in esame livello di evidenza VI C.
PSA velocity Uno dei possibili metodi per rendere più efficiente il PSA totale è quello di usare misurazioni seriate per distinguere le forme benigne da quelle maligne.
Nella prima metà degli anni 90 è stato introdotto il concetto che un incremento del PSA totale superiore a 0. Il razionale di questo approccio è prostatite uomini con carcinoma prostatico avranno un incremento più rapido del PSA rispetto a quelli senza carcinoma prostatico.
I limiti asap prostata my pearsons utilizzo del PSA velocity sono legati alle variazioni inter e intra impotenza nella determinazione dei valori del PSA asap prostata my pearsons alla variazione biologica del valore di PSA totale nei singoli individui livello di evidenza III C. Il valore ottenuto è infatti dipendente dalle variazioni del dosaggio del PSA e asap prostata my pearsons un accurata valutazione ecografia transrettale del volume prostatico.
Color-Doppler mode, tissue harmonic imaging and contrast-enhanced techniques may provide additional information.
Utility Cura la prostatite ultrasound in the evaluation of acute prostatitis might be of clinical interest in the differential diagnosis of parenchymal abscess 31 or in the detection of a significant post-voiding volume, which is an indication for temporary bladder catheterization.
Hyperechoic areas should be described in the ultrasound report because of their clinical significance. The development of a standardized method for a quantitative assessment of such calcification has been advocated. Transrectal images of the prostate acquired with a standard protocol can easily been analyzed using a digital-processing software, able to calculate the extension of calcification area. Open-source software like ImageJ by NIH asap prostata my pearsons of great importance in making the access to this technology easier.
The asap prostata my pearsons between the area of prostatic calcification and the prostate area can be expressed as a percentage. In a recent study it has been demonstrated that asap prostata my pearsons a quantitative-based model, a higher percentage of prostatic calcification is more frequently observed in patients with chronic bacterial prostatitis and is related to worse urinary symptoms The utility of an objective method could be of augmented interest either for researchers and clinician.
De Visschere. T2-WI exquisitely depicts the prostatic anatomy and pathology. DWI provides information about the amount of random movement of water molecules as determined by tissue density and cell organization. In DCE, the prostate is repetitively scanned before and during intravenous bolus injection of contrast agent. MRSI demonstrates the relative concentrations of the cellular metabolites citrate and choline in the prostate. Currently, there is a trend to treat only patients with clinically significant PC.
When Prostatite suspicious lesion is detected on mpMRI, a targeted biopsy can be performed. When mpMRI is normal, it asap prostata my pearsons been asap prostata my pearsons that a biopsy postponed provided that the patient is closely followed upas alternative to systematic biopsies 37but the debate is still ongoing about which strategy should be recommended Interpretation of mpMRI may however be difficult, because every prostate exists of a mixture asap prostata my pearsons histological conditions, which are Trattiamo la prostatite variable in extent and distribution among patients and some of them may mimic PC.
In our own study 36we compared a series of whole-mount radical prostatectomy specimens with the corresponding mpMRI images. Pure normal prostate glands are iso-intense on T2-WI and the high signal intensity areas asap prostata my pearsons cystic atrophy CyA or largegland variant of simple asap prostata my pearsons SA.
On DWI, there is a considerable overlap in imaging characteristics between inflammation and well-differentiated PC The restricted diffusion in peri glandular inflammation may be explained by the high density asap prostata my pearsons inflammatory cells.
Granulomatous prostatitis, a chronic inflammation that may develop after Bacillus Calmette-Guerin therapy for bladder cancer, is a well-known mimicker of PC on mpMRI. A variety of benign conditions may thus mimic PC and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions at mpMRI. It is the challenging role of the radiologist to distinguish this multitude of benign or indolent conditions from aggressive forms of PC.
Alessandra Sensini, Christian Leli Any microorganism virtually can cause prostatitis. Bacteria infect prostate gland by: ascending the urethra, reflux of urine into the prostatic ducts, direct inoculation of bacteria through inserted biopsy needles or hematogenous seeding.
Enterobacteriaceae, especially Escherichia coli, are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role asap prostata my pearsons Enterococci has been reported 42, Many strains asap prostata my pearsons these uropathogens exhibit the ability to form biofilm, which can be responsible of the treatment failure.
Fungal etiology is generally limited to patients with impaired immunity. Sexually Transmitted Infections STI agents, in particular Chlamydia trachomatis, have been also considered as causative pathogens of chronic bacterial prostatitis Due to the improvement of diagnostic technologies, recent studies supported the etiologic role of Mycoplasma genitalium, a cell wall-deficient small bacterium belonging to the Mycoplasmataceae family, as a true causative pathogen of STI and possibly of prostatitis.
Miglior integratore prostatico 2020
Under the designation "Genital Mycoplasmas" are included other species, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum. They are considered commensals of the lower female genital asap prostata my pearsons, indeed are frequently recovered from genital samples in asymtomatic subjects.
Their effective role in genital diseases asap prostata my pearsons both women and men is still a much debated issue. The midstream specimen of urine MSU is the sample of choice to test in acute bacterial prostatitis. In presence of clinical signs suggestive of a blood-stream infection, impotenza blood culture should be taken.
Linee Guida Biopsia Prostatica.
The traditional Meares-Stamey 4glass test is recommended for the diagnosis of chronic bacterial prostatitis. The 2-glass test also called Nickel test is an acceptable alternative. The analyses of data collected by a questionnaire sent to italian urologists showed that a higher number of seminal fluid cultures asap prostata my pearsons Meares-Stamey test were performed for diagnosis of chronic bacterial prostatitis.
Semen culture is not recommended by the European guidelines because of low specificity due to possible contamination by urethral and skin bacteria. Moreover, a diagnostic cut-off in colony count for symptomatic patients has not been determined. Semen culture can be used for diagnosis in addition to Meares-Stamey test as 5th glass and results compared to the other samples. If used alone, it should be Archivio Italiano di Urologia e Andrologia ; 90, 4. Sexually Transmitted Infections agents should be investigated by molecular methods test of choice in asap prostata my pearsons patient and sexual partner.
In conclusion, the microbiological examination of the seminal fluid may present a useful integration of the impotenza of the Meares-Stamey test.
The possible diagnostic role of the microbiological examination of the seminal fluid is still controversial, due to the possible contamination of the fluid in the urethral passage and the presence of secretions from accessory glands seminal vesicles, bulbo-urethral glands of Cowper and urethral of Litrrè. The EAU guidelines 19 exclude asap prostata my pearsons use of semen culture in the diagnosis of chronic prostatitis, although the recommendation strength is weak, and the PERG 20 does not mention this test.
Furthermore, Stamey himself 1 has asap prostata my pearsons that semen cultures may be likely reliable for the identification of Gram negative infections and other authors have considered the use of this investigation if associated with a collection of urine VB1 first voiding and VB2 midstream or when it is not possible to obtain the expressed prostatic secretion EPS sample with prostate massage 50, In our experience in These data agree with a previous study that showed that the semen examination is positive in This observation confirms what was said by Nickel 53 that observed that the culture of the seminal fluid increased the number of patients classified as category II, even in the absence of precise evidence of the literature and data that demonstrate Trattiamo la prostatite clinical improvement after antibiotic treatment of patients with positive culture of seminal fluid.
Subsequently, however, asap prostata my pearsons numerically consistent studies impotenza, 55 have confirmed that the examination of the seminal fluid may be a good indicator of prostatic infection when the semen asap prostata my pearsons analyzed. Chronic bacterial prostatitis CBP is diagnosed by clinical symptoms and microbiological analysis by using biological samples from Meares-Stamey test; treatment with appropriate antibiotics is usually prescribed, in line with the European Association of Urology EAU guidelines Several times, fluorquinolones are considered drugs of choice to treat patients with CBP, regardless of a bacterial isolation.
Antibiotic treatment usually improves the clinical symptoms, although short-term recurrences are reported frequently The role of biofilm-producing bacteria in development of acute and chronic prostatitis have been recently discussed. Bacteria living in a biofilm usually have significantly different properties compared with free-floating bacteria planktonic of the same species, as the dense and protected environment of the film allows them to interact in various ways They benefit in this environment by an increased resistance to antibiotics, as asap prostata my pearsons dense extracellular matrix and asap prostata my pearsons outer layer of cells protect the interior of the community.
Moreover, it is well demonstrated that biofilm persisting bacteria, which are usually asap prostata my pearsons to tissue surfaces through their own fimbriae and slime, represent the main limitation of antibiotic efficacy and the potential site of short-term infection recurrences. Recently, Bartoletti and Cai demonstrated that biofilm-producing bacteria were commonly found in CBP patients and had a significant negative impact on the clinical response to antibiotic therapy Moreover, they demonstrated that the relief asap prostata my pearsons symptoms seemed to be much more inversely related to the bacterial biofilm production than to apparent negative microbiological tests after treatment.
On the other hand, Cai et al. In this sense the role of prostate calcifications should be reconsidered. Prostate calcifications are not only a sonographic sign of. The presence of a bacterial biofilm represents a chronic inflammatory stimulus that could lead to the development of symptoms related to the grade of inflammation and the immune response of the asap prostata my pearsons.
In the case of high-grade inflammation, the patient could report urinary or pelvic pain. The fluctuating symptomatology reported by the majority of patients might be explained prostatite variation in the inflammatory response to the development and maturation of the bacterial biofilm The antibiotic treatment is probably effective in mitigating the grade of the infection but is not fully effective in eradicating the bacterial biofilm.
Future studies should be designed to explore whether effective eradication of the bacterial biofilm could be associated with a good medium- and long-term clinical outcome of treatment. CBP is a very common and highly bothersome urologic condition. It remains poorly understood 14, 60, Despite progress in its management, many cases Prostatite undertreated and a significant number relapse.
The reasons Prostatite cronica practically unknown and include host, bacterial and treatment-related factors. Inappropriate treatment, incomplete treatment and increased resistance of responsible bacteria to antibiotics have been proposed to contribute most While the two first conditions can be easily rule out, the hypothesis of alteration of drug resistance patterns of responsible bacteria remains asap prostata my pearsons unclarified.
We planned a study to retrospectively investigate the resistance of microbes to antibacterials in patients with chronic bacterial prostatitis that had as secondary objective to determine whether the resistance of pathogens increases in patients with Asap prostata my pearsons recurrence.
Patients underwent the Meares-Stamey test a few cases underwent the 2-glass test. Depending on asap prostata my pearsons history and specific symptoms, urethral smear and sperm cultures were additionally obtained from asap prostata my pearsons patients. Those presenting with febrile prostatitis were investigated by a midstream specimen of urine culture MUC only. Samples from patients diagnosed with chronic prostatitis for the first time were compared with those of patients with a history of chronic prostatitis and previous antibiotic treatment.
Given that no standard cut-off level of. Recorded demographical data and medical history of the patients were revised: patients suffering from conditions affecting either bacterial virulence or host response eg. The accepted level of significance in this study was 0. The locally appointed Ethics Committee approved the research protocol.
These cases were excluded from the study. The remaining out of bacterial isolates diagnosed as CBP finally consisted the material of the study. The most frequent pathogen -in both groups was E. Of note, bacterial frequencies were similar in both groups A and B Table 2 in Supplementary Materials. Regarding clinical relapses, pathogens most commonly associated were Enterococcus faecalis, Staphylococcus CoN and E coli.
The mean time interval between chronic prostatitis relapses was In sperm cultures, in asap prostata my pearsons groups, the most frequent isolate was Enterococcus faecalis 13 and 8 respectively. Generally, a relatively increased resistance to quinolones was observed and a sufficient degree of susceptibility to the least used antibiotics TMP-SMX, tetracyclines, aminoglycosides, penicillins, and asap prostata my pearsons Table 5 in Supplementary Archivio Italiano di Urologia e Andrologia ; 90, 4.
In some cases cross resistance between ciprofloxacin and newest quinolones was not observed.
The nature of this study explain the high rate The low number of assessable EPSs in this study may indicate the need of better preparing e. In confirmation to the above, the number of assessable EPSs in Group B was greater probably because of the familiarization of patients of Group B with the examination process.
The proportion of Gram-positive isolates in the current study is high. The reason explaining the above fact is unknown however it may be associated with asap prostata my pearsons better understanding of the role of Gram-positive bacteria in the asap prostata my pearsons of the disease and the consequent awareness of clinicians and laboratory assistants. The interpretation of this finding is twofold: on one hand it is possible that repeated antibiotic treatment reveals participating microbial members of prostate biofilm and in the other hand may suggest a chronic decline of the immune system function.
Our finding of increased resistance to quinolones has been previously described. Combined with the finding of sufficient degree of susceptibility to the least used antibiotics this fact can be easily attributed explained by the over-prescription of quinolones in our country. High resistance rates of Enterococci strains may reflect its intrinsic resistance to antibiotics.
Asap prostata my pearsons note, differences in susceptibility between Enterococci strains in monomicrobial isolates and polymicrobial isolates may be explained by genomic interactions. Notably, the coexistent urethral infection found in patients of both groups indicates the continuity of the infection of the genitourinary tract system4. In addition, the fact that the findings from sperm cultures were comparable to those of EPS and post PM cultures supports the supplementary role of sperm cultures to the MearesStamey test.
Finally, the wide variation in the number of colonies, the presence of different microorganisms in the same culture as well as the presence of CoN Staphylococcus, strengthen the newer appreciation of chronic prostatitis as a biofilm disease. In conclusion, given the regional variation of the distribution of uropathogens and their susceptibility pattern to antibiotics, knowledge of the susceptibility of causative microorganisms to various antibiotics is necessary in order to asap prostata my pearsons the optimal treatment thus providing better eradication rates and make the creation of drug-resistant strains less likely.
Chronic bacterial prostatitis CBP is a clinical entity defined by the isolation of bacteria in the asap prostata my pearsons secretion that according to National Institutes of Health.
The use of sequential bacteriologic localization cultures represents the most accurate method for diagnosing CBP. The most common organism associated with CBP is Escherichia coli, although infections with Klebsiella, Enterobacter, Proteus, Pseudomonas, and enterococci have also been documented In CBP patients biofilm-producing bacteria were frequently demonstrated as an explanation of the unsatisfactory response to antibiotic therapy Antimicrobials are the first line agents for the treatment of CBP asap prostata my pearsons The success of antimicrobial treatment of chronic bacterial prostatitis depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations at the site of infection, that is prostate secretion and prostate tissue The asap prostata my pearsons molecules reach greater concentrations in the plasma pH 7.
Beta-lactam drugs have a low pKa and poor lipid solubility, asap prostata my pearsons thus penetrate poorly into prostatic fluid; macrolides, tetracyclines and trimethoprim are bases showing excellent penetration into prostatic fluid and tissue. Fluoroquinolones are amphoteric and have a more complex behavior acting either as zwitterions or neutral molecules depending on the medium. Experimental results in the dog confirm this tendency Table 1 in Supplementary Materials.
Experimental animal studies are not easily transferred to the human clinic because the pH of the prostatic secretion in humans is less acidic and it is increased in chronic prostatitis. Evaluation of tissue concentrations of antimicrobials measured on samples coming from endoscopic prostate resections after antibiotic administration confirms the good penetration of fluoroquinolones in prostatic tissues Table 2 in Supplementary Materials.
Clinical results of antibiotic treatment in CBP Before there are only few randomized studies on the use of non-quinolone drugs in the treatment of CBP, the studies are underpowered so it is difficult to draw conclusions on the effectiveness of these treatments Table 3 in Supplementary Materials. Tetracyclines, especially doxycycline asap prostata my pearsons minocycline, and macrolides have been extensively used to treat CBP.
Fluoroquinolones are generally well tolerated but In Cura la prostatite patients prolonged use of quinolones may be contraindicated due to potential adverse effects in presence of various contraindications history of tendonitis or long Trattiamo la prostatite syndrome.
Randomized clinical trials The meta-analysis of Perletti et asap prostata my pearsons. Prostatite concluded that for the treatment of traditional pathogens the different fluoroquinolones used in the treatment of CBP have equal microbiological and clinical efficacy.
The rate of adverse events of treatment also appeared to be equivalent. On the contrary, for the treatment of Chlamydial prostatitis macrolides were shown to be more effective than fluoroquinolones, both microbiologically and clinically. No differences were observed in microbiological and clinical efficacy and adverse effect between macrolides and tetracyclines for the treatment of patients with CBP caused by intracellular pathogens, both Chlamidial asap prostata my pearsons Mycoplasma Table 5 in Supplementary Materials.
Asap prostata my pearsons antibiotic regimens The increased emergence of bacterial resistance and the decline in newly developed antibiotics are limiting the armamentarium for the treatment of CBP. Aminoglycosides diffuse in the prostatic tissue and fluids although less than other antibiotics and in previous years, some aminoglycosides, such as kanamycin and streptomycin were successfully used in small series of patients with CBP.
Genetic testing of patients for mutations predisposing to sensorineural deafness allowed safer administration of aminoglycosides. Orally absorbed fosfomycin trometamol has also been proposed for the treatment of CBP because of its good penetration in prostatic impotenza. Fosfomycin was administered orally 3 grams every 48 or 72 hours for periods of 2 to 6 weeks, although in some critical cases it was administered for longer periods of up to 16 weeks.
An another option to improve the success rate of antibiotic treatment of CBP is the association of two antibiotics.
Asap prostata my pearsons particular, macrolides can be associated with quinolones to exploit their ability to reduce biofilms growth. Combination treatment of ciprofloxacin and azithromycin showed a Combination treatment showed high eradication rates of infection by both traditional uropathogens and unusual pathogens.
Locally injected antimicrobial drugs Local injection of antibiotics into the prostate has been reported to be asap prostata my pearsons although no RCT validated this modality of treatment The potential advantage of direct injection into the prostate should be to bypass the prostatic capsule to allows use of antimicrobials that are asap prostata my pearsons easily concentrated in the prostatic tissue after oral administration.
Small case series showed encouraging results and a small RCT 50 men with prostatic secretions sensitive to amikacin demonstrated that anal submucosal injection of amikacin for 10 days significantly improved clinical and bacteriological cure rate at 3 months in comparison with intramuscular injection for the same period.
Adjuvant treatment with herbal products and probiotics few RCTs on adjuvant treatment with herbal products mainly Serenoa repens extract and probiotics have been published Table 7 in Supplementary Materials The combination treatment was able to improve the clinical and in some studies the microbiological efficacy of prulifloxacin in patients affected asap prostata my pearsons CBP. In patients with CBP and irritable bowel syndrome a prolonged treatment with rifamixin and probiotics was effective in lowering the progression of prostatitis into more complicated forms of male accessory gland infections.
However a minimum duration of antibiotic treatment of 4 weeks should be considered. Chronic oral antibiotic suppression has been proposed to reduce or eliminate bacterial growth in the urine in order to limit the urinary symptoms asap prostata my pearsons the disease. A chronic suppression approach only mandates adequate Archivio Italiano di Urologia e Andrologia ; 90, 4. Low-dose trimethoprim 50 or mg once dailytrimethoprim-sulfamethoxazole 40 and mg once dailyand nitrofurantoin 50 or mg once daily are remarkably effective for this purpose.
Enterobacteriaceae are the most common cause of either acute or chronic prostatitis. Resistance to fluoroquinolones, considered the drug of asap prostata my pearsons for the management of prostatitis, has been increasing since These enzymes are frequently associated with the expression of additional genes harboring resistance to other antimicrobial classes, such as fluoroquinolones and aminoglycosides Treatment asap prostata my pearsons acute and chronic bacterial prostatitis represents always a challenge, as only few antimicrobials Prostatite therapeutic concentrations in the prostate High lipid solubility, a low degree of ionization, a high dissociation constant pKa, allowing diffusion of the unionized component into the prostatelow protein binding, and small molecular size enhance molecular penetration within prostate Only a limited number of agents adopted for infections due to multi-drug resistant MDR gram-negative bacteria showing asap prostata my pearsons to at least three different classes of antimicrobials have these characteristics In some cases, even if limited pharmacokinetic data available, they have been described to be effective in treating prostatitis In all other cases, especially in chronic prostatitis, antimicrobial treatment should be guided by drug susceptibility test DST.
Whenever possible outpatient treatment should be preferred, but the majority of antibiotics for MDR bacteria require parenteral administration. Studies on site-specific pharmacokinetic and pharmacodynamic of piperacillin-tazobactam and meropenem justify their administration in susceptible asap prostata my pearsons prostatitis 74, Prostate tissue penetration of colistin has not asap prostata my pearsons studied and should possibly not be used. Tigecycline undergoes minimal urinary asap prostata my pearsons and is asap prostata my pearsons not considered the first choice for susceptible MDR gram-negative bacteria in urinary tract infections.
Nevertheless, few case reports describe the utilization of tigecycline in susceptible strains, with variable clinical and microbiological outcomes So far, Fosfomycin seems the most interesting drug for its susceptibility profile, prostate penetration and availability of oral administration. In patients. Ceftolozane-tazobactam and ceftazidimeavibactam are two novel drugs which have been introduced for the management of MDR gram-negative infections.
At the moment, there are no data on their utilization and penetration in prostate tissues. However, based on previously available data on cephalosporins prostate penetration, both are unlikely to be considered the primary choice in prostate infections, but further studies are needed to assess their possible role in this clinical setting. The problem of antibiotic resistance asap prostata my pearsons some questions.
In the 40s, shortly after the introduction of the antibiotic into the therapeutic armamentarium of the clinicians, there appeared the first bacterial resistance. From the 60s onwards it has been a progressive and constant increase of antibiotic resistances that has been overcome with the use of new molecules that were periodically synthesized and marketed.
In the last decades it is no longer like that. The antibiotic resistance is still increased and many bacterial strains also became multi-resistant to various antibiotics This modification of the bacterial ecosystem has been accompanied by progressive abandonment of the research for new anti-infective by most pharmaceutical companies.
Meanwhile the ecosystem has further changed and not only for the use and abuse of antibiotic therapy in the human field but also for the spread in the veterinary, zootechnical and aquaculture sectors.
All this brought to recent finding of infections related to bacteria that are less sensitive to antibiotics available and always more often multi-resistant, if not even resistant to all the antibiotics tested and available. At this point the diffusion of bacterial resistance has so spread to make the phenomenon no longer a problem limited to some clinical cases to asap prostata my pearsons treated in hospital but a global threat that we have to considered asap prostata my pearsons a public health problem.
In this last decade, in particular, it has started a run to find solutions at least so hopefully. The alternative is a return to the pre-antibiotic era when there were no suitable drugs to treat most infections. Of course, now there are the alarms of the scientific and health world to combat the phenomenon but the reaction of the political authorities and civil society is still ongoing.
Everyone agrees for this global and synergistic action at world and national level promoting a collaborative and inter-sectorial commitment among the various operators of human and veterinary medicine, agriculture and food production and consumers. It is crucial to increase the level of awareness that a prudent and responsible use of antibiotics is necessary in asap prostata my pearsons to counteract antimicrobial resistance that is a growing threat involving.
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