Diagnosis and treatment of prostatitis (prostate inflammation)
For this there are after analyzing many studies by a group of experts clear guidelines.They were presented in an overview of the currently inadequate evidence for prostate inflammation on the German Association of Urology congress in 2006.
The prostatitis is (Bethesda, United States National Institute of Health) divided as follows according to NIH:
- I: Acute bacterial prostatitis
- II: Chronic bacterial prostatitis
- III: Chronic pelvic pain syndrome (engl. chronic pelvic pain syndrome, CPPS); IIIa-inflammatory, non-inflammatory CPPS IIIb
- IV: Asymptomatic prostatitis (inflammation without signs of disease)
Diagnostics
The acute and chronic bacterial prostatitis can be diagnosed on the basis of the seed detection in urine and prostatic fluid. Serve this purpose, the four-glass test (see urine tests ) or a Two glasses sample of midstream urine and urine after prostatic massage. A sole sperm-examination is not enough.
In chronic pelvic pain syndrome (CPPS) is detected and one first evaluates the complaints with a standardized questionnaire, the NIH-CPSI (NIH chronic prostatitis symptom index). Then we examine the urine, prostatic fluid and possibly sperm on inflammatory cells (leukocytes) to distinguish between inflammatory and non-inflammatory CPPS. The determination of residual urine and urine flow (urine flow) is recommended, but not the routine use of methods to search for difficult to detect pathogens, endoscopy ("mirroring"), TRUS (see transrectal ultrasound ) and other special investigations.
Therapy
In acute bacterial prostatitis until proof of the seed and its susceptibility test to antibiotics Experience has shown that a potent, broad-spectrum antibiotic in high dose is given into a vein.
In chronic bacterial prostatitis, however, it is advisable to antibiotic treatment with so-called fluoroquinolones in tablet form over 4-6 weeks. The success rate is 60-76%, a combination with alpha-blockers (reduce muscle tension in the prostate and bladder neck) to increase the effectiveness.
For the treatment of CPPS different medications are eligible (see chronic prostatitis ). Very few of them were not so far been tested in trials against placebo (a dummy treatment). For a general recommendation is to ask, however, that the drugs are more effective than placebo.Because it is known that this very well help with CPPS symptoms.
For a treatment of asymptomatic prostatitis, there is no recommendation. Discussed antibiotic therapy only in special cases (eg PSA increase).
Further studies
9% of all men suffer from moderate to severe signs of prostatitis, in severe even under considerable discomfort when urinating. This is the result of a study in which 1759 men CPSI questionnaire (to prostatitis symptoms) and the IPSS questionnaire (to discomfort with urination, see IPSS in the lexicon) had filled out. The incidence increased with age: 5.4% (20-30 years), 6.3% (31-40 years), 8.5% (41-50 years), 11.7% (51-70 years ), 13% (71-80 years).Other risk factors could not be identified.
The germ proof and thus the targeted antibiotic therapy are often difficult to treat prostate disorders and also Harnweginfekten. They can be potentially speed up with a new method and improve: Known nuclei are analyzed with a special mass spectrometry. In this case, each seed is a characteristic protein pattern is stored in a database. On the basis of this pattern in the future to identify nuclei are in the urine may quickly and clearly.
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