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In 1995, the NIH-NIDDK defined four categories of prostatitis: Category 1, acute bacterial prostatitis; Category 2, chronic bacterial prostatitis; Category 3, chronic abacterial prostatitis/chronic pelvic pain syndrome; and Category 4, asymptomatic prostatitis (diagnosed only histologically). Among the symptomatic forms of prostatitis, Category 3 is by far the most common, representing over 90 % of all cases. This form of “prostatitis” is misnamed and therefore, frequently misdiagnosed and inappropriately treated. It should be correctly referred to only as chronic pelvic pain or pelvic pain syndrome. While this chapter includes discussion of all four categories of prostatitis, most of this chapter will be dedicated to the most common and most challenging, chronic pelvic pain syndrome. Because it represents a form of muscle dysfunction and/or a functional somatic syndrome, a non-urological perspective is included.

Health screening regimens are a form of secondary prevention of a disease or its serious or fatal sequelae. Cancer screening is intended to diagnose malignant or premalignant conditions while still curable and usually before the development of signs or symptoms. However, all cancer screening tests, including those for genitourinary (GU) cancers, must meet certain ethical and economic criteria, and most certainly must possess a meaningful positive predictive value. Based on such criteria, the US Preventive Task Force does not currently endorse prostate specific antigen (PSA) for prostate cancer screening, nor does it endorse screening for bladder cancer. To date there has never been a widely recognized screening protocol for Kidney or Testicular Cancers. Nevertheless, primary care physicians need to be aware of current debate regarding GU cancer screening, particularly prostate cancer screening. This chapter will summarize the pros and cons of prostate cancer screening and outline the diagnostic tests for other GU malignancies, which should be considered among high-risk patients. Predisposing factors and risks will be included in the bladder and kidney cancer screening sections and more briefly in the testicular cancer section. The content of this chapter will enhance the practice of shared decision making in the primary care setting.

Various types of urinary tract infections (UTIs) affecting specific patient populations are addressed in several other chapters of this book, within the context of a respective theme. This chapter addresses UTI in general, with an expanded focus on recurrent infections in women and complicated infections in patients with neurological disorders, those who require urinary catheterization or who are in an immunocompromised state. Sexually transmitted infections of the urethra and vagina are also discussed. The intent of the authors is to raise awareness regarding types of infections occurring in diverse patient populations and to enhance evaluation the evaluation skills of health-care providers by broadening the differential diagnosis. Judicious use of antibiotics is emphasized to avoid antibiotic overuse, a current serious public health concern.

Genitourinary pain and inflammation : , Genitourinary pain and inflammation : , کتابخانه دیجیتال جندی شاپور اهواز

NIH Category III chronic prostatitis/chronic pelvic pain syndrome is associated with neuromuscular abnormalities as manifested by pain, voiding, and sexual dysfunction. With techniques adopted from physical therapy, these abnormalities can be more readily identified and treated. Techniques such as biofeedback, myofascial trigger point release, and relaxation have been applied successfully in this group of patients. This approach, although more time consuming and low tech, affords patients with safe effective tools for self care and empowerment.

Approximately 2 million men in the United States are diagnosed and treated for prostatitis each year. It is estimated that 35–50% of men will experience pain or discomfort attributed to prostatitis at some time during their lifetime. Recent epidemiological studies suggest that 5–9% of unselected men in the community experience prostatitis symptoms at any given time. The prevalence of self-reported prostatitis among health professionals was 16% and correlated with greater odds with history of sexually transmitted disease and stress reported at home or at work.

Primary prevention through universal safe-sex precautions would eliminate the costly and sometimes tragic consequences of sexually transmitted disease (STD). However, because STD transmission remains prevalent, secondary prevention through screening and early diagnosis remains our most valuable weapon against the devastating disease sequelae.