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Pathogenic bacteria cause chronic bacterial prostatitis (CBP). CPB is characterized by urinary tract infection and persistence of pathogenic bacteria in prostatic secretion. Owing to poor blood supply to the prostate gland and limited drug penetration, CBP treatment is difficult. Transferosomes are ultradeformable vesicles for nanocarrier applications, which have become an important area of nanomedicine. Such carriers are specifically targeted to the pathological area to provide maximum therapeutic efficacy. It consists of a lipid bilayer soybean lecithin phosphatidylcholine (PC), an edge activator Tween 80 with various ratios, and a chloroform/methanol core. Depending on the lipophilicity of the active substance, it can be encapsulated within the core or among the lipid bilayer. Due to their exceptional flexibility, which enables them to squeeze themselves through narrow pores that are significantly smaller than their size, they can be a solution. One formulation (Cipro5 PEG) was selected for further in vitro analysis and was composed of phosphatidylcholine (PC), Tween 80, and polyethylene glycol-6 stearate (PEG-6 stearate) in a ratio of 3:3:1 in a chloroform/methanol mixture (1:2 v/v). In vitro, the results showed that PEGylated transferosomes had faster drug release, higher permeation, and increased bioavailability. The transferosomes were quantified with a particle size of 202.59 nm, a zeta potential of-49.38 mV, and a drug entrapment efficiency of 80.05%. The aim of this study was to investigate drug targeting. Therefore, Monoclonal antibody IgG was coupled with Cipro5 PEG, which has specificity and selectivity for conjugated nanoparticles. In vivo, a total of twenty-five adult Wistar rats were obtained and randomly divided into 5 groups, each of 5 rats at random: the control group, blank group, positive control group, Cipro 5PEG group, and Cipro 5PEG coupled with IgG antibody group. The cytokines levels (IL-1β, IL-8, and TNF-α) in the serum were detected by analysis kits. Compared with the control group, treatment with Cipro 5PEG coupled with the IgG antibody could significantly inhibit cytokines, according to histological analysis. Cipro 5PEG, coupled with the IgG antibody group, reduced prostate tissue inflammation. Hence, our results show a promising approach to delivering antibiotics for the targeted therapy of CBP.

Background: Chronic Bacterial Prostatitis (CBP) is inflammation of the prostate caused by bacterial infection. An estimated 8.2% of men have prostatitis, most commonly under the age of 50. Antibiotics often fail to treat CBP due to presence of bacterial biofilms and rising antibiotic resistance of pathogenic bacterial strains. The multidrug resistant (MDR) bacterial strains often implicated in cases of CBP include Extended Spectrum Beta Lactam resistant Escherichia coli, Vancomycin resistant Enterococci, Gram-positive bacterial strains like Staphylococci and Streptococci, Enterobacteriaceae like Klebsiella and Proteus, and Pseudomonas aeruginosa. CBP patients experience significant deterioration in quality of life, with impact on mental health comparable with patients of diabetes mellitus and chronic heart failure, leading patients to explore alternatives like phage therapy. Case presentation: We present the case of a patient diagnosed with and exhibiting typical symptoms of CBP. Tests of the prostatic and seminal fluids identified E. coli as the causative pathogen. The patient did not experience favourable long-term treatment outcomes despite repeated antibiotic courses administered over 5 years. This led him to seek phage therapy for treatment of his condition. Methods and outcome: The cultured strain of E. coli was tested against bacteriophage preparations developed by the Eliava Institute, Georgia. Preparations showing lytic activity against the strain were used for the patient's treatment at the Eliava Phage Therapy Center (EPTC). The patient underwent two courses of treatment with the EPTC. The first treatment course resulted in significant symptomatic improvement, followed by complete resolution of symptoms post the second course of phage therapy. Samples tested during treatment showed declining bacterial growth, corresponding with symptomatic improvement. Post-treatment cultures had no growth of pathogenic bacteria. Discussion: This case illustrates the efficacy of bacteriophages in treating CBP, a condition that is often resistant to antibiotic therapies. Antibiotics such as ofloxacin, Fosfomycin, trimethoprim, nitrofurantoin and ceftriaxone were administered in multiple courses over 5 years, but the infection recurred after each course. After two courses of phage therapy, the patient experienced longterm symptom resolution and substantial reduction in bacterial load. Increasing numbers of such cases globally warrant further research into the potential for bacteriophages for treating MDR and chronic infections. [ABSTRACT FROM AUTHOR]

Background: Chronic Bacterial Prostatitis (CBP) is inflammation of the prostate caused by bacterial infection. An estimated 8.2% of men have prostatitis, most commonly under the age of 50. Antibiotics often fail to treat CBP due to presence of bacterial biofilms and rising antibiotic resistance of pathogenic bacterial strains. The multidrug resistant (MDR) bacterial strains often implicated in cases of CBP include Extended Spectrum Beta Lactam resistant Escherichia coli, Vancomycin resistant Enterococci, Gram-positive bacterial strains like Staphylococci and Streptococci, Enterobacteriaceae like Klebsiella and Proteus, and Pseudomonas aeruginosa. CBP patients experience significant deterioration in quality of life, with impact on mental health comparable with patients of diabetes mellitus and chronic heart failure, leading patients to explore alternatives like phage therapy.Case presentation: We present the case of a patient diagnosed with and exhibiting typical symptoms of CBP. Tests of the prostatic and seminal fluids identified E. coli as the causative pathogen. The patient did not experience favourable long-term treatment outcomes despite repeated antibiotic courses administered over 5 years. This led him to seek phage therapy for treatment of his condition.Methods and outcome: The cultured strain of E. coli was tested against bacteriophage preparations developed by the Eliava Institute, Georgia. Preparations showing lytic activity against the strain were used for the patient’s treatment at the Eliava Phage Therapy Center (EPTC). The patient underwent two courses of treatment with the EPTC. The first treatment course resulted in significant symptomatic improvement, followed by complete resolution of symptoms post the second course of phage therapy. Samples tested during treatment showed declining bacterial growth, corresponding with symptomatic improvement. Post-treatment cultures had no growth of pathogenic bacteria.Discussion: This case illustrates the efficacy of bacteriophages in treating CBP, a condition that is often resistant to antibiotic therapies. Antibiotics such as ofloxacin, Fosfomycin, trimethoprim, nitrofurantoin and ceftriaxone were administered in multiple courses over 5 years, but the infection recurred after each course. After two courses of phage therapy, the patient experienced long-term symptom resolution and substantial reduction in bacterial load. Increasing numbers of such cases globally warrant further research into the potential for bacteriophages for treating MDR and chronic infections.

Nowadays chronic prostatitis (CP) is considered as the inflammatory disease of infectious genesis with the possible addition of the autoimmune disorders, which are characterized by the damage of both parenchymal tissue and interstitial tissue of prostate. Despite more than a century history of studying different pathogenetic links of the development of CP, this disease still remains insufficiently studied. The epidemiology details of CP are contradictory and they are studied quite fragmented. 25% of men with the urological diseases have symptoms of prostatitis, which very often leads to sexual disorders. One of the important triggers of CP is the tissue damage of prostate, which is caused by the violation of hemodynamics. Experimental studies have shown that the venous stasis causes damage to endothelium followed by the migration of the leukocytes through the venous wall. The venous stasis or the deceleration of venous blood flow in prostate leads to the damage of its tisuses. The objective: to study of the effectiveness and safety of the combined use of dietary supplements based on extracts from cordyceps, guarana, ginkgo-biloba, grape seeds and Peruvian maca extract for the treatment of patients with CP against the background of standard treatment. Material and methods. 38 patients with chronic bacterial prostatitis were examined. The age of the patients ranged from 19 to 49 years (average age - 37.3±3.5 years). Patients were divided into two groups. The first group consisted of 18 patients who received basic therapy. Patients of the II group (20 patients) received basic treatment in combination with nutritional supplements. Results. As a result of the treatment it was found that all 20 patients with the CP, who were taking capsels of Potenza and Longsil for 30 days noticed the positive effect. At the same time a pronounced positive effect noticed 11 (31,4%) patients, good effect noticed 14 (40,0%) patients and satisfying effect noticed 10 (28,6%) patients. Against the background of standard treatment with the addition of dietary supplements based on extracts of cordyceps, guarana, ginkgo-biloba, grape seeds and Peruvian maca extract, reliable positive dynamics of the vast majority of hemodynamic indicators were obtained, namely: peak arterial blood flow velocity, diastolic velocity., pulsation index, resistance index. Conclusions. The application of combination therapy: basic anti-inflammatory therapy based on antibiogram, a set of Kegel exercises and dietary supplements based on extracts of cordyceps, guarana, ginkgo-biloba, grape seeds, and Peruvian maca extract in most cases allows to reach sustainable clinical effect in patients, suffering from chronic bacterial prostatitis. [ABSTRACT FROM AUTHOR]

Introduction. The tactics of managing and treating patients with chronic recurrent bacterial prostatitis (CRBP) in some cases is a difficult-to-treat condition for a practicing urologist. This circumstance occurs because the disease has several predisposing factors, a complex and multifaceted pathogenesis, and certain difficulties in diagnosis and treatment.Objective. To study the effectiveness of recombinant interferon α-2b medications in post-COVID-19 patients with chronic recurrent prostatitis against the background of antibiotic multi-drug resistance of microorganisms verified in prostate secretion.Materials and methods. The treatment of 52 post-COVID-19 patients with CRBP was analyzed, divided into three therapy-dependent groups. Group 1 patients (n = 18) received antibiotic therapy (ABT): Levofloxacin 500 mg q.d. PO for 28 days. Group 2 patients (n = 18) underwent combined therapy: ABT supplemented with recombinant interferon α-2b with an antioxidant complex of vitamins E and C (“Viferon®” rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. Group 3 patients (n = 16) received monotherapy with recombinant interferon α-2b with an antioxidant complex of vitamins E and C (“Viferon®”rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. The follow-up period was 6 months with monitoring of clinical and laboratory parameters assessed before treatment, after 1, 3 and 6 months from the start of therapy.Results. Based on the monitoring of the clinical picture and laboratory parameters, after 1 follow-up month, there was a significant decrease in the symptoms of the disease in all study groups. However, after 3 and 6 follow-up months, this trend was observed only in patients of groups 2 and 3 receiving recombinant interferon alfa-2b with an antioxidant complex (vitamins E and C).Conclusions. Strengthening the standard CRBP-therapy with recombinant interferon α-2b with an antioxidant complex of vitamins E and C makes it possible to normalize both clinical and laboratory parameters in most patients.

The review article, based on the results of modern clinical and experimental studies, discusses general issues of the pathophysiology of oxidative stress as a universal pathogenetic factor of human diseases and particular pathophysiological aspects of oxidative stress on the example of chronic bacterial prostatitis. Separately, the most studied mechanisms of oxidative stress in the pathogenesis of the infectious and inflammatory process associated with chronic bacterial prostatitis are highlighted, which contribute to the occurrence and persistence of oxidative disorders in the prostate gland and disrupt the full restoration of its anatomical and functional state after inflammation with a potentially negative effect on the results of standard chronic bacterial prostatitis pharmacotherapy.

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Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%–10% of the world’s male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39 years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient’s prostatic secretion and semen samples revealed a chronic Enterococcus faecalis prostate infection, supporting a diagnosis of CBP. The patient’s E. faecalis strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by E. faecalis bacteriophage ϕEf11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the E. faecalis infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy.

Introduction/Aim: A spectrum of psychological problems is commonly found in CP/CPPS patients, though it is not yet clear whether, a priori, psychological dysfunctions are the cause of these pain syndromes, or whether these pain conditions are themselves causing psychological disturbances. In this article we present the current perspective on the impact of psychological problems in chronic prostatitis syndromes and we discuss the implications thereof from a clinical perspective. Materials and Methods: A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, EMBASE, and other libraries using the key words “prostatitis syndromes”, “chronic bacterial prostatitis”, “chronic pelvic pain”, in various combinations with the terms “psychological issues”, “depression” “anxiety”, “stress”, “unhappiness”, “cognitive status” and “personality”. Two independent reviewers performed data extraction. We included clinical studies with available information on chronic prostatitis and related psychological conditions. We considered full-text written papers. We excluded reviews and case reports. In order to reduce the risk of bias we analyzed only studies including patients with confirmed CBP or CP/CPPS. Bibliographic information in the selected publications was checked for relevant records not included in the initial search. Results: Database search allowed us to retrieve 638 studies to which we added to 16 additional studies retrieved by hand-searching. After screening, 34 relevant papers were identified for thorough review. Most studies included patients with chronic pelvic pain and prostatitis-like symptoms, whereas a smaller number of studies included patients with methodologically con- firmed CP/CPPS including studies with a microbiologically confirmed diagnosis of CBP. The psychosocial factors examined in the selected studies include pain, catastrophizing, stress, personality factors and social aspects. Comorbid psychiatric disorders evidenced in the studies included depression, anxiety and trauma-related disorders, somatization disorders, and substance abuse. Some studies investigated the association of pain with each individual psychological disturbance, while others examined the impact of pain in association with the overall quality of life. Sample size, study design and diagnostic measures varied among studies. Conclusions: Despite limitations and variations in sample size, study design and diagnostic measures in all included studies, a relation between chronic prostatitis and psychological problems is a consistent finding. The existing evidence does not permit to definitely conclude whether psychological problems are a risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease.

Introduction/Aim: A spectrum of psychological problems is commonly found in CP/CPPS patients, though it is not yet clear whether, a priori, psychological dysfunctions are the cause of these pain syndromes, or whether these pain conditions are themselves causing psychological disturbances. In this article we present the current perspective on the impact of psychological problems in chronic prostatitis syndromes and we discuss the implications thereof from a clinical perspective. Materials and methods: A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, EMBASE, and other libraries using the key words "prostatitis syndromes", "chronic bacterial prostatitis", "chronic pelvic pain", in various combinations with the terms "psychological issues", "depression" "anxiety", "stress", "unhappiness", "cognitive status" and "personality". Two independent reviewers performed data extraction. We included clinical studies with available information on chronic prostatitis and related psychological conditions. We considered full-text written papers. We excluded reviews and case reports. In order to reduce the risk of bias we analyzed only studies including patients with confirmed CBP or CP/CPPS. Bibliographic information in the selected publications was checked for relevant records not included in the initial search. Results: Database search allowed us to retrieve 638 studies to which we added to 16 additional studies retrieved by handsearching. After screening, 34 relevant papers were identified for thorough review. Most studies included patients with chronic pelvic pain and prostatitis-like symptoms, whereas a smaller number of studies included patients with methodologically confirmed CP/CPPS including studies with a microbiologically confirmed diagnosis of CBP. The psychosocial factors examined in the selected studies include pain, catastrophizing, stress, personality factors and social aspects. Comorbid psychiatric disorders evidenced in the studies included depression, anxiety and trauma- related disorders, somatization disorders, and substance abuse. Some studies investigated the association of pain with each individual psychological disturbance, while others examined the impact of pain in association with the overall quality of life. Sample size, study design and diagnostic measures varied among studies. Conclusions: Despite limitations and variations in sample size, study design and diagnostic measures in all included studies, a relation between chronic prostatitis and psychological problems is a consistent finding. The existing evidence does not permit to definitely conclude whether psychological problems are a risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease. [ABSTRACT FROM AUTHOR]

Bacterial prostatitis is a highly prevalent infection responsible for significant morbidity among men. The diagnosis and treatment for bacterial prostatitis remains complicated. The difficulty in diagnosis is in part owing to the paucity of high-quality evidence that guides a clinician's interpretation of patients' history, physical examination, and laboratory findings. Treatment is challenging because of the few antimicrobials capable of prostate penetration, growing antimicrobial resistance limiting effective treatment options, and the high risk of recurrence. We aimed to provide a useful resource for clinicians in effectively diagnosing and managing acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). A PubMed literature search on prostatitis was performed with no restrictions on publication date. The epidemiology, pathophysiology, diagnosis, and treatment for ABP and CBP are explored using a clinical vignette as relevant context. Bacterial prostatitis can be diagnosed through a focused history and microbiological investigations. The Meares-Stamey 4-glass test or modified 2-glass test can help confirm the diagnosis if uncertainty exists. Typical uropathogens are common contributors to bacterial prostatitis but there is growing interest in exploring the role atypical and traditional non-pathogenic organisms may have. Fluoroquinolones remain first-line therapy, followed by trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline if the pathogen is susceptible. Fosfomycin has emerged as a repurposed and useful agent because of the increasing incidence of multidrug-resistant pathogens. Selection of appropriate antimicrobial regimens can be challenging and is dependent on the host, chronicity of symptoms, uropathogens' susceptibilities, antimicrobials' side effect profile, and the presence of prostatic abscesses or calcifications. ABP can typically be treated similar to other complicated urinary tract infections. However, CBP requires prolonged therapy, with a minimum of 4 weeks and up to 12 weeks of therapy. [ABSTRACT FROM AUTHOR]

Chronic bacterial prostatitis usually occurs in men and seriously affects the quality of life of patients. The efficacy of chronic bacterial prostatitis treatment is limited by the difficulty for free drugs (e.g., antibiotics) to penetrate the prostate epithelium and target inflammatory tissues. The advent of nanotechnology offers the possibility to address this issue, such as the development of targeted nanoparticle delivery strategies that may overcome these important limitations. The physicochemical properties of nanoparticles, such as particle size, shape and surface modification ligands, determine their targeting effectiveness. In this study, nanoparticles with different physicochemical properties were prepared to explore and confirm their targeting capacities to inflammatory prostate tissues of chronic bacterial prostatitis, focusing on the effects of size and different modification ligands on the targeting performance. In vivo and ex vivo imaging results verified that folic acid-modified nanoparticles with a particle size of 180–190 nm via tail intravenous injection had the optimal targeting efficiency to prostate tissues. Our results provide an experimental basis and reference value for targeted therapy of prostate-related diseases with nanotechnology in the future.

Chronic prostatitis is the most common inflammatory disease of the prostate gland, which is difficult to treat and significantly impairs the quality of life. Today, not only middle-aged men are in the risk group, but also young and older men. One of the frequent manifestations of chronic prostatitis are sexual dysfunctions, which cause psycho-emotional disturbances and negatively affect various spheres of men’s life. Maximum removal of sexual disorders is an important task in the treatment of this disease. The objective: to analyze the effectiveness of complex treatment with the inclusion of dietary supplements on the sexual health in men with chronic bacterial prostatitis. Materials and methods. 162 patients with chronic bacterial prostatitis with sexual dysfunction took part in the study. All men received complex antibacterial and anti-inflammatory therapy. The average age of the examined persons was 33.4±0.6 years old. Sexual dysfunctions in patients were studied by the survey method. The questions and answer options were based on the International Index of Erectile Function. After traditional complex antibacterial anti-inflammatory treatment, 87 patients of the 1st group (main group) received the dietary supplements produced by Harmony Ukraine Ltd. At the same time, of the 2d group (control one) did not receive additional treatment. Men of both groups were comparable in age and severity of disease manifestations, in particular sexual disorders, which were mostly pronounced. Results. As a result of the treatment, the sexual health of patients in both groups improved: sexual desire increased, the frequency of intimate relations increased, erection improved, the duration of the friction period of sexual intercourse increased, as well as the brightness of orgasmic sensations. The therapy was more effective in men of the 1st group. First of all, it concerned stability, duration and controllability of erection during sexual intercourse, increased sexual desire, regularity of intimate relations. In persons who took additionally dietary supplements, the normalization of individual sexual functions was observed in 51.7– 62.1% of cases; of all functions – in an average of 57.5% of cases. In patients who received only antibacterial anti-inflammatory treatment, individual sexual functions were completely restored in 33.3–41.3% of cases; all functions on average – in 38.0% of cases (р<0.01). Significantly pronounced sexual dysfunctions in men of the 1st group were not determined after treatment, they were found only in isolated cases; all of them on average – 0.9% of cases. In the persons of the 2d group, similar indicators were 6.7–25.3% of cases, respectively, on average – 14.3% of cases (р<0.001). The positive effect of treatment with the inclusion of dietary supplements was determined in 82.8% of men. 60.9% of patients were very satisfied with the therapy. The specified treatment contributed to satisfaction with sexual relations and improved general health, and also had a positive effect on all spheres of men’s lives. At the same time, the patients who received only antibacterial anti-inflammatory therapy had its high effectiveness in 62.7% of cases (p<0.01). 30.7% of men were very satisfied with the treatment (p<0.001). Conclusion. It is advisable to widely use dietary supplements in the complex therapy of patients with chronic bacterial prostatitis with sexual disorders. [ABSTRACT FROM AUTHOR]

Chronic bacterial prostatitis (CBP) occurs frequently in the male population and significantly influences quality of life. Antibiotics are the main strategy for managing chronic bacterial prostatitis; however, most antibiotics have low efficacy due to their poor penetration of prostate tissues. To overcome this challenge, we fabricated cefpodoxime proxetil (CPD)-loaded reactive oxygen species (ROS)-responsive nanoparticles (NPs) for targeted treatment of CBP. These NPs were modified with folic acid (FA) and could be effectively internalized by bacteria-infected macrophages and prostatic epithelial cells because of the high expression of folate receptors (FRs) in these cells. In vitro cellular assays demonstrated that the CPD-loaded nanomedicine can obviously reduce proinflammatory cytokine expression in cells since the nanomedicine can efficiently eradicate cellular bacteria. In vivo imaging results verified that FA-modified nanomedicines can penetrate the prostatic epithelium and accumulate in the glandular lumen because FRs overexpression was also observed in the prostate tissues of CBP mice. Animal experiments demonstrated that FA-modified nanomedicine can remarkably relieve pelvic pain in CBP mice and dramatically decrease proinflammatory cytokine expression in prostate tissues via eradication of bacteria and scavenging of ROS. Our results provide a new strategy to deliver antibiotics for targeted therapy of CBP. To overcome poor penetration of antibiotics in prostatic tissues, we developed an antibiotics-loaded ROS-responsive NPs for targeted treatment of CBP. We demonstrated that both bacteria-infected macrophages and prostatic epithelial cells have FRs overexpression, thus FA-modified NPs can be efficiently internalized by these cells. FA-modified NPs can penetrate the prostatic epithelium and accumulate in the glandular lumen via FRs-mediated endocytosis, and the accumulated NPs can smartly release their payload under high ROS microenvironment. A distinguished therapy outcome was obtained in murine CBP model since CPD-loaded NPs can efficiently eradicate the resident bacteria in prostate tissues and downregulate proinflammatory cytokine expression. Our work provides a practicable strategy to expand the application of antibiotics for management of CBP. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To explore the influence of the microbiota of prostate secretion on the clinical status of patients with chronic bacterial prostatitis. Methods: This was an observational, single‐center, comparative study. We evaluated the survey cards of 230 outpatients aged 18–45 years with a history of prostatitis from 2012 to 2019. As a result, 170 outpatients were selected for the study. All patients underwent an assessment of symptoms using International Prostate Symptom Score‐quality of life, National Institutes of Health‐Chronic Prostatitis Symptom Index, International Index of Erectile Function, pain visual analog scale. A bacteriological study (after the Meares–Stamey test) of post‐massage urine was carried out on an extended media set. The following parameters were determined in each patient: leukocyturia and bacteriuria, serum testosterone and total prostate‐specific antigen levels. Uroflowmetry, transrectal prostate ultrasound with color duplex mapping and ejaculate analysis were also carried out. Results: Aerobic–anaerobic bacterial associations were identified in all patients. Three comparison groups were identified depending on the microbiota's spectrum (in post‐massage urine): aerobes prevailed in group 1 (n = 67), anaerobes prevailed in group 2 (n = 33), and the levels of aerobic and anaerobic bacteriuria were higher than ≥103 colony‐forming units per mL in group 3 (n = 70). It was found that the severity of clinical symptoms (urination disorders, sexual dysfunction etc.) of chronic bacterial prostatitis, laboratory and instrumental changes (testosterone, prostate‐specific antigen, prostate volume etc.) in groups 2 and 3 were significantly higher than in group 1. Conclusion: In patients with chronic bacterial prostatitis, a predominance of anaerobes or a combination of aerobes and anaerobes in a titer of ≥103 colony‐forming units per mL in post‐massage urine is associated with worse clinical status. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of Escherichia coli Nissle 1917 (EcN) in association with levofloxacin in patients with chronic bacterial prostatitis (CBP). Methods: Patients with CBP referred to our clinic from September 2017 to July 2019 were enrolled. At baseline, the symptomatology was assessed with the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), while the Meares–Stamey test was used to diagnose the infection. Patients were randomized (1:1) in two groups (A and B). All subjects underwent oral administration of Levoxacin® 500 mg once daily for 4 weeks. Only the patients in Group B underwent oral administration of EcN® 320 mg, twice daily for 4 weeks and then once daily for 8 weeks. After 3 months, each patient repeated the NIH-CPSI questionnaire, while the Meares–Stamey test was repeated at 3 and 6 months in patients who reported persistent symptoms. All adverse events (AEs) were recorded. Results: A total of 110 patients were enrolled. After 3 months patients in Group B reported a significantly lower NIH-CPSI score (5.85 ± 3.07 vs. 7.64 ± 3.86; p = 0.009) and biological recurrences rate (9.8 vs. 26.9%; p = 0.043). At 6 months the biological recurrences rate was significantly lower in Group B (8.7 vs. 28.9%; p = 0.038). Only three patients in Group A and six in Group B (p = 0.25) complained mild AEs. Conclusions: Combination therapy with EcN and levofloxacin allows a better control of symptoms and biological recurrences in patients with CBP, without worsening the safety of the treatment. [ABSTRACT FROM AUTHOR]

Background. Chronic bacterial prostatitis is a common disease clinically diagnosed based on signs of inflammation and the presence of infection in the prostatic fluid. Standard antibiotic therapy in most cases does not lead to a decrease in the number of recurrences. In this regard, an integrated approach is often used in therapy, and in addition to antibacterial therapy, biostimulators, extracts of various plants and animals are prescribed. One of the main advantages of these prescriptions is that the drugs have minimal side effects.Objective. To assess the effectiveness of Adenoprosin® in the combined treatment of patients with chronic bacterial prostatitis.Material and Methods. 60 patients aged 24–50 (average age is 31.3 ± 2.8 years) with chronic bacterial prostatitis were examined and treated, the duration of the disease ranged from 6 months to 15 years (average duration of the disease is 1.5 ± 0.3 years). The patients were divided into two groups: group I included 30 patients who were treated with antibacterial drugs and Adenoprosin®, group II included 30 patients who were treated with antibacterial drugs only. The course of treatment lasted 30 days, the total time of observation of the patients was 3 months. Clinical control was carried out during the first visit to the urologist, on the 14th, 28th, 45th and 90th days from the start of therapy and included filling out the following: The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), The International Prostate Symptom Score (IPSS) and Quality of Life (QoL), as well as the International Index of Erectile Function (IIEF-5) questionnaire in order to identify the possible effect of therapy on sexual function.Results. The analysis revealed that the use of the Adenoprosin® in complex therapy in patients with chronic bacterial prostatitis reduces the overall score of the NIH-CPSI questionnaire by an average of 4 points. When conducting a questionnaire at the end of treatment, 2 (6.6%) patients in the group II noted dissatisfaction with the therapy, on the 90th day of observation, complaints of dissatisfaction with the treatment remained in 1 (3.3%) patient. In 5 (16.6%) patients of the group II, against the background of the therapy, there was no subjective improvement in the treatment; on the 90th day of observation, the number of unsatisfied patients remained the same. Microscopic examination of the prostatic fluid and microflora after 28-day-treatment showed the decrease in leukocytes (less than 10 leukocytes in the field of view) in 25 (80%) patients of the group I. This point was higher in comparison with 21 (70%) patients of the group II. In 5 (16.6%) patients of the group I, the number of leukocytes in the prostatic fluid was in the range of 10–20 in the field of view, all patients previously had recurrent forms of the disease. The number of leukocytes more than 10 was in 7 (23.3%) patients of the group II after antibacterial therapy. Among them, 5 (16.6%) patients had recurrent forms of the disease, and 2 (6.6%) patients were diagnosed with prostatitis for the first time. Thus, the use of combination therapy in the group I, to a greater extent, reduced the inflammatory markers of the disease.Conclusion. The Adenoprosin® in complex therapy has a proven anti-inflammatory effect on the prostate gland, reduces the pain rapidly, decreases the total score of prostatic symptoms when analyzing the NIH-CPSI questionnaires, improves erectile function, reduces markers of inflammation in the pre-fetal gland and can be recommended for patients with chronic bacterial inflammation in the prostate gland.

Background: Chronic prostatitis (CP) is a bothersome disease affecting young and middle-aged men. Routine cultures often fail to localize the source of infection. Although the four-glass test is considered the gold-standard test for evaluating CP, it has found less favour in clinical practice. We re-inspected its utility in patients suffering from CP. Methods: Seventy cases of CP of Indian origin were enrolled. The four-glass test was conducted, and the samples were labelled as VB1, VB2, VB3 and EPS. A quantitative culture and drug sensitivity test for 16 antimicrobials was performed. Results: Samples from 61 patients (M age=36 years) were analysed. Chronic bacterial prostatitis was identified in 29 (47.5%) cases. Enterococcus spp. were the most common isolate, followed by Escherichia coli. A wide variability in positivity pattern was noted in the four-glass test. The most common pattern was for only the EPS sample to be positive (nine cases; 16.1%), followed by all four samples to be positive (seven cases; 12.5%). High susceptibility was found (94–100%) against third-generation cephalosporins, meropenem, amikacin, gentamicin and nitrofurantoin. Conclusions: The four-glass test is still important in the evaluation of CP. In about half of the cases examined in this study, bacterial localization could be made to the prostate. Level of evidence: Level IIIb. [ABSTRACT FROM AUTHOR]

Background: Chronic Bacterial Prostatitis (CBP) is an inflammatory condition caused by a persistent bacterial infection of the prostate gland and its surrounding areas in the male pelvic region. It is most common in men under 50 years of age. It is a long-lasting and debilitating condition that severely deteriorates the patient’s quality of life. Anatomical limitations and antimicrobial resistance limit the effectiveness of antibiotic treatment of CBP. Bacteriophage therapy is proposed as a promising alternative treatment of CBP and related infections. Bacteriophage therapy is the use of lytic bacterial viruses to treat bacterial infections. Many cases of CBP are complicated by infections caused by both nosocomial and community acquired multidrug resistant bacteria. Frequently encountered strains include Vancomycin resistant Enterococci, Extended Spectrum Beta Lactam resistant Escherichia coli, other gram-positive organisms such as Staphylococcus and Streptococcus, Enterobacteriaceae such as Klebsiella and Proteus, and Pseudomonas aeruginosa, among others.Case Presentation: We present a patient with the typical manifestations of CBP. The patient underwent multiple courses of antibiotic treatment without any long-term resolution of his symptoms. Testing of prostatic secretion and semen samples revealed pathogenic bacteria in each case, which collectively included members of the Staphylococcal species such as Methicillin resistant Staphylococcus aureus (MRSA) and Staphylococcus haemolyticus, Enterococcus faecalis, and Streptococcus mitis, among others.Methods and Outcome: Bacteriophage preparations from the Eliava Institute were used to treat the patient after establishing phage sensitivity to the pathogenic bacteria. Significant improvements in symptoms and re-testing of samples after bacteriophage treatment indicated a reduction in the bacterial load and resolution of the infection.Discussion: The patient saw significant improvement of symptoms, and positive dynamics in bacterial titers and ultrasound controls after phage therapy. The failure of antibiotic therapy and subsequent success of bacteriophage therapy in treating chronic bacterial prostatitis shows the effectiveness of bacteriophages in controlling chronic infections in areas of low vascularity and anatomical complexity. These cases also highlight the efficacy of phages in overcoming antibiotic-resistant infections as well as biofilm infections.

Background: Chronic Bacterial Prostatitis (CBP) is an inflammatory condition caused by a persistent bacterial infection of the prostate gland and its surrounding areas in the male pelvic region. It is most common in men under 50 years of age. It is a long-lasting and debilitating condition that severely deteriorates the patient's quality of life. Anatomical limitations and antimicrobial resistance limit the effectiveness of antibiotic treatment of CBP. Bacteriophage therapy is proposed as a promising alternative treatment of CBP and related infections. Bacteriophage therapy is the use of lytic bacterial viruses to treat bacterial infections. Many cases of CBP are complicated by infections caused by both nosocomial and community acquired multidrug resistant bacteria. Frequently encountered strains include Vancomycin resistant Enterococci , Extended Spectrum Beta Lactam resistant Escherichia coli , other gram-positive organisms such as Staphylococcus and Streptococcus , Enterobacteriaceae such as Klebsiella and Proteus , and Pseudomonas aeruginosa , among others. Case Presentation: We present a patient with the typical manifestations of CBP. The patient underwent multiple courses of antibiotic treatment without any long-term resolution of his symptoms. Testing of prostatic secretion and semen samples revealed pathogenic bacteria in each case, which collectively included members of the Staphylococcal species such as Methicillin resistant Staphylococcus aureus (MRSA) and Staphylococcus haemolyticus , Enterococcus faecalis , and Streptococcus mitis , among others. Methods and Outcome: Bacteriophage preparations from the Eliava Institute were used to treat the patient after establishing phage sensitivity to the pathogenic bacteria. Significant improvements in symptoms and re-testing of samples after bacteriophage treatment indicated a reduction in the bacterial load and resolution of the infection. Discussion: The patient saw significant improvement of symptoms, and positive dynamics in bacterial titers and ultrasound controls after phage therapy. The failure of antibiotic therapy and subsequent success of bacteriophage therapy in treating chronic bacterial prostatitis shows the effectiveness of bacteriophages in controlling chronic infections in areas of low vascularity and anatomical complexity. These cases also highlight the efficacy of phages in overcoming antibiotic-resistant infections as well as biofilm infections. [ABSTRACT FROM AUTHOR]

The study objective is to investigate some initial characteristics of prostate oxidative status and their dynamics during the course of etiotropic antimicrobial monochemotherapy in patients with chronic bacterial prostatitis (CBP).Materials and methods. The work is based on treatment of 90 men aged 24–46 years (mean age 38.2 ± 1.4 years) with CBP (the treatment group), and 30 clinically healthy men aged 20–45 years (mean age 35.5 ± 1.5 years) (control group). All men underwent the same type of comprehensive examination during the study, and the results of the examination of the men of the control group were taken as reference values of the conditional norm. Complaints and anamnesis were collected. General physical, special urological, microbiological, laboratory, sonographic studies were performed. The etiotropic antimicrobial monochemotherapy was selected according to the results of microbiological studies of the secretion of the prostate gland, and levofloxacin (500 mg within 28 days) was chosen as a base drug for the subgroup of treatment (n = 15) isolated from the treatment group in the 2nd stage of the study. To assess the characteristics of the prostate oxidative status and its dynamics during etiotropic antimicrobial monochemotherapy, various modifications of biochemical studies of the secretion of the prostate were performed (reactive oxygen species (ROS), lipid peroxidation products (diol conjugates, malonic dialdehyde), activity of superoxide dismutase).Results. In patients with CBP in the secretion of the prostate due to increased ROS formation, increased functional activity (free radical aggression), increased reactions of lipid peroxidation and increased functional load on prostatic superoxide dismutase. Antimicrobial monochemotherapy of CBP was characterized by a microbiological efficacy of 86.7 % and was accompanied by a positive dynamics of a number of clinical and laboratory parameters of chronic bacterial prostatitis, however, this did not lead to the complete elimination of pain syndrome and oxidative disorders in the secretion of the prostate, and also did not significantly improve the quality life of patients and prostate secretory function. In patients with CBP a significant positive relationship was found between the amount of ROS and superoxide dismutase activity in the secretion of the prostate (n = 90; r = 0.413; p = 0.001); and the positive relationship between the amount of ROS in the secretion of the prostate and the clinical pain index (n = 90, r = 0.304, p = 0.001), which reflected the essential role of free radical prostatic aggression as an non-infectious component of the multifactorial pathogenesis of the pain syndrome in CBP.Conclusion. The persistence of residual oxidative disorders and functional deficits in the prostate after a standard course of microbial monochemotherapy justifies the advisability of the additional administration of antioxidants and antihypoxic agents in CBP.

The article discusses the effectiveness of herbal medicine in inflammatory diseases of the prostate. This literature review presents clinical studies of the successful use of herbal ingredients in the treatment of chronic prostatitis and relief of lower urinary tract symptoms (LUTS). Biological active substances of Urtica dioica, Cucurbita moschata, Saw palmetto (Serenoa repens), and zinc are effective in the treatment of chronic prostatitis due to anti-inflammatory, antiproliferative, antiandrogenic and antioxidant action. Phytopreparations containing these substances can be recommended as the first line of correction of LUTS in chronic forgive categories III and IV; as a general tonic for men leading a sedentary lifestyle over the age of 35 years.

Introduction. The effectiveness of methods for treating chronic prostatitis, which are aimed at improving the hemodynamics of the pelvic organs, has been proven by numerous studies conducted over more than thirty years. At the same time, pelvic myofascial syndrome can lead to impaired pelvis' hemodynamics.Purpose of research. This study aimed to determine the effect of myofascial syndromes on the blood circulation in the prostate in patients with chronic bacterial prostatitis, as well as an assessment of the dynamics of changes in blood flow in the prostate on the treatment of concomitant myofascial syndrome.Materials and methods. 59 men 34-52 years old with various clinical manifestations of myofascial syndrome (patients of the neurological clinic) were examined to assess the dynamics of blood circulation in the prostate. In addition, 127 men aged 28-52 years (mean age 38 years) with typical clinical manifestations of chronic prostatitis, who repeatedly and unsuccessfully received treatment for this disease, evaluated the effect of treatment of concomitant myofascial syndrome on prostate hemodynamicsResults. The results suggest violations of microcirculation in the prostate in patients with chronic pelvic pain with myofascial syndrome. At the same time, hemodynamic impairment in the prostate is directly associated with impaired pelvic hemodynamics in general. The state of microcirculation in the prostate depends on the severity of pain symptoms in nonspecific chronic pelvic pain, and the treatment of nonspecific chronic pelvic pain leads to a reduction in the main symptom of the disease (pain) and to the normalization of microcirculation in the prostate.Treatment of concomitant myofascial syndrome in patients with chronic bacterial prostatitis allowed to achieve the disappearance of clinical manifestations of the disease and normalization of hemodynamics in the prostate, as well as a decrease in laboratory signs of inflammation.Conclusions. Concomitant myofascial syndrome in patients with chronic pelvic pain is a cause of pelvic hemodynamic disorders and because of the development of the inflammatory process. The severity of hemodynamic disturbances directly depends on the intensity of painful manifestations of the myofascial syndrome. Treatment of myofascial syndrome in patients with chronic bacterial prostatitis is accompanied by the disappearance of disease's clinical symptoms and the restoration of prostate's blood circulation, as well as the reduction or disappearance of inflammation's signs.

Pathogenic bacteria cause chronic bacterial prostatitis (CBP). CPB is characterized by urinary tract infection and persistence of pathogenic bacteria in prostatic secretion. Owing to poor blood supply to the prostate gland and limited drug penetration, CBP treatment is difficult. Transferosomes are ultradeformable vesicles for nanocarrier applications, which have become an important area of nanomedicine. Such carriers are specifically targeted to the pathological area to provide maximum therapeutic efficacy. It consists of a lipid bilayer soybean lecithin phosphatidylcholine (PC), an edge activator Tween 80 with various ratios, and a chloroform/methanol core. Depending on the lipophilicity of the active substance, it can be encapsulated within the core or among the lipid bilayer. Due to their exceptional flexibility, which enables them to squeeze themselves through narrow pores that are significantly smaller than their size, they can be a solution. One formulation (Cipro5 PEG) was selected for further in vitro analysis and was composed of phosphatidylcholine (PC), Tween 80, and polyethylene glycol-6 stearate (PEG-6 stearate) in a ratio of 3:3:1 in a chloroform/methanol mixture (1:2  v /v). In vitro, the results showed that PEGylated transferosomes had faster drug release, higher permeation, and increased bioavailability. The transferosomes were quantified with a particle size of 202.59 nm, a zeta potential of-49.38 mV, and a drug entrapment efficiency of 80.05%. The aim of this study was to investigate drug targeting. Therefore, Monoclonal antibody IgG was coupled with Cipro5 PEG, which has specificity and selectivity for conjugated nanoparticles. In vivo, a total of twenty-five adult Wistar rats were obtained and randomly divided into 5 groups, each of 5 rats at random: the control group, blank group, positive control group, Cipro 5PEG group, and Cipro 5PEG coupled with IgG antibody group. The cytokines levels (IL-1β, IL-8, and TNF-α) in the serum were detected by analysis kits. Compared with the control group, treatment with Cipro 5PEG coupled with the IgG antibody could significantly inhibit cytokines, according to histological analysis. Cipro 5PEG, coupled with the IgG antibody group, reduced prostate tissue inflammation. Hence, our results show a promising approach to delivering antibiotics for the targeted therapy of CBP., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Randa mohammed zaki reports financial support was provided by Prince Sattam bin Abdulaziz University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Chronic bacterial prostatitis is increasingly difficult to treat due to rising antimicrobial resistance limiting oral treatment options. In this case series, 11 men with CBP (including patients with urological comorbidities) due to multi-resistant E. coli were treated with once-daily ceftriaxone intravenously for 6 weeks. Nine patients were clinically cured at 3 months follow up. No early withdrawal of medication due to side effects occurred. A literature review was conducted to describe the prostate pharmacokinetics of ceftriaxone and its use in prostatic infection. In conclusion, ceftriaxone can be considered an appropriate treatment of chronic bacterial prostatitis.

Introduction: Chronic prostatitis (CP) is a relative common prostate condition in men. Nevertheless, the relationship among sexuality, sexual orientation and CP has not been thoroughly investigated. Current clinical evidence and experimental data, tend to associate, chronic bacterial prostatitis (CHB) one of the forms of CP with sexually transmitted diseases. Methods: In this retrospective study, 1783 visits owing to investigation of prostatitis-like symptoms and routine follow up were reviewed. Results: A total of 389 patients, provided information regarding sexuality and sexual orientation while the remaining not. The mean age of these patients was 45.5 years. According their reports, 92.28% were heterosexual, 6.16% homosexual kαι 1.54% bisexual. Regarding sexuality, 26.6% reported multiple sexual partnerships while 73,4% reported a single sexual partnership and 1.3% reported abstinence from sexual intercourse. There was a statistically significant association between CBP and multiple sexual partnerships (p = 0.05). In contrast, the association between CBP and sexual orientation was not statistically significant (p =0,111). Conclusions: In conclusion, CBP can be associated with sexuality however with the last being multifactorial further research is required to determine their correlation. [ABSTRACT FROM AUTHOR]

Purpose of Review: We conducted a review of the literature describing the most up-to-date diagnosis and treatment options of chronic bacterial prostatitis. Recent Findings: Recurrence after oral antimicrobial therapy is common, due in part to the rising rates of antimicrobial resistance and inability to completely clear the offending bacteria from the prostate following prostatitis. Recent literature has described various treatment options for chronic bacterial prostatitis refractory to conventional antimicrobial agents, including the use of alternative agents such as fosfomycin, direct antimicrobial injections into the prostate, surgical removal of infected prostatic tissue, chronic oral antibiotic suppression, and an emerging novel therapy utilizing bacteriophages to target antibiotic resistant bacteria. Summary: Management of chronic bacterial prostatitis, especially recurrence after oral antimicrobial treatment, remains challenging. This review highlights an urgent need for further evidence assessing the efficacy and safety of treatment modalities for chronic bacterial prostatitis refractory to conventional oral antimicrobials. [ABSTRACT FROM AUTHOR]

Introduction: Literature data prove the important role of oxidative stress in the pathogenesis of Chronic Bacterial Prostatitis (CBP) and its recurrence, which reduces the effectiveness of standard etiotropic therapy of the disease. Aim of study: To improve the results of the pharmacotherapy of CBP by a comprehensive assessment of oxidative disorders in the prostate gland in a clinical and experimental study to provide evidence for antioxidant support. Material and methods: The results of experimental simulation of CBP in 60 male rats and examination of 90 patients with CBP (average age 38.2 ± 1.4; main group) and 30 clinically healthy men (average age 35.5±1.5; control group), which included history-taking, collecting complaints, questioning, general and special examinations, biochemical, cytological, microbiological, sonographic studies. In some experimental animals and patients with CBP, different modes of pharmacotherapy were tested (antimicrobial monochemotherapy; antimicrobial chemotherapy+zinc picolinate; antimicrobial chemotherapy+L--carnitine tartrate in standard doses). The data were processed using descriptive and comparative statistics. Results and discussion: Clinical and experimental fndings showed the compensatory nature of the prostatic oxidative disorders after a standard antimicrobial monochemotherapy of the first episode of CBP and their continued persistence with a high risk of decompensation and development of mitochondrial dysfunction after a course of standard antimicrobial monochemotherapy in CBP recurrence. Zinc deficiency in the patients with CBP was detected on average 2.7 times more often than in the healthy men, so zinc determination in the prostatic fluid and subsequent drug compensation should be considered as first--line diagnostic and treatment measures. In the patients with CBP without zinc deficiency, L-carnitine may be an effective alternative to pharmacological correction of the prostatic oxidative disorders. Conclusion: To increase the effectiveness of standard etiotropic therapy of CBP, simultaneous antioxidant support is necessary, using differentiated administration of antioxidants/antihypoxants (zinc or L-carnitine). [ABSTRACT FROM AUTHOR]

The goal of the research is to study the impact of vacuum interference therapy on the state of the regional hemodynamics and the processes of microcirculation among patients with chronic bacterial prostatitis. Material and Meth- ods. The study included 90 patients with average age 32.5 years with chronic bacterial prostatitis in a latent phase of inflammation. The study was conducted on a comparative basis using three randomized groups of patients (n=30), comparable on all criteria, divided depending on the methods applied into two treatment groups and one control group. Besides, the originally assigned basic medication treatment was an obligatory component in all three groups. Results. After therapy course the more significant results in hemodynamic changes were shown in the group of patients who received vacuum-interference therapy. The second group, which received interference currents, there was also positive dynamics in the hemodynamic parameters, but to a smaller extent, while in the control group there were no vivid changes found in the studied parameters. Conclusion. The course treatment using vacuum interference therapy among patients with chronic bacterial prostatitis had a significant positive corrective effect on the system of hemodynamics.

The article represents a description for microbiocenosis of isolated prostate secret. The initial samples were taken on the territory of the Irkutsk region from men diagnosed with chronic bacterial prostatitis in the acute stage. 90 % of samples of isolated prostate secret were tested by cultural method revealed 4l representatives of opportunistic pathogenic microflora. Gram-positive microorganisms were found in most samples (86.7 %). Staphylococcus genus representatives formed the majority in isolated samples of conditionally pathogenic microflora (66.7 %). As for gram-negative representatives (which role in chronic bacterial prostatitis is proven by multiple research), E. coli and K. pneumoniae were isolated. In the half of samples, we revealed bacterial associations consisting mostly of two kinds of microorganisms. Staphylococcus epidermidis was isolated in 70 % of such associations.

Introduction/Aim: Although prostatic calculi/calcifications are encountered frequently in the urological practice, little is known about the incidence of such lesions, their mechanism of formation, their relationship to other prostate conditions and their clinical significance. The purpose of this study is to describe the characteristics and to investigate the clinical significance of prostatic calcifications (PCs) in patients with chronic bacterial prostatitis (CBP). Materials and methods: This study was conducted between 01/02/2013 and 20/02/2018. The patient population for this study included subjects with or without PCs and a confirmed diagnosis of NIH category II Chronic Bacterial Prostatitis (CBP). Demographics and clinical history of each assessed patient were reviewed. Eligible patients underwent prostatic ultrasound with post-void residual measurement, and the Meares-Stamey “4-glass” test. Symptom severity was measured using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostatic Symptoms Score (IPSS). Antimicrobials were administered to confirmed cases of CBP according to the results of susceptibility tests. After four weeks off-therapy, the NIH-CPSI and IPSS tests were repeated. Variables were compared between patients with and without prostatic calcifications. Results: Ninety-five CBP patients were included in the study. According to the presence of PCs detected by ultrasound examination, patients were divided into two groups: 41 had PCs (group 1) and 54 didn’t (group 2). No significant between-group baseline differences were found regarding age, marital status, prostate volume, the proportion of common CBP pathogens. Concerning highrisk sexual behavior, a significantly higher number of men with PCs practiced anal penetration. Moreover, a significantly higher number of men with PCs had a history of chronic prostatitis relapsing episodes. Microbiological eradication and the complete resolution of clinical symptoms occurred in similar proportions between the two groups. However, intergroup analysis resulted in significantly higher scores of the NIH-CPSI test in group 1, both at the pre-therapy and at the post-therapy time points. Conversely, no IPSS score differences between groups 1 and 2 were found at both pre- and post-therapy time points. Conclusions: Prostatic calcifications do not seem to influence the microbiological outcome of antibacterial treatment. However, the CBP symptoms appear to be more severe in carriers of prostatic calcifications, either before or after antibacterial therapy.

The modern clinical research on prostatitis started with the work of Stamey and coworkers who developed the basic principles we are still using. They established the segmented culture technique for localizing the infections in the males to the urethra, the bladder, or the prostate and to differentiate the main categories of prostatitis. Such categories with slight modifications are still used according to the NIH classification: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis. Prostatic inflammation is considered an important factor in influencing both prostatic growth and progression of symptoms of benign prostatic hyperplasia and prostatitis. Chronic inflammation/neuroinflammation is a result of a deregulated acute phase response of the innate immune system affecting surrounding neural tissue at molecular, structural and functional levels. Clinical observations suggest that chronic inflammation correlates with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) and an history of clinical chronic prostatitis significantly increases the odds for prostate cancer. The NIHNIDDK classification based on the use of the microbiological 4- glasses localization test or simplified 2-glasses test, is currently accepted worldwide. The UPOINT system identifies groups of clinicians with homogeneous clinical presentation and is used to recognize phenotypes to be submitted to specific treatments. The UPOINTS algorithm implemented the original UPOINT adding to the urinary domains (U), psycho-social (P), organspecific (O), infection (I), neurological (N), muscle tension and tenderness (T) a further domain related to sexuality (S). In fact sexual dysfunction (erectile, ejaculatory, libido loss) has been described in 46-92% of cases with a high impact on the quality of life of patients with CP/CPPS. Prostatic ultrasound represents the most popular imaging test in the work-up of either acute and chronic prostatitis although no specific hypo-hyperechoic pattern has been clearly associated with chronic bacterial prostatitis and CPPS. Use of a digital-processing software to calculate the extension of prostatic calcification area at ultrasound demonstrated a higher percentage of prostatic calcification in patients with chronic bacterial prostatitis. Multiparametric Magnetic Resonance Imaging (mpMRI) is the current state-of-the art imaging modality in the assessment of patients with prostate cancer although a variety of benign conditions, including inflammation, may mimic prostate cancer and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions. Bacteria can 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 are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role of Enterococci has been reported. Many strains of these uropathogens exhibit the ability to form biofilm and multidrug- resistance. Sexually Transmitted Infections (STI) agents, in particular Chlamydia trachomatis and Mycoplasma genitalium, have been also considered as causative pathogens of chronic bacterial prostatitis. On the contrary the effective role in genital diseases of other "genital mycoplasmas" is still a much debated issue. Sexually Transmitted Infections agents should be investigated by molecular methods in both patient and sexual partner. “Next generation” investigations, such as cytokine analysis, cytological typing of immune cells could help stratifying the immune response. Epigenetic dysregulation of inflammatory factors should be investigated according to systemic and compartment-specific signals. The search for biomarkers should also include evaluation of hormonal pathways, as measurement of estrogen levels in semen. Antimicrobials are the first line agents for the treatment of bacterial prostatitis. The success of antimicrobial treatment depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations in prostate secretion and prostate tissue. Acute bacterial prostatitis can be a serious infection with a potential risk for urosepsis For iInitial treatment of severely ill patients, intravenous administration of high doses of bactericidal antimicrobials, such as broad-spectrum penicillins, third-generation cephalosporins or fluoroquinolones, is recommended in combination with an aminoglycoside. Use of piperacillin-tazobactam and meropenem is justified in presence of multiresistant gramnegative pathogens. The antibiotic treatment of chronic prostatitis is currently based on the use of fluoroquinolones that, given for 2 to 4 weeks, cured about 70% of men with chronic bacterial prostatitis. For the treatment of Chlamydial prostatitis macrolides were shown to be more effective than fluoroquinolones, whereas no differences were observed in microbiological and clinical efficacy between macrolides and tetracyclines for the treatment of infections caused by intracellular pathogens. Aminoglycosides and fosfomycin could be considered as a therapeutic alternative for the treatment of quinolone resistant prostatitis. Use of alpha-blockers in CP/CPPS patients with urinary symptoms and analgesics +/- non steroidal anti-inflammatory drugs (NSAID), in presence of pain demonstrated a reduction of symptoms reduction and an improvement of quality of life, although long term use of NSAID is limited by side effect profile. However, the multimodal therapeutic regimen by contemporary use of alphablockers, antibiotics and anti-inflammatory showed a better control of prostatitis symptoms than single drug treatment. Novel therapeutic substances for the treatment of pain, such as the cannabinoid anandamide would be highly interesting to test. An alternative for the treatment of chronic prostatitis/chronic pelvic pain syndrome is phytotherapy, as primary therapy or in association with other drugs. Quercetin, pollen extract, extract of Serenoa repens and other mixtures of herbal extracts showed a positive effect on symptoms and quality of life without side effects. The association of CP/CPPS with alterations of intestinal function has been described. Diet has its effects on inflammation by regulation of the composition of intestinal flora and direct action on the intestinal cells (sterile inflammation). Intestinal bacteria (microbiota) interacts with food influencing the metabolic, immune and inflammatory response of the organism. The intestinal microbiota has protective function against pathogenic bacteria, metabolic function by synthesis of vitamins, decomposition of bile acids and production of trophic factors (butyrate), and modulation of the intestinal immune system. The alteration of the microbiota is called “dysbiosis” causing invasive intestinal diseases pathologies (leaky gut syndrome and food intolerances, irritable bowel syndrome or chronic inflammatory bowel diseases) and correlating with numerous systemic diseases including acute and chronic prostatitis. Administration of live probiotics bacteria can be used to regulate the balance if intestinal flora. Sessions of hydrocolontherapy can represent an integration to this therapeutic approach. Finally, microbiological examination of sexual partners can offer supplementary information for treatment.

Background: Mounting worldwide resistance trends make the use of fluoroquinolone (FQ) antibacterial agents increasingly difficult. This is felt more acutely in the case of urogenital infections, which are mainly caused by Gram-negative pathogens. For years, levofloxacin and other FQs have been the first-line drugs for treating National Institutes of Health (NIH) category II chronic bacteria prostatitis (CBP). Eradication rates achieved by levofloxacin in the frame of randomized trials vary greatly, ranging between 71 and 86%. Objectives: This was a retrospective observational study to investigate the efficacy of levofloxacin against CBP in a real-life setting (urological outpatient wards). Methods: A database including the clinical records of >2,500 CBP patients was reviewed. Patients were selected based on strict inclusion criteria. They were treated for 4 weeks with 500 mg levofloxacin per day, alone or combined with other antibacterials. Besides standard urological procedures including the 4-glass test for pathogen isolation, international symptom questionnaires (the NIH Chronic Prostatitis Symptom Index [NIH-CPSI] and International Prostate Symptom Score [IPSS]) were administered. Results: Pathogen eradication was achieved in 79% of the cases treated with levofloxacin as a single agent and 87.8% of patients who received a combination of levofloxacin and azithromycin. The 11% increase in the eradication rate in the latter group is statistically significant. In addition, the levofloxacin-azithromycin combination caused a significant decrease in prostate volume and significantly increased the bladder-voided volume. IPSS and NIH-CPSI values and the urinary peak flow rate decreased to a similar extent in both treatment groups. No adverse effects were reported by patients belonging to either treatment group. Conclusion: Levofloxacin retained its therapeutic efficacy in patients assessed in a real-life setting, and high eradication rates were attained when it was administered as a single agent. A combination of an FQ with azithromycin induced a significant improvement of eradication rates. This strategy may be an interesting option in both first-referral and relapsing cases, although caution should be exercised when patients are at risk of developing arrhythmias, tendinitis, or other adverse effects. [ABSTRACT FROM AUTHOR]

Prostate tuberculosis is considered a rare disease. The established perception is that it occurs mainly in immunosuppressed individuals, however, in recent years, diagnosis of prostate tuberculosis has been described in otherwise healthy patients. Given the low incidence and the consequent lack of familiarity with this disease, we present it's clinical and laboratory characteristics and review the relevant literature on the occasion of two consecutive incidents. [ABSTRACT FROM AUTHOR]

Objective: To investigate the category 2 frequency and microorganism distribution of patients diagnosed with chronic prostatitis in a Turkish population. Methods: Data of 3200 patients diagnosed with chronic prostatitis in the urology outpatient clinic between 2009 and 2014 were retrospectively reviewed. The symptom scores were calculated considering the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) according to pain (0-21 points), quality of life (0-12 points), and urinary (0-10 points) subdomains to a total score of 0-43 points. All patients were checked for symptoms, urinalysis, expressed prostatic secretion (EPS), or urine after prostatic massage (VB3) culture and PCR (Polymerase Chain Reaction) of EPS or VB3 for Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Trichomonas vaginalis. Results: The mean age of the patients was calculated as 37.7±7.4 (range 22-65) years. The average of total NIH-CPSI score was determined as 9.08 (range 1-40). In 223 of 3200 patients, positive culture and/or PCR results were observed. The results were as follows: E. coli 27 (12.1%), E. faecalis 18 (8.1%), S. epidermidis 15 (6.7%), S. haemolyticus 10 (4.5%), S. aureus 5 (2.2%), S. agalactiae 4 (1.8%), Pseudomonas 3 (1.3%), C. trachomatis 24 (10.8%), U. urealyticum 95 (42.6%), M. genitalium 6 (2.7%), M. hominis 14 (6.3%), and T. vaginalis 2 (0.9%). Conclusion: In a Turkish population, category 2 patients constitute 7% of all chronic prostatitis patients. This ratio is consistent with the NIH classification of prostatitis data, but it differs etiologically with U. urealyticum, E. coli, and C. trachomatis being the most proliferated pathogens in our study. [ABSTRACT FROM AUTHOR]

Objective: To date, the management of patients with chronic bacterial prostatitis (CBP) is not satisfactory, especially in terms of symptoms relief. Here, we evaluated the efficacy and the safety of a combination of serenoa repens, selenium and lycopene extract + bromelain and methylsulfonylmethane extract associated with levofloxacin in patients with CBP. Materials and methods: All patients with clinical and instrumental diagnosis of CBP, admitted to a single Urological Institution from March to June 2015 were enrolled in this phase III study. All enrolled patients were randomized into two groups: Group A received levofloxacin 500 mg o.d. for 14 days associated with lycopene and methylsulfonylmethane; Group B received levofloxacin (500 mg o.d. for 14 days) only. Clinical and microbiological analyses were carried out at the time of admission (T0) and during the followups at 1 month (T1) and 6 months (T2) from the end of the treatment. NIH Chronic Prostatitis Symptom Index (CPSI), International Prostatic Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The main outcome measures were the rate of microbiological cure and the improvement in questionnaire results from baseline at the end of the follow-ups period. Results: Forty patients were enrolled in Group A and 39 in Group B. During the follow-up (T1), we recorded a significant changes in terms of NIH-CPSI and IPSS in Group A (mean difference: 17.6 ± 2.65; 12.2 ± 2.33; p < 0.01; p < 0.05, respectively) and versus Group B at the intergroup analysis (mean difference: -9 ± 1.82; -8.33 ± 1.71; p < 0.05; p < 0.05, respectively). No differences were reported in terms of microbiological findings between the two groups. At the second follow-up visit (T2), questionnaire results demonstrated statistically significant differences between groups (p < 0.001). One patient in Group A (2.5%) and 7 patients (17.9%) in Group B showed a symptomatic and microbiological recurrence (p = 0.02). Conclusions: The combination of serenoa repens, selenium, lycopene + bromelain and methylsulfonylmethane extracts improved the clinical efficacy of levofloxacin in patients affected by CBP without the development of side effects.