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The last 2 decades have brought an explosion of research, new products, and general attention to the problem of urinary urgency, and yet patients continue to be plagued by this symptom – especially the elderly. What is it? What does it mean? How can we guide patients successfully through this challenge? This paper presents a review of current thinking about urgency relevant to the practicing clinician, including the epidemiology, pathophysiology, evaluation, and treatment of these patients.

Decades of prostatocentric research and publications have hampered care for men with genital or pelvic pain syndromes who are often misdiagnosed with prostatitis. The prostatitis classification system as well as other misuse of terminology may have direct and indirect influence on physicians and lay persons alike. Taxonomy, medical culture, and gender issues perpetuate the substandard evaluation of men with this condition as well as the continued overuse of antibiotics. Because the vast majority of men with this condition have neither an infection nor a disease of the prostate gland, physicians must alter their approach to these patients. Thankfully, there is growing interest and evidence to show that male pelvic pain can and should be approached more broadly, even as a nonurological condition.

Men with pelvic pain are too often misdiagnosed as having prostatitis, which is a rare infectious condition. Symptoms of pain in the genitalia, perineum, and/or pelvic region with or without lower urinary tract symptoms are most often due to pelvic floor muscle dysfunction, myofascial pain syndromes, neuralgias, and/or central sensitization syndromes also known as functional somatic syndromes. This condition is also associated with sexual pain, dysorgasmia, or prolonged post-ejaculatory discomfort. Men suffering with this condition deserve a more compassionate and comprehensive approach, which is thoroughly explained and justified in this chapter. The end of the chapter includes a review of bacterial prostatitis, which affects only 5 % of men who are erroneously diagnosed with “prostatitis.”

The incidence of metabolic syndrome is growing in the USA and abroad. Many unhealthy habits and abnormal health parameters are associated with MetS, which in turn predispose patients to other serious conditions. The metabolic syndrome (MetS) has been defined as a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, occurring together more often than could be attributed to chance alone. Thyroid dysfunction, dementia, sexual dysfunction, and depression are also possible consequences of MetS. These conditions pose additional challenges, which may contribute to the perpetuation of this vicious cycle through decreasing physical activity and increasing weight.

Sexual function is an essential component of physical and psychological well-being and should be addressed as such in the clinical setting. Because the many facets of sexuality can be influenced by other physical and mental health issues, sexual concerns should be approached as genuine medical problems.

In 2012 the USPSTF published its findings, stating there was no evidence of benefit for PSA screening, citing increased harm secondary to overdiagnosis and treatment. The task force recommended against routine screening in the general population. While there has been a decrease in the use of PSA for prostate cancer screening, other modalities to enhance the specificity of PSA are being explored.

A common urologic diagnosis in men, urologic chronic pelvic pain (UCPP) is often associated with bothersome lower urinary tract symptoms (LUTS), which contribute to the diminished quality of life observed in these patients. The differential diagnosis of LUTS as a separate entity should be considered during evaluation of UCPP patients to exclude other urologic or neurological conditions. However, most patients can be afforded improvement of LUTS as they receive appropriate therapy for UCPP.

BACKGROUND: Prostate cancer is the most frequently diagnosed malignancy in men in the United States, with even higher prevalence and death rates among black men. The authors sought to compare trends in prostate-specific antigen (PSA), age, and prostate-cancer detection among black and white men in our region during a 16-year period. METHODS: This was a retrospective study of patient archives between 1990 through 2006. Data collection was accomplished by examining patients' charts and electronic medical records. Data from 5570 patients, of whom 911 were black, were analyzed statistically by testing and comparing parameters over time. RESULTS: During this 16-year period, mean age at the time of initial diagnostic prostate biopsy did not change in either group, despite what we had believed about the effects of patient education and screening campaigns. However, prostate-cancer detection rates did decrease during the time period studied. Over time, the authors also observed significant decreases in the sensitivity and specificity of PSA as a screening tool. Indeed, analysis of more recent cases demonstrated a positive predictive value comparable to a coin toss. While Gleason scores remained relatively stable over time, reporting of prostate intraepithelial neoplasia (PIN) and inflammation increased. CONCLUSIONS: Using lower PSA thresholds, promoting younger screening age, and increasing efforts to educate the public have not seemed to influence age at time of diagnostic testing, which may reflect other factors such as usefulness of screening, physician referral patterns, patient compliance, and other sociodemographic issues. The usefulness of PSA as a screening tool appears to be diminishing. Cancer 2010. © 2010 American Cancer Society.

Objectives To determine the feasibility of conducting a randomized clinical trial designed to compare two methods of manual therapy (myofascial physical therapy (MPT) and global therapeutic massage (GTM)) among patients with urologic chronic pelvic pain syndromes.

Chronic nonbacterial prostatitis, or urological chronic pelvic pain syndrome (UCPPS), remains a common and often challenging disorder to evaluate and treat. Employing a more holistic approach, including urological therapy, physical therapy, and psychosocial perspectives, may be more appropriate for most patients. Growing evidence supports the use of biofeedback, myofascial trigger point release, prescribed exercise regimens, relaxation techniques, and supportive counseling to treat men with UCPPS.

This article addresses the importance of screening for sexually transmitted diseases as a form of secondary prevention. The differential diagnoses of genital ulcers or inflammatory disorders of the genitourinary tract, with a higher index of suspicion for sexually transmitted disease, are discussed, as well as currently recommended treatment options for the same.

Chronic pelvic pain in men has often been misdiagnosed as prostatitis. After excluding serious or acute urological, neurological or colorectal conditions, it is essential to approach these patients with a much more comprehensive criteria. Thoughtful interview and methodical physical examination can very often reveal pelvic floor muscle dysfunction, Myofascial pain syndromes, Functional Somatic Syndrome/Central Sensitization Syndromes and/or psychosocial distress. One must be aware that many of these syndromes frequently overlap. Acknowledgement of these conditions and validation of both their physical and psychological distress is paramount to creating trust and confidence in the patient. These are the cornerstones for empowerment and self-care required in the management of chronic pelvic pain.

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, a-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.

Objectives To determine the influence of asymptomatic inflammatory processes of the prostate on serum prostate-specific antigen (PSA) levels. Methods A total of 51 patients with no evidence of prostate cancer or clinical prostatitis were prospectively studied. All subjects underwent 10 to 12 sector transrectal-ultrasound guided needle biopsies of the prostate. Serum PSA was measured 10 minutes before the biopsies. The fragments were stained and histologically analyzed. Two different classifications were used. One divided patients according to the number of specimens with inflammatory processes: 20% or less (group 1), more than 20% to 50% or less (group 2), and greater than 50% (group 3). Any kind of inflammatory process was considered positive. The second was the presence or absence of foreign body-type giant cells. Pearson's nonparametric test was used in the statistical analysis, with P Results The number of specimens with an inflammatory process was statistically significant ( P = 0.02), with a median PSA level of 4.96 ng/mL in group 1 patients, 7.40 ng/mL in group 2, and 8.03 ng/mL in group 3 patients. The presence of foreign body-type giant cells in the histologic analysis was not statistically significant, with a median PSA level of 10.21 ng/mL compared with 5.89 ng/mL in the group without these cells. Conclusions The extension of the inflammatory process, as evaluated by the number of specimens involved, was directly related to elevations of serum PSA levels in asymptomatic patients. We could not find a statistically significant relationship between the presence of foreign body-type giant cells and serum PSA levels.

Specific mechanisms underlying chronic pelvic pain syndrome have yet to be identified. However, the disorder has features common to other chronic pain syndromes, such as fibromyalgia and chronic pelvic pain in women. Like other chronic pain patients, men presenting with chronic prostatitis may meet diagnostic criteria for other functional pain syndromes as well as affective disorders, which should be screened for. Finally, as with other chronic pain conditions, chronic nonbacterial prostatitis patients respond very well to non-specific modalities that act to reduce stress and/or muscle tension, including progressive relaxation and biofeedback.

Prostatitis is an inflammation of the prostate that can be produced by various agents, principally bacterial infections. The diagnosis of prostatitis is complex and can be frustrating, both for the patient and for the physician, since in many cases the symptoms are non-specific and hard to control.

Purpose: Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance.Materials and Methods: From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinar...

Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters.A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay.Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens.Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.

The most common form of prostatitis is National Institutes of Health category III, also known as chronic abacterial prostatitis/chronic pelvic pain syndrome. The search for effective and durable therapy for this condition remains frustrating for both patients and physicians. A new approach incorporating a neurobahavioral and musculoskeletal perspective is emerging as a means of diagnosing and treating affected patients. Adopting methods from gynecology, colorectal surgery, and physical therapy has had promising effects in men diagnosed with chronic prostatitis.

Purpose: More than 30 million couples throughout the world are using vasectomy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite the high cost and relatively low success rate of the procedure. We identified characteristics that predict which vasectomy patients may request reversal. We also examined the cost and effectiveness of pre-vasectomy sperm cryopreservation followed by intrauterine insemination as an alternative method of achieving pregnancy.Materials and Methods: We reviewed medical charts of 365 patients who underwent vasectomy and 290 who underwent vasectomy reversal between 1990 and 1997. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children, reason for reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successful pregnancy we...

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.

Prostatitis is a broad term used to describe inflammation of the prostate that may be associated with a myriad of lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. The condition affects 5% to 10% of the male population and is the most common urologic diagnosis in men younger than 50 years. Prostatitis is classified into four categories, including acute and chronic bacterial forms, a chronic abacterial form, and an asymptomatic form. The bacterial forms are more readily recognized and treated, but symptoms in most affected men are not found to have an infectious cause. Indeed, chronic abacterial prostatitis (also known as chronic pelvic pain syndrome) is both the most prevalent form and also the least understood and the most challenging to evaluate and treat. This form of prostatitis may respond to non-prostate-centered treatment strategies such as physical therapy, myofascial trigger point release, and relaxation techniques. Because the various forms of prostatitis call for vastly different treatment approaches, appropriate evaluation, testing, and differential diagnosis are crucial to effective management.

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.

Chronic pelvic pain syndrome (National Institutes of Health Category III [abacterial] prostatitis) is quite prevalent in the urologic outpatient setting. Evaluation to exclude serious urologic pathology and nonurologic causes must be undertaken. Treatment options include pharmacologic, behavioral, and surgical interventions. The author of this article advocates a multidisciplinary approach for the management of patients diagnosed with chronic pelvic pain.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urological diagnosis affecting young and middle aged men. Symptoms of genital or pelvic pain associated with voiding or sexual dysfunction were historically attributed to an inflamed prostate gland. A review of urological and non-urological literature pertaining to CPPS was conducted in order to devise a plausible alternative description of this syndrome. Due to publisher's criteria, only select articles are included and cited for this purpose. Evidence of a bacterial etiology is non-existent, while evidence of prostatic inflammation is conflicting and non-specific. More plausible causes of prostatitis-like symptoms include musculoskeletal pain, pelvic floor muscular dysfunction, myofascial pain syndromes or functional somatic syndromes. Thorough evaluation and appropriate therapy for patients has been seriously hindered by decades of a prostatocentric approach to CP/CPPS. The following article introduces an alternative perspective.

National Institutes of Health Category III prostatitis/ chronic pelvic pain syndrome continues to pose a diagnostic and treatment challenge to most urologists. While this form of so-called prostatitis is the most prevalent and frustrating, little progress has been made in proving an etiology and consequently, in finding an effective remedy. The diagnostic dilemma is illustrated by the conflicting data employed to describe prostatitis. What is prostatitis? Is it a malady of the prostate gland itself? Is it a form of voiding dysfunction? Is it a myofascial pain syndrome? Or, is prostatitis urology’s brand of functional somatic syndrome? It is time we address the dilemma by looking beyond the prostate gland and toward a multidisciplinary perspective.

To diagnose prostatitis correctly and select appropriate therapy, one should use the Meares-Stamey technique for culturing urine and prostatic secretions and apply the classification system for prostatitis devised by the National Institutes of Health. The continuing search for an effective therapy for the most common type, chronic abacterial prostatitis, has led to adoption of treatments from other specialties and reevaluation of standard treatments.

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.

Objectives. An association between prostatitis and male infertility has been suspected, yet is poorly understood. Prostatitis is often associated with granulocytes in the prostatic fluid that generate reactive oxygen species (ROS), known to impair male fertility. We compared ROS, the total antioxidant capacity (TAC), and a novel index of oxidative stress (ROS-TAC score) in patients with chronic prostatitis and in healthy controls. Methods. Semen specimens from 36 men with chronic prostatitis (National Institutes of Health category IIIa), 8 men with prostatodynia (National Institutes of Health category IIIb), and 19 controls attending our urologic clinic were examined according to the World Health Organization criteria. Leukocytospermia was measured by the Endtz test (myeloperoxidase assay). ROS and TAC production was measured by chemiluminescence assay. A composite ROS-TAC score was also calculated in patients and controls. Results. The sperm concentration, percentage of motility, and morphology among the groups did not differ. The mean ± standard error log-transformed ROS level was significantly higher in patients with leukocytospermia (3.2 ± 0.6) than in patients without leukocytospermia (1.8 ± 0.2; P = 0.04) and controls (1.3 ± 0.3, P = 0.01). TAC was significantly lower in patients with or without leukocytospermia (859.69 ± 193.0 and 914.9 ± 65.2, respectively) than in controls (1653.98 ± 93.6, P = 0.001). The mean ROS-TAC score of controls (50.0 ± 4.1) was significantly higher than those of patients with chronic prostatitis and leukocytospermia (8.2 ± 9.2) and those without leukocytospermia (34.2 ± 2.9; P Conclusions. Men with chronic prostatitis or prostatodynia have seminal oxidative stress, irrespective of their leukocytospermia status. These observations may help shed light on the long-standing controversy surrounding prostatitis and infertility.

Objectives. To determine the incidence of Ureaplasma urealyticum in women experiencing chronic urinary symptoms and to determine whether antibiotic therapy targeting these organisms is effective. Methods. Forty-eight consecutive women referred to our academic medical center for chronic voiding symptoms and possible interstitial cystitis underwent urologic evaluation, including culture screening for U. urealyticum and Mycoplasma hominis. Patients with positive cultures were treated with a 1-g dose of azithromycin; persistent infection was treated with 7 days of doxycycline, ofloxacin, or erythromycin. Patients reported symptom severity (0, mild; 3, severe) and voiding frequency before and 6 months after treatment. Results. Positive cultures were obtained in 23 (48%) of 48 patients; 22 had U. urealyticum and 1 had M. hominis. All had negative cultures after treatment. The mean symptom severity score improved with treatment (2.2 to 0.7, P