View text source at Wikipedia

Chronic bacterial prostatitis

Chronic bacterial prostatitis
Other namesCBP
SpecialtyUrology Edit this on Wikidata

Chronic bacterial prostatitis (CBP) is a bacterial infection of the prostate gland and a form of prostatitis (prostate inflammation). It should be distinguished from other forms of prostatitis such as acute bacterial prostatitis (ABP) and chronic pelvic pain syndrome (CPPS).[1]

Signs and symptoms

[edit]

Chronic bacterial prostatitis is a relatively rare condition that usually presents with an intermittent UTI-type picture. It is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.[2] It has been said that recurrent and relapsing UTIs (i.e., UTIs due to the same pathogen) are a hallmark of chronic bacterial prostatitis.[3][4][5]

Chronic bacterial prostatitis occurs in less than 5% of patients with prostate-related non-BPH lower urinary tract symptoms (LUTS).[citation needed]

Dr. Weidner, Professor of Medicine, Department of Urology, University of Gießen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were E-coli."[6]

Causes

[edit]

Chronic bacterial prostatitis is thought to be caused by ascending urethral infection and by reflux into the ejaculatory duct or prostatic ducts.[7] Risk factors for chronic bacterial prostatitis include functional or anatomic abnormalities, catheterization, prostate biopsy or urethritis (due to sexually transmitted infections), and unprotected penetrative anal sex.[7] In theory, the ability of some strains of bacteria to form biofilms might be one of the factors that facilitate the development of chronic bacterial prostatitis.[8] Recurrent infections may be caused by inefficient urination (benign prostatic hyperplasia, neurogenic bladder), prostatic stones, or a structural abnormality that acts as a reservoir for infection.[citation needed]

Diagnosis

[edit]

In chronic bacterial prostatitis, there are bacteria in the prostate, but there may be no symptoms or milder symptoms than occur with acute prostatitis.[9] The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor performing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria.[citation needed]

Prostate specific antigen levels may be elevated, although there is no malignancy. Semen analysis is a useful diagnostic tool.[10] Semen cultures are also performed. Antibiotic sensitivity testing is also done to select the appropriate antibiotic. Other useful markers of infection are seminal elastase and seminal cytokines.[citation needed]

Treatment

[edit]

Curative therapy

[edit]

Antibiotics

[edit]

Antibiotics are effective in the treatment of chronic bacterial prostatitis and are a first-line therapy for the condition.[11] A blood–prostate barrier exists that prevents many antibiotics from penetrating the prostate and achieving adequate antibacterial concentrations.[12][13][14] As such, only certain classes of antibiotics are effective and recommended for treatment of chronic bacterial prostatitis.[11][15] These include fluoroquinolones like ciprofloxacin and levofloxacin; trimethoprim; tetracyclines like doxycycline; and macrolides like azithromycin and clarithromycin.[11][15] Fluoroquinolones are the first-line antibiotics for chronic bacterial prostatitis, whereas trimethoprim and tetracyclines are second-line antibiotics and azithromycin is reserved for special situations.[11][15] Fosfomycin has also been repurposed for chronic bacterial prostatitis and is increasingly being employed in its treatment.[15][16] Antibiotic therapy of chronic bacterial prostatitis requires prolonged antibiotic courses of generally 4 to 6 weeks of treatment, but up to 12 weeks of treatment.[11][15][7] Microbiological eradication rates have ranged from 40 to 77% for ciprofloxacin, 75 to 86% for levofloxacin, 77% for doxycycline, 80% for azithromycin, 80% for clarithromycin, and 62 to 77% for a combination of ciprofloxacin and azithromycin.[11][17] Although antibiotics are effective in the curative treatment of chronic bacterial prostatitis, recurrence rates are high and range from 25 to 50%.[18]

Levofloxacin (the levorotatory enantiomer of ofloxacin) has been found to reach prostatic fluid concentrations that are 5.5 times higher than those of the same dose of ciprofloxacin.[19][20][21] These findings indicate that levofloxacin has a greater ability to penetrate the prostate than ciprofloxacin and suggest that it might be comparatively more effective in the treatment of chronic bacterial prostatitis.[19][20][21] However, clinical findings have been mixed, with one large clinical trial finding that levofloxacin was more effective than ciprofloxacin (bacterial eradication rate = 86% vs. 60%; clinical cure/improvement = 93% vs. 72%; bacterial recurrence rate = 4% vs. 19%) and another similarly large trial finding that they were equivalent (bacterial eradication rate = 75% vs. 77%; clinical cure/improvement = 75% vs. 73%).[11][19][17][22] Moxifloxacin shows even greater prostatic penetration than levofloxacin as well as a broader spectrum of antibacterial activity.[23][18] It may be the only fluoroquinolone able to obtain prostatic concentrations that are 10-fold above the minimum inhibitory concentration (MIC) against Enterococcus faecalis.[18] However, limited experience with and data on moxifloxacin for chronic bacterial prostatitis are available as of 2022.[18][23] Another limitation of moxifloxacin for such purposes is that it may have greater safety concerns than other fluoroquinolones, for instance higher cardiovascular risks.[23]

Aside from moxifloxacin, certain other antibiotics with the potential for improved activity, including linezolid, tigecycline, daptomycin, clindamycin, and vancomycin, have also been used limitedly off-label in the treatment of chronic bacterial prostatitis with reported success.[23][15] Antibiotics with poor prostatic penetration that may not be suitable for curative treatment of chronic bacterial prostatitis include nitrofurantoin,[24][25][16][12] sulfamethoxazole, aminoglycosides, and β-lactams (except some cephalosporins), among others.[7][12] Findings on the penetration of amoxicillin into the prostate are inconsistent, with prostate tissue levels of 0.77 to 26.4 μg/mL reported in two different studies.[12][26] Clinical findings of amoxicillin/clavulanic acid for treatment of chronic bacterial prostatitis are also mixed, with reports of high rates of both success[25][27][28] and failure.[29][30]

Prostatectomy

[edit]

In some men, chronic bacterial prostatitis can be severe and highly refractory to treatment or relapsing.[31][32] In addition, it can be life-threatening due to urinary tract infections (UTIs).[32] Prostatectomy, or prostate removal surgery, has been used rarely and in well-selected patients to treat these kinds of cases.[31][32] A 2017 systematic review evaluated prostatectomy for chronic prostatitis.[31] Transurethral resection of the prostate (TURP) by electrocautery was done in 110 patients, and in these individuals, symptoms were cured in 70%, improved in 15%, and unchanged in 15%.[31] Radical prostatectomy was done in 21 patients and resulted in symptoms being cured in 95%.[31] There are significant rates of erectile dysfunction and urinary incontinence with prostatectomy.[31][32] These complications can be reduced with minimally invasive and nerve-sparing surgical techniques, such as robotically assisted radical prostatectomy or laparoscopic prostatectomy.[31][32] However, significant rates of complications still occur even with minimally invasive forms of prostatectomy.[31][32] All of the studies in the 2017 systematic review were prospective or retrospective case series and there were no randomized controlled trials.[31] As such, little evidence is available to inform clinical decision-making in terms of prostatectomy for chronic prostatitis.[31]

Other treatments

[edit]

The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial and prostate massage may mechanically break up the biofilm and enhance the drainage of the prostate gland.[33][34] However, in more recent trials, this was not shown to improve outcome compared to antibiotics alone.[35]

Bacteriophages hold promise as another potential treatment for chronic bacterial prostatitis.[7][36]

Symptomatic and suppressive therapy

[edit]

Persistent infections may be helped in 80% of patients by the use of alpha blockers (α1-adrenergic receptor antagonists) or by long-term low-dose antibiotic therapy.[11][24][37] Alpha blockers, including tamsulosin, alfuzosin, and doxazosin among others, are used specifically in the management of voiding lower urinary tract symptoms (LUTS) like slow urinary flow or urinary hesitancy, although they might also help with pain and other symptoms.[11] However, their effectiveness is modest and the clinical significance has been questioned.[11] Possibilities for low-dose suppressive antibiotic therapy include nitrofurantoin, trimethoprim/sulfamethoxazole, fluoroquinolones, cephalosporins, and tetracyclines.[24][37] Prostate-penetrant nonsteroidal anti-inflammatory drugs (NSAIDs), like celecoxib and rofecoxib, as well as possibly ibuprofen, naproxen, and diclofenac, can also be used as analgesics to treat pain and inflammation in chronic bacterial prostatitis.[7][38]

Methenamine is a urinary antiseptic and antibacterial agent which is used in the prevention of recurrent urinary tract infections (UTIs).[39] It is non-inferior to low-dose prophylactic antibiotics for this purpose.[40][41][42] In contrast however, methenamine itself is not an antibiotic and does not promote antibiotic resistance.[39][40] The drug works by being selectively and pH-dependently decomposed in acidic environments like the bladder into the active form formaldehyde, which is potently bactericidal.[39] Since formaldehyde is only formed from methenamine in acidic environments, it is not expected to be effective in the curative treatment of chronic bacterial prostatitis, and hence is not recommended for such purposes.[39] Methenamine decomposes into formaldehyde at a pH of below 6,[39] whereas the normal pH of prostatic fluid is 6.5 to 6.7 and in chronic prostatitis the pH is 7.0 to 8.3.[12] However, in persistent chronic bacterial prostatitis, prophylactic methenamine may be useful as an alternative to low-dose prophylactic antibiotics in preventing prostatitis-derived UTIs and managing associated symptoms.[24] Prophylactic low-dose methenamine combined with an ascorbic acid (vitamin C) supplement, which is theorized to enhance its activity by making the urine more acidic, has been reported to be effective for this purpose based on clinical experience.[24] In any case, supporting clinical data for this use are lacking as of 2020.[24]

Androgen deprivation therapy with surgical castration, estrogens, and the 5α-reductase inhibitor finasteride have shown beneficial effects on chronic bacterial prostatitis in terms of bacterial growth and inflammation in animal models, but clinical studies in humans have not been performed.[18][43][44]

Prognosis

[edit]

Over time, the relapse rate is high, exceeding 50%. However, recent research indicates that combination therapies offer a better prognosis than antibiotics alone.

A 2007 study showed that repeated combination pharmacological therapy with antibacterial agents (ciprofloxacin/azithromycin), alpha-blockers (alfuzosin) and Serenoa repens extracts may eradicate infection in 83.9% of patients with clinical remission extending throughout a follow-up period of 30 months for 94% of these patients.[45]

A 2014 study of 210 patients randomized into two treatment groups found that recurrence occurred within 2 months in 27.6% of the group using antibiotics alone (prulifloxacin 600 mg), but in only 7.8% of the group taking prulifloxacin in combination with Serenoa repens extract, Lactobacillus sporogens (now Heyndrickxia coagulans), and arbutin (a combination referred to by the name "Lactorepens").[46]

Large prostatic stones was shown to be related with the presence of bacteria,[47] a higher urinary symptoms and pain score, a higher IL-1β and IL-8 concentration in seminal plasma, a greater prostatic inflammation and a lower response to antibiotic treatment.[48]

Epidemiology

[edit]

In a 2008 systematic review of 10,617 men, 8.2% had experienced prostatitis symptoms.[11][49] It has been estimated that 35 to 50% of men may be affected by prostatitis symptoms during their lifetime.[11]

Additional images

[edit]

References

[edit]
  1. ^ Holt JD, Garrett WA, McCurry TK, Teichman JM (February 2016). "Common Questions About Chronic Prostatitis". American Family Physician. 93 (4): 290–6. PMID 26926816.
  2. ^ Habermacher GM, Chason JT, Schaeffer AJ (2006). "Prostatitis/chronic pelvic pain syndrome". Annual Review of Medicine. 57 (1): 195–206. doi:10.1146/annurev.med.57.011205.135654. PMID 16409145.
  3. ^ Najar MS, Saldanha CL, Banday KA (October 2009). "Approach to urinary tract infections". Indian J Nephrol. 19 (4): 129–39. doi:10.4103/0971-4065.59333. PMC 2875701. PMID 20535247.
  4. ^ Lipsky BA, Byren I, Hoey CT (June 2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
  5. ^ Wright ET, Chmiel JS, Grayhack JT, Schaeffer AJ (December 1994). "Prostatic fluid inflammation in prostatitis". J Urol. 152 (6 Pt 2): 2300–3. doi:10.1016/s0022-5347(17)31662-2. PMID 7966728.
  6. ^ Schneider H, Ludwig M, Hossain HM, Diemer T, Weidner W (October 2003). "The 2001 Giessen Cohort Study on patients with prostatitis syndrome--an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis". Andrologia. 35 (5): 258–62. doi:10.1046/j.1439-0272.2003.00586.x. PMID 14535851. S2CID 21022117.
  7. ^ a b c d e f Marquez-Algaba E, Burgos J, Almirante B (June 2022). "Pharmacotherapeutic interventions for the treatment of bacterial prostatitis". Expert Opin Pharmacother. 23 (9): 1091–1101. doi:10.1080/14656566.2022.2077101. PMID 35574695.
  8. ^ Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, et al. (August 2013). "Bacterial prostatitis". World Journal of Urology. 31 (4): 711–6. doi:10.1007/s00345-013-1055-x. PMID 23519458. S2CID 1925596.
  9. ^ "Prostatitis - Symptoms". NHS Choices. 2017-10-19.
  10. ^ Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. (July 2009). "Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications". Asian Journal of Andrology. 11 (4): 461–77. doi:10.1038/aja.2009.5. PMC 3735310. PMID 19377490.
  11. ^ a b c d e f g h i j k l Rees J, Abrahams M, Doble A, Cooper A (October 2015). "Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline". BJU Int. 116 (4): 509–525. doi:10.1111/bju.13101. PMC 5008168. PMID 25711488.
  12. ^ a b c d e Charalabopoulos K, Karachalios G, Baltogiannis D, Charalabopoulos A, Giannakopoulos X, Sofikitis N (December 2003). "Penetration of antimicrobial agents into the prostate" (PDF). Chemotherapy. 49 (6): 269–279. doi:10.1159/000074526. PMID 14671426. S2CID 14731590. Good to excellent penetration into prostatic fluid and tissue has been demonstrated with many antimicrobial agents, including tobramycin, netilmicin, tetracyclines, macrolides, quinolones, sulfonamides and nitrofurantoin. [...] Nitrofurantoin is a lipid-soluble weak acid with a pKa value that is somewhat favorable for diffusion into prostatic fluid [78]. Although low levels of nitrofurantoin were achieved in prostatic fluid in dogs, the administration of standard oral doses of this drug to men results in levels of ≤1 μg/ml of blood; such levels guarantee that the levels attained in prostatic fluid will be nontherapeutic.
  13. ^ Fulmer BR, Turner TT (May 2000). "A blood-prostate barrier restricts cell and molecular movement across the rat ventral prostate epithelium". The Journal of Urology. 163 (5): 1591–1594. doi:10.1016/S0022-5347(05)67685-9. PMID 10751894.
  14. ^ Barza M (January 1993). "Anatomical barriers for antimicrobial agents". European Journal of Clinical Microbiology & Infectious Diseases. 12 (Suppl 1): S31–S35. doi:10.1007/BF02389875. PMID 8477760. S2CID 23753756.
  15. ^ a b c d e f Lam JC, Lang R, Stokes W (January 2023). "How I manage bacterial prostatitis". Clin Microbiol Infect. 29 (1): 32–37. doi:10.1016/j.cmi.2022.05.035. PMID 35709903.
  16. ^ a b Chou A, Welch E, Hunter A, Trautner BW (March 2022). "Antimicrobial Treatment Options for Difficult-to-Treat Resistant Gram-Negative Bacteria Causing Cystitis, Pyelonephritis, and Prostatitis: A Narrative Review". Drugs. 82 (4): 407–438. doi:10.1007/s40265-022-01676-5. PMC 9057390. PMID 35286622. We agree with guidelines [270] recommending fluoroquinolones, trimethoprim, and tetracyclines for treatment of chronic bacterial prostatitis, if the causative organism is susceptible. Emerging pharmacologic and clinical data also support the use of oral fosfomycin 3g every 2 days for 6–12 weeks for treatment of chronic bacterial prostatitis [256, 266, 271]. We avoid prescribing nitrofurantoin due to concerns of poor prostatic concentration [265].
  17. ^ a b Zhang ZC, Jin FS, Liu DM, Shen ZJ, Sun YH, Guo YL (November 2012). "Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients". Asian J Androl. 14 (6): 870–874. doi:10.1038/aja.2012.48. PMC 3720113. PMID 22864282.
  18. ^ a b c d e Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, Chen L, Wang G, Fu B (2020). "Pharmacological Interventions for Bacterial Prostatitis". Front Pharmacol. 11: 504. doi:10.3389/fphar.2020.00504. PMC 7203426. PMID 32425775.
  19. ^ a b c Naber KG (April 2004). "Levofloxacin in the treatment of urinary tract infections and prostatitis". J Chemother. 16 Suppl 2: 18–21. doi:10.1080/1120009x.2004.11782369. PMID 15255558.
  20. ^ a b Naber KG (2009). "Levofloxacin and its effective use in the management of bacterial prostatitis" (PDF). Penetration: 21–26. Archived from the original (PDF) on 2017-08-09. Retrieved 2016-02-08.
  21. ^ a b Bulitta J, Kinzig-Schippers M, Naber CK, Naber KG, Sauber C, Kleinschnitz M, Wahode H, Rodamer M, Sörgel F (2000). Limitations in the Use of drug cocktails (DC) to compare pharmacokinetics (PK) of drugs: ciprofloxacin (CIP) vs. levofloxacin (LEV) [poster No. 506]. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 17–20, 2000; Toronto, Canada.
  22. ^ Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA, Wright PA, Wu SC, Zadeikis N, Kahn JB (September 2003). "Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study". Urology. 62 (3): 537–541. doi:10.1016/s0090-4295(03)00565-x.
  23. ^ a b c d Perletti G, Trinchieri A, Stamatiou K, Magri V (February 2022). "Safety considerations with new antibacterial approaches for chronic bacterial prostatitis". Expert Opin Drug Saf. 21 (2): 171–182. doi:10.1080/14740338.2021.1956459. PMID 34260337. S2CID 235907298.
  24. ^ a b c d e f Su ZT, Zenilman JM, Sfanos KS, Herati AS (June 2020). "Management of Chronic Bacterial Prostatitis". Curr Urol Rep. 21 (7): 29. doi:10.1007/s11934-020-00978-z. PMID 32488742. Chronic oral antibiotic suppression for men with persistent or recurrent prostatic infections despite antibiotic treatment is frequently used in clinical practice, even though supporting data are presently lacking [2, 18]. This approach appears to be generally effective, so long as suppression can be maintained [17]. Suitable choices include nitrofurantoin, trimethoprim-sulfamethoxazole, methenamine, fluoroquinolones, cephalosporins, tetracyclines, or any agent previously effective for the isolated pathogen. [...] In our experience, many patients who previously struggled with symptomatic recurrences have been well controlled with chronic low-dose prophylaxis with methenamine combined with a vitamin C supplement. However, the long-term utility of prophylaxis with methenamine therapy is not well documented in the existing literature [60].
  25. ^ a b Lipsky BA, Byren I, Hoey CT (June 2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–1652. doi:10.1086/652861. PMID 20459324. Nitrofurantoin prostatic levels are likely nontherapeutic.
  26. ^ Pilmis B, Lécuyer H, Lortholary O, Charlier C (November 2015). "Enterococcus faecalis-related prostatitis successfully treated with moxifloxacin". Antimicrob Agents Chemother. 59 (11): 7156–7157. doi:10.1128/AAC.01988-15. PMC 4604358. PMID 26349832. The treatment of enterococcal prostatitis remains a challenge because of the paucity of antibiotics achieving both bactericidal effect and good prostatic diffusion. Indeed, prostatic concentrations of amoxicillin have not been consistently assessed, with concentrations varying from 0.77 to 26 μg/ml (2).
  27. ^ Bowen DK, Dielubanza E, Schaeffer AJ (August 2015). "Chronic bacterial prostatitis and chronic pelvic pain syndrome". BMJ Clin Evid. 2015. PMID 26313612. Amoxicillin-clavulanic acid (co-amoxiclav) and clindamycin. One case series included 50 men resistant to empirical treatment with quinolones. The expressed prostatic secretions from 24 of these men exhibited high colony counts of gram-positive and gram-negative anaerobic bacteria, either alone (18 men) or in combination with aerobic bacteria (6 men). After treatment with either amoxicillin-clavulanic acid or clindamycin for 3 to 6 weeks, all men had a decrease or total elimination of symptoms, and no anaerobic bacteria were detected in prostatic secretions.
  28. ^ Szöke I, Török L, Dósa E, Nagy E, Scultéty S (June 1998). "The possible role of anaerobic bacteria in chronic prostatitis". Int J Androl. 21 (3): 163–168. doi:10.1111/j.1365-2605.1998.00110.x. PMID 9669200. Patients with chronic prostatitis who gave positive culture results for anaerobes were treated with amoxicillin/clavulanic acid or clindamycin for 3-6 weeks. After treatment, samples were again taken and cultured for all pathogens known to cause prostatitis. These post-therapeutic samples revealed a decrease or total elimination of the symptoms, and no anaerobic bacteria could be detected.
  29. ^ Benway BM, Moon TD (February 2008). "Bacterial prostatitis". Urologic Clinics of North America. 35 (1): 23–32, v. doi:10.1016/j.ucl.2007.09.008. PMID 18061021. Although penicillin derivatives have a reported role in the treatment of acute bacterial prostatitis, one study found that no patients treated with amoxicillin/clavulanic acid had resolution of their prostatitis [7,60].
  30. ^ Shoskes DA, Zeitlin SI (May 1999). "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer Prostatic Dis. 2 (3): 159–162. doi:10.1038/sj.pcan.4500308. PMID 12496826. In the NIH category II patients, there was no correlation between type of organism isolated or antibiotic used with response to therapy with the exception that no patient treated with [amoxicillin]–clavulonic acid had a complete and durable response.
  31. ^ a b c d e f g h i j Schoeb DS, Schlager D, Boeker M, Wetterauer U, Schoenthaler M, Herrmann TR, Miernik A (November 2017). "Surgical therapy of prostatitis: a systematic review". World J Urol. 35 (11): 1659–1668. doi:10.1007/s00345-017-2054-0. PMID 28612108. S2CID 9256455.
  32. ^ a b c d e f Orji PU, Khooblall P, Doolittle J, Lundy SD, Shoskes D (October 2023). "Surgical management of National Institutes of Health category II chronic bacterial prostatitis: a case series and scoping review of the literature". Transl Androl Urol. 12 (10): 1581–1588. doi:10.21037/tau-23-142. PMC 10643389. PMID 37969767.
  33. ^ Nickel JC, Downey J, Feliciano AE, Hennenfent B (September 1999). "Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience". Techniques in Urology. 5 (3): 146–51. PMID 10527258.
  34. ^ Shoskes DA, Zeitlin SI (May 1999). "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer and Prostatic Diseases. 2 (3): 159–162. doi:10.1038/sj.pcan.4500308. PMID 12496826.
  35. ^ Ateya A, Fayez A, Hani R, Zohdy W, Gabbar MA, Shamloul R (April 2006). "Evaluation of prostatic massage in treatment of chronic prostatitis". Urology. 67 (4): 674–8. doi:10.1016/j.urology.2005.10.021. PMID 16566972.
  36. ^ Letkiewicz S, Międzybrodzki R, Kłak M, Jończyk E, Weber-Dąbrowska B, Górski A (November 2010). "The perspectives of the application of phage therapy in chronic bacterial prostatitis". FEMS Immunology and Medical Microbiology. 60 (2): 99–112. doi:10.1111/j.1574-695X.2010.00723.x. PMID 20698884.
  37. ^ a b Shoskes DA, Hakim L, Ghoniem G, Jackson CL (April 2003). "Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome". The Journal of Urology. 169 (4): 1406–10. doi:10.1097/01.ju.0000055549.95490.3c. PMID 12629373.
  38. ^ Appiya Santharam M, Khan FU, Naveed M, Ali U, Ahsan MZ, Khongorzul P, Shoaib RM, Ihsan AU (August 2019). "Interventions to chronic prostatitis/Chronic pelvic pain syndrome treatment. Where are we standing and what's next?". European Journal of Pharmacology. 857: 172429. doi:10.1016/j.ejphar.2019.172429. PMID 31170381.
  39. ^ a b c d e Lo TS, Hammer KD, Zegarra M, Cho WC (May 2014). "Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era". Expert Rev Anti Infect Ther. 12 (5): 549–554. doi:10.1586/14787210.2014.904202. PMID 24689705.
  40. ^ a b Gu C, Ackerman AL (June 2023). "An oldie but a goodie: Methenamine as a nonantibiotic solution to the prevention of recurrent urinary tract infections". PLOS Pathog. 19 (6): e1011405. doi:10.1371/journal.ppat.1011405. PMC 10270343. PMID 37319137.
  41. ^ Li JM, Cosler LE, Harausz EP, Myers CE, Kufel WD (February 2024). "Methenamine for urinary tract infection prophylaxis: A systematic review". Pharmacotherapy. 44 (2): 197–206. doi:10.1002/phar.2895. PMID 37986168.
  42. ^ Davidson SM, Brown JN, Nance CB, Townsend ML (March 2024). "Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence". Int Urogynecol J. 35 (3): 483–489. doi:10.1007/s00192-024-05726-2. PMID 38329493.
  43. ^ Lee CB, Ha US, Yim SH, Lee HR, Sohn DW, Han CH, Cho YH (2011). "Does finasteride have a preventive effect on chronic bacterial prostatitis? Pilot study using an animal model". Urol Int. 86 (2): 204–209. doi:10.1159/000320109. PMID 21273757.
  44. ^ Seo SI, Lee SJ, Kim JC, Choi YJ, SW SW, Hwang TK, Cho YH (September 2003). "Effects of androgen deprivation on chronic bacterial prostatitis in a rat model". Int J Urol. 10 (9): 485–491. doi:10.1046/j.1442-2042.2003.00666.x. PMID 12941127.
  45. ^ Magri V, Trinchieri A, Pozzi G, Restelli A, Garlaschi MC, Torresani E, et al. (May 2007). "Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis". International Journal of Antimicrobial Agents. 29 (5): 549–56. doi:10.1016/j.ijantimicag.2006.09.027. PMID 17336504.
  46. ^ Busetto GM, Giovannone R, Ferro M, Tricarico S, Del Giudice F, Matei DV, et al. (July 2014). "Chronic bacterial prostatitis: efficacy of short-lasting antibiotic therapy with prulifloxacin (Unidrox®) in association with saw palmetto extract, lactobacillus sporogens and arbutin (Lactorepens®)". BMC Urology. 14 (1): 53. doi:10.1186/1471-2490-14-53. PMC 4108969. PMID 25038794.
  47. ^ Mazzoli, Sandra (August 2010). "Biofilms in chronic bacterial prostatitis (NIH-II) and in prostatic calcifications". FEMS Immunology and Medical Microbiology. 59 (3): 337–344. doi:10.1111/j.1574-695X.2010.00659.x. ISSN 1574-695X. PMID 20298500.
  48. ^ Soric, Tomislav; Selimovic, Mirnes; Bakovic, Lada; Šimurina, Tatjana; Selthofer, Robert; Dumic, Jerka (2017). "Clinical and Biochemical Influence of Prostatic Stones". Urologia Internationalis. 98 (4): 449–455. doi:10.1159/000455161. ISSN 1423-0399. PMID 28052296. S2CID 4927272.
  49. ^ Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE (February 2008). "Epidemiology of prostatitis". Int J Antimicrob Agents. 31 Suppl 1 (Suppl 1): S85–S90. doi:10.1016/j.ijantimicag.2007.08.028. PMC 2292121. PMID 18164907.
[edit]