Prostatitis: Etiopathology, Diagnosis and Therapy PDF
Preview Prostatitis: Etiopathology, Diagnosis and Therapy
W. Weidner P.O. Madsen H.G. Schiefer {Eds.} Prostatitis Etiopathology, Diagnosis and Therapy With 58 Figures and 52 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest Prof. Dr. Wolfgang Weidner U rologische Klinik Klinikum der lustus-Liebig-Universitat Klinikstr. 29 35392 Giessen, Germany Prof. Dr. PaulO. Madsen Veterans Administration Medical Center and Department of Surgery University of Wisconsin School of Medicine 2500 Overlook Terrace Madison, Wisconsin 53705, USA Prof. Dr. Hans Gerd Schiefer Institut fiir Medizinische Mikrobiologie Klinikum der lustus-Liebig-Universitat Schubertstr. 1 35392 Giessen, Germany ISBN-13:978-3-642-78183-4 e-ISBN-13:978-3-642-78181-0 DOl: 10.1007/978-3-642-78181-0 Library of Congress Cataloging-in-Publication Data. Prostatitis: etiopathology, diagnosis and therapy / W. Weidner, P.O. Madsen, H.G. Schiefer (eds.) p. em. Includes bibliographical references and index. ISBN-13:978-3-642-78183-4 1. Prostatitis. I. Weidner, W. (Wolfgang) II. Madsen, PaulO., 1927- III. Schiefer, H.G. (Hans Gerd). RC899.P77 1994 616.6'5 - dc20 93-29539 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations; recitation, broadcasting reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1994 Sol'!cover reprint of the hardcover 1s t edition 1994 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting: Macmillan India Ltd., Bangalore-25 SPIN: 10083393 31/3130/SPS - 5 4 3 2 1 0 - Printed on acid-free paper Contributors Ameye, F. Department of Urology, University Hospitals Leuven, UZ. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Baert, L. Department of Urology, University Hospitals Leuven, UZ. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Blacklock, N.J. 42 Western Way, Alverstoke, Gosport, Hampshire POl2 2NQ, UK Brahler, E. Klinik und Poliklinik fUr Psychotherapie und Psychosomatische Medizin der Universitat, Karl-Tauchnitz-Str. 25, 04107 Leipzig, Germany Ceri, H Department of Biological Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada Clements, R. Department of Clinical Radiology, Royal Gwent Hospital, Newport, Gwent NP9 2UB, UK De Ridder, D. Department of Urology, University Hospitals Leuven, UZ. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Doble, A. Department of Urology, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK Drescher, P. Veterans Administration Medical Center and Department of Surgery, University of Wisconsin School of Medicine, 2500 Overlook Terrace, Madison, Wisconsin 53705, USA VI Contributors Frick,1. Landeskrankenanstalten, Urologische Abteilung, Mullner Hauptstr. 48, 5020 Salzburg, Austria e. Gasser, T. Urologische UniversiHitsklinik, Department fUr Chirurgie der Universitat Basel, Kantonsspital, 4031 Basel, Switzerland Griffiths, G.1. Department of Clinical Radiology, Royal Gwent Hospital, Newport, Gwent NP9 2UB, UK Herremans, D. Department of Urology, University Hospitals Leuven, U.Z. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Hofstetter, A.G. Urologische Klinik und Poliklinik der Universitat, Klinikum GroBhadern, Marchioninistr. 15,81377 Munchen, Germany Kawamura, N. Department of Urology, Tokai University School of Medicine, Boseidai, Isehara, Kanagawa 259-11, Japan Krause, W. Abteilung fUr Dermatologie mit Schwerpunkt Andrologie, Medizinisches Zentrum fUr Hautkrankheiten der Universitat, Deutschhaussstr. 9, 35037 Marburg, Germany Ludwig, M. Klinik und Poliklinik fur Urologie der Universitat, Robert-Koch-Str. 40, 37075 Gottingen, Germany Madsen, P.O. Veterans Administration Medical Center and Department of Surgery, University of Wisconsin School of Medicine, 2500 Overlook Terrace, Madison, Wisconsin 53705, USA Naber, K.G. Urologische Klinik, Elisabeth Krankenhaus, Schulgasse 20, 94315 Straubing, Germany Nickel, J.e. Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario K7L 2V7, Canada Contributors VII Olson, M.E. Department of Biological Sciences, University of Calgary, Calgary, Alberta T2N IN4, Canada Peeling, WB. St. Woolos Hospital, South Gwent Health Unit, 131 Stow Hill, Newport, Gwent NP9 4SZ, UK Petrovich, Z. Department of Urology, University Hospitals Leuven, U.Z. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Pfau, A. Department of Urology, Hebrew University - Hadassah Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel Schaeffer, A.J. Department of Urology, Northwestern University Medical School, 303 E. Chicago Avenue, Chicago, Illinois 60611, USA Schiefer, H.G. Institut fiir Medizinische Mikrobiologie der Universitat, Schubertstr. 1, 35392 Giessen, Germany Taylor-Robinson, D. Division of Sexually Transmitted Diseases, Clinical Research Centre, Watford Road, Harrow, Middlesex HAl 3UJ, UK Thin, R.NT. Department of Genitourinary Medicine, St. Thomas' Hospital, London SE1 7EH, UK Vahlensieck, W Jr. Urologische Klinik und Poliklinik der Universitat, Klinikum GroBhadern, Marchioninistr. 15, 81377 Miinchen, Germany Van Poppel, H. Department of Urology, University Hospitals Leuven, HZ. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Van Th illo , E. Department of Urology, University Hospitals Leuven, U.Z. Sint-Pieter, Brusselsestraat 69, 3000 Leuven, Belgium Weidner, W Urologische Universitatsklinik, Klinikstr. 29, 35392 Giessen, Germany Preface Prostatitis syndromes continue to be a major problem in urology. About every second man will experience symptoms of prostatitis during his lifetime. A study by the U.S. National Center for Health Statistics showed that approximately 25% of the men seen for urogenital problems suffer from prostatitis. What is the intention of this book? Although investigations in recent years, including microbiologic and immunologic ones, have focused on the correct diagnosis of prostatitis, much confusion still remains regarding its correct classification, its etiology, and the evaluation of diagnostic results. Many clinicians, therefore, tend to lump together several diseases of variable type and sequela as prostatitis. The term "prostatitis" implies an inflammatory disease, but true bacterial infection is detected in only 5 %-1 0% of patients. In fact, most patients reveal no significant bacterial counts in the prostatic fluid. Nonetheless, 40%-60% of these patients suffer from non bacterial prostatitis, as shown by the fact that the prostatic fluid contains elevated leukocyte counts while common uropathogens are not detected. Essentially, three clinical types of real inflammatory prostatitis are widely accepted: acute and chronic bacterial and nonbacterial prostatitis. There re mains a condition denoted as prostatodynia, covering patients in whom signs of neither inflammation nor infection are found. Multiple extraprostatic disorders are suspected causes of these complaints, e.g., bladder outlet disorders, detrusor hyperreflexia, pelvic floor tension myalgia, interstitial cystitis, urolithiasis, ostitis pubis, and anogenital disorders. Proven data concerning these special problems are rare, and their association to prostatodynia is unclear. The intention of this book is to provide the reader with a clarification of the etiopathogenesis of prostatitis and the competence to exclude the patient with complaints and symptoms of prostatitis but without true prostatic inflammation, i.e., to identify the man suffering from prostatodynia, thus preventing multiple and useless antibiotic trials. Instead, if the diagnosis prostatodynia is clarified, there may be an indication for, among other things, psychodynamic investigation and therapy. This book concentrates on clinical prostatitis strictu sensu and does not treat the various types of histologically detected inflammation of the prostate, e.g., "prostatitis" associated with benign prostatic hypertrophy. Very rarely, prost atectomy specimens of younger patients or autopsy samples of prostates x Preface without evidence of hyperplasia demonstrate inflammatory infiltrates. In men up to the age of 40, prostatitis is mainly located in the peripheral gland, not in the transition zone. Demographic data demonstrate that prostatitis symptoms mostly occur in men over 40 years of age, with decreasing frequency in men beyond the age of 50, in whom chronic recurrent prostatitis is almost exclusively seen in biopsies of hyperplastic prostatic glands. Since inflammatory infiltrates of the prostate must be considered noncharacteristic, we have decided not to include chapters on histology or cytology in consideration of the fact that prostatic biopsies for the morphological diagnosis of prostatitis syndromes are indicated only in cases of clinical suspicion of carcinoma. The book contains some introductory chapters on basic data, e.g., patho physiology, host-parasite interactions, anatomy of prostatic infection, and also general considerations of disease-related complaint complexes, psychosomatics, diagnostic management, ultrasonography, and ejaculate analysis. Additionally, the basic conditions of therapy are discussed not only from a pharmacokinetic angle but also considering the development of acceptable animal models, allowing standardized therapeutic trials. Clinical management of acute and chronic bacterial prostatitis has now been established, following a widely accepted schedule of therapy with a good prognosis for cure. Obviously, the new fluoroquinolones are a significant improvement in therapy, but the urgent question is how to treat patients in whom antibiotic therapy fails. Baert et al. have analyzed this problem, contrib uting their experience with local therapy and transurethral and open surgery of infected prostatic glands. Our book also deals with non bacterial prostatitis. It is our opinion that this complex entity is a major problem as regards its still unknown etiology and missing rational therapy in most cases. In patients with nonbacterial prostatitis, diagnostic efforts should not only concentrate on chlamydial and/or mycoplas mal infections, but on unconventional pathogens, too, in view of the increasing incidence of AIDS and the reestablished significance of parasites as treatable causes of urogenital infections in sexually active men. For practical use, the procedures suggested by Thin seem to us to be a feasible schedule for daily work. The editors would feel satisfied if this monograph could assist the practicing physician to provide optimal diagnosis and treatment to every patient suffering from prostatitis syndromes. Finally, the editors gratefully acknowledge the continuous efforts and assistance of Mrs. Karoline Karrer in the production of this book. Giessen, Germany W Weidner Madison, Wisconsin, USA P.O. Madsen Giessen, Germany H.G. Schiefer January 1994 Contents I Introduction Classification, Etiology, and Diagnosis of Prostatitis P.O. Madsen, P. Drescher, and T.e. Gasser. With 1 Figure 3 II Prostatitis: Basic Data Physiology and Pathophysiology of Prostate Infection J. Frick. With 3 Figures ................. . 11 Host -Parasite Interactions in Prostatitis H.G. Schiefer. . . . . . . . . . . . . . . . . 23 The Anatomy of the Prostate: Relationship with Prostatic Infection N.J. Blacklock. With 6 Figures . . . 32 Complaint Complexes and Psychosomatic Aspects E. Briihler. . . . . . . . . . . . . . . . . . . . . .. 40 Diagnostic Management in Chronic Prostatitis W Weidner and M. Ludwig. With 7 Figures 49 Ultrasonographic Features of Prostatitis R. Clements, G.J. Griffiths, and WE. Peeling. With 18 Figures. . . . 66 Prostatitis and Male Infertility W Krause. With 7 Figures .. 91 Basis for Antibacterial Treatment of Prostatitis: Experimental and Clinical Pharmacokinetic Studies and Models P.O. Madsen, P. Drescher, and T.e. Gasser. With 6 Figures. 110 Experimental Prostatitis J.e. Nickel, M.E. Olson, and H. Ceri. 123 XII Contents III Acute Bacterial Prostatitis Acute Prostatitis and Prostatic Abscess W. Vahlensieck, Jr., and A.G. Hofstetter. 133 IV Chronic Bacterial Prostatitis Etiology, Pathogenesis, and Inflammatory Reactions in Chronic Bacterial Prostatitis A.J. Schaeffer. With 1 Figure . . . . . . . . . . . . . . . . . . . . . 151 The Treatment of Chronic Bacterial Prostatitis: Principles and Management A. Pfau ........................ . 158 The Role of Quinolones in the Treatment of Chronic Bacterial Prostatitis K.G. Naber. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 In Loco Antibiotics in Chronic Bacterial Prostatitis L. Baert and D. De Ridder. With 3 Figures. . . . . 191 Radical Transurethral Prostatectomy for Chronic Bacterial Prostatitis L. Baert and D. H erremans. . . . . . . . . . . . . . . . . . . 197 Radical Prostatectomy for Chronic Bacterial Prostatitis L. Baert and H. Van Poppel. . . . . . . . . . . . . . . ... 206 Immunotherapy and Prostatitis L. Baert and E. Van Thil/o . ... 210 V Nonbacterial Prostatitis The Diagnosis, Aetiology and Pathogenesis of Chronic Abacterial Prostatitis A. Doble and D. Taylor-Robinson. With 2 Figures. . . 215 Prostatic Infection by Unconventional, Fastidious Pathogens H.G. Schiefer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Trichomonas vaginalis N. Kawamura. With 2 Figures. 245
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