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Anthony J Schaeffer - One of the best experts on this subject based on the ideXlab platform.
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Chronic Prostatitis and the Chronic Pelvic Pain Syndrome
2015Co-Authors: Anthony J Schaeffer, N Engl, J MedAbstract:A 38-year-old man reports pelvic pain, dysuria, and urinary urgency for the past 4 weeks. He has had several similar episodes over the past 2 years; urine cultures were not performed. He is sexually active and notes frequent discomfort after ejacula-tion. He is otherwise healthy and takes no medication. He does not have fever, chills, or flank pain. How should he be evaluated and treated? The Cl inic a l Probl em Prostatitis accounts for approximately 2 million outpatient visits per year in the United States, including 8 % of all visits to urologists and 1 % of those to primary care phy-sicians.1 The direct costs of care approach $4,000 per patient per year.2 A classifica-tion system for the Prostatitis syndromes has been developed by the National Insti-tutes of Health (NIH) (Table 1).3 About 5 to 10 % of men with symptoms of Prostatitis have acute or chronic bacte-rial Prostatitis,4 conditions that are well defined according to clinical and microbio-logic measures and that usually respond to antimicrobial therapy. Acute bacterial Prostatitis is a life-threatening systemic infection, and its diagnosis and treatmen
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ccl2 and ccl3 are essential mediators of pelvic pain in experimental autoimmune Prostatitis
American Journal of Physiology-regulatory Integrative and Comparative Physiology, 2012Co-Authors: Marsha L Quick, Anthony J Schaeffer, Soumi Mukherjee, Charles N Rudick, Joseph D Done, Praveen ThumbikatAbstract:Experimental autoimmune Prostatitis (EAP) is a murine model of chronic Prostatitis/chronic pelvic pain syndrome (CPPS) in men, a syndrome characterized by chronic pelvic pain. We have demonstrated ...
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brain functional and anatomical changes in chronic Prostatitis chronic pelvic pain syndrome
The Journal of Urology, 2011Co-Authors: Melissa A Farmer, Mona L Chanda, Elle L Parks, Marwan N Baliki, Vania A Apkarian, Anthony J SchaefferAbstract:Purpose: Research into the pathophysiology of chronic Prostatitis/chronic pelvic pain syndrome has primarily focused on markers of peripheral dysfunction. We present the first neuroimaging investigation to our knowledge to characterize brain function and anatomy in chronic Prostatitis/chronic pelvic pain syndrome.Materials and Methods: We collected data from 19 male patients with chronic Prostatitis/chronic pelvic pain syndrome, and 16 healthy age and gender matched controls. Functional magnetic resonance imaging data were obtained from 14 patients with chronic Prostatitis/chronic pelvic pain syndrome as they rated spontaneous pain inside the scanner. Group differences (16 patients per group) in gray matter total volume and regional density were evaluated using voxel-based morphometry, and white matter integrity was studied with diffusion tensor imaging to measure fractional anisotropy. Functional and anatomical imaging outcomes were correlated with the clinical characteristics of chronic Prostatitis/chro...
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Prostatitis chronic pelvic pain syndrome
Annual Review of Medicine, 2006Co-Authors: Geoffrey M Habermacher, Judd T Chason, Anthony J SchaefferAbstract:We review the diagnosis, categorization, and treatment of Prostatitis/chronic pelvic pain syndrome based on the National Institutes of Health (NIH) classification. Prostatitis is an extremely common syndrome that afflicts 2%–10% of men. Formerly a purely clinical diagnosis, Prostatitis is now classified within a complex series of syndromes (NIH category I–IV Prostatitis) that vary widely in clinical presentation and response to treatment. Acute bacterial Prostatitis (category I) and chronic bacterial Prostatitis (category II) are characterized by uropathogenic infections of the prostate gland that respond well to antimicrobial treatment. In contrast, chronic Prostatitis/chronic pelvic pain syndrome (category III), which accounts for 90%–95% of Prostatitis cases, is of unknown etiology and is marked by a mixture of pain, urinary, and ejaculatory symptoms with no uniformly effective therapy. Asymptomatic inflammatory Prostatitis (category IV) is an incidental finding of unknown clinical significance. This r...
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acute and chronic Prostatitis
Medical Clinics of North America, 2004Co-Authors: Vi N Hua, Anthony J SchaefferAbstract:Historically speaking, Prostatitis is a complex inflammatory condition with an array of causes that are still under investigation. In a recent study of published and unpublished epidemiology studies, Krieger et al [1] found a worldwide prevalence of Prostatitis-like symptoms or the diagnosis of Prostatitis in the range of 2% to 10%. Even with the technology of the twenty-first century, science has not specifically identified the etiology in most cases. As one examines how Prostatitis has evolved as a disease process, one finds traditional diagnosis principles based on clinical findings transformed by clinical and basic science research. During the early twentieth century, practitioners primarily treated Prostatitis with prostatic massage [2]. When sulfonamides were discovered, antimicrobials became the mainstay of therapy; however, antimicrobial therapy resolved only a fraction of patients. It was not until 1968 when Meares and Stamey [3] published their landmark description of the four-part localization protocol to delineate better the pathophysiology of Prostatitis that further refinement of the disease process begin. In 1978, after 10 years of experience with the localization protocol described by Meares and Stamey [3], Drach et al [4] introduced a classification system to direct therapy better for each patient based on clinical findings. The traditional classification of Prostatitis In 1978, Drach et al [4] divided Prostatitis into four classes based on Meares and Stamey’s [3] examination of four specimens from the patient. In review of the Meares-Stamey test, the first 10 mL of voided urine were termed VB1; after 200 mL were discarded, a second specimen (termed the midstream culture) was designated VB2. The clinician then performed
Curtis J Nickel - One of the best experts on this subject based on the ideXlab platform.
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silodosin for men with chronic Prostatitis chronic pelvic pain syndrome results of a phase ii multicenter double blind placebo controlled study
The Journal of Urology, 2011Co-Authors: Curtis J Nickel, Lawrence A. Hill, Michael P Oleary, Herbert Lepor, Kim E Caramelli, Heather Thomas, Gary HoelAbstract:Purpose: We evaluated the efficacy and safety of 2 doses of silodosin vs placebo in men with moderate to severe abacterial chronic Prostatitis/chronic pelvic pain syndrome who had not been treated previously with α-blockers for chronic Prostatitis/chronic pelvic pain syndrome.Materials and Methods: In this multicenter, randomized, double-blind, phase II study, men 18 years old or older with chronic Prostatitis/chronic pelvic pain syndrome, a total National Institutes of Health Chronic Prostatitis Symptom Index score of 15 or greater and a National Institutes of Health Chronic Prostatitis Symptom Index pain score of 8 or greater received 4 or 8 mg silodosin, or placebo once daily for 12 weeks. The primary efficacy end point was change from baseline to week 12 in National Institutes of Health Chronic Prostatitis Symptom Index total score.Results: Of 151 patients (mean age 48 years) 52 received 4 mg silodosin, 45 received 8 mg silodosin and 54 received placebo. Silodosin 4 mg was associated with a significan...
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examination of the relationship between symptoms of Prostatitis and histological inflammation baseline data from the reduce chemoprevention trial
The Journal of Urology, 2007Co-Authors: Curtis J Nickel, Michael P Oleary, Claus G Roehrborn, David G Bostwick, Matthew C Somerville, Roger S RittmasterAbstract:Purpose: Symptoms of abacterial chronic Prostatitis/chronic pelvic pain syndrome are considered to be associated with prostate inflammation. The ongoing Reduction by Dutasteride of Prostate Cancer Events trial is a 4-year, phase III, placebo controlled study to determine whether 0.5 mg dutasteride daily decreases the risk of biopsy detectable prostate cancer. All men underwent biopsy before study entry, allowing review of the relationship between histological prostate inflammation and Prostatitis symptoms.Materials and Methods: Eligible men were 50 to 75 years old with serum prostate specific antigen 2.5 ng/ml or greater and 10 ng/ml or less (ages 50 to 60 years), or 3.0 ng/ml or greater and 10 ng/ml or less (older than 60 years), and an International Prostate Symptom Score of less than 25 (or less than 20 if already on α-blocker therapy). Acute Prostatitis was an exclusion criterion. The National Institutes of Health Chronic Prostatitis Symptom Index was used to assess Prostatitis-like symptoms. Spearman...
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category iii chronic Prostatitis chronic pelvic pain syndrome insights from the national institutes of health chronic Prostatitis collaborative research network studies
Current Prostate Reports, 2007Co-Authors: Curtis J Nickel, Richard B Alexander, Rodney U Anderson, Richard A Berger, Craig V Comiter, Nand S Datta, Jackson E Fowler, John N Krieger, Richard J Landis, Mark S LitwinAbstract:Chronic Prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic Prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic Prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.
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research guidelines for chronic Prostatitis consensus report from the first national institutes of health international Prostatitis collaborative network
Urology, 1999Co-Authors: Curtis J Nickel, Leroy M Nyberg, Mike HennenfentAbstract:Abstract Objectives. The National Institutes of Health (NIH) organized the first International Prostatitis Collaborative Network workshop (November 5 and 6, 1998, Washington, DC) to address the confusion surrounding the diagnostic and treatment strategies in chronic Prostatitis. Methods. A panel of North American and international urologic researchers, interested physicians, medical industry representatives, and patients were invited to participate and reviewed current definitions, classification systems, and recent epidemiologic and both published and “in progress” treatment studies. Results. A general concensus was developed for adoption of the following criteria for clinical studies in chronic Prostatitis/chronic pelvic pain syndrome: (a) the NIH definition of chronic Prostatitis/chronic pelvic pain syndrome; (b) the 1995 NIH Classification System; (c) the eligibility (inclusion/exclusion) criteria developed by the NIH Chronic Prostatitis Clinical Research Network; (d) the NIH Chronic Prostatitis Symptom Index. It was agreed that clinical treatment trials involving presently available, experimental, and theoretical therapeutic modalities be prioritized according to maximum potential benefits and that regulatory authorities (ie, Food and Drug Administration in the United States) consider major changes in the approval process for treatment modalities in chronic Prostatitis. Conclusions. Chronic Prostatitis is a major health care issue. Standardization of definitions, classification, study design, and outcome parameters will promote rational and comparative evaluation of diagnostic and therapeutic strategies.
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transurethral microwave thermotherapy for nonbacterial Prostatitis a randomized double blind sham controlled study using new Prostatitis specific assessment questionnaires
The Journal of Urology, 1996Co-Authors: Curtis J Nickel, Ron SorensenAbstract:AbstractPurpose: We investigated the effectiveness and durability of transurethral microwave thermotherapy in the treatment of chronic nonbacterial Prostatitis using 2 new Prostatitis specific assessments in a randomized, double-blind, sham controlled trial.Materials and Methods: Patients with nonbacterial Prostatitis were randomly assigned to receive either transurethral microwave thermotherapy or sham therapy. Patients were assessed using a symptom severity index and symptom frequency questionnaire. These 2 new Prostatitis symptom assessment tools were validated by applying them to 30 similar patients without Prostatitis. All nonresponders received transurethral microwave thermotherapy at 3 months and were reassessed at 6 months. Long-term followup of the responder group averaged 21 months.Results: The symptom severity index and symptom frequency questionnaire were confirmed to be valid for symptom assessment in Prostatitis patients. The transurethral microwave thermotherapy group benefited from therapy...
Du Geon Moon - One of the best experts on this subject based on the ideXlab platform.
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clinical and microbiological characteristics of spontaneous acute Prostatitis and transrectal prostate biopsy related acute Prostatitis is transrectal prostate biopsy related acute Prostatitis a distinct acute Prostatitis category
Journal of Infection and Chemotherapy, 2015Co-Authors: Jong Wook Kim, Jae Hyun Bae, Seok Ho Kang, Hong Seok Park, Du Geon MoonAbstract:Abstract Purpose This study aimed to compare the clinical and microbiological characteristics between acute bacterial Prostatitis and transrectal biopsy-related acute Prostatitis. Materials and methods We retrospectively reviewed the records of 135 patients hospitalized for acute Prostatitis in three urological centers between 2004 and 2013. Acute bacterial Prostatitis was diagnosed according to typical symptoms, findings of physical examination, and laboratory test results. Clinical variables, laboratory test results, and anti-microbial susceptibility results were reviewed. Patients were classified into the spontaneous acute Prostatitis group (S-ABP) or biopsy-related acute Prostatitis (Bx-ABP) for comparison of their clinical, laboratory, and microbiological findings. Results The mean age of all patients was 61.7 ± 12.9 years. Compared with S-ABP patients, Bx-ABP patients were significantly older, had larger prostate volumes, higher PSA values, higher peak fever temperatures, and higher incidence of septicemia and antibiotic-resistant bacteria. Overall, of the 135 patients, 57.8% had positive bacterial urine and/or blood cultures. Bx-ABP patients had a higher incidence of bacterial (urine and/or blood) positive cultures compared to S-ABP patients (66.7% versus 55.6%). Escherichia coli was the predominant organism in both groups, but it was more common in Bx-ABP (88.9%) than in S-ABP (66.7%). Extended spectrum beta-lactamase -producing bacteria accounted for 64.7% of culture-positive patients in the Bx-ABP group compared to 13.3% in the S-ABP group. Conclusions Bx-ABP patients showed a higher incidence of septicemia and antibiotic-resistant bacteria than S-ABP patients. These results have important implications for the management and antimicrobial treatment of Bx-ABP, which may well deserve to be considered a distinct Prostatitis category.
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positive culture for extended spectrum β lactamase during acute Prostatitis after prostate biopsy is a risk factor for progression to chronic Prostatitis
Urology, 2013Co-Authors: Ji Yun Chae, Jong Wook Kim, Du Geon Moon, Jin Wook Kim, Cheol Yong Yoon, Min Gu ParkAbstract:Objective To analyze whether strains positive for extended-spectrum β-lactamase (ESBL) affected the clinical course and progression to chronic Prostatitis in patients with postbiopsy acute Prostatitis. Methods From 2002 to 2011, 3657 patients underwent transrectal ultrasound-guided biopsy of the prostate, and 33 patients with acute Prostatitis were enrolled. Acute Prostatitis was defined as a fever greater than 38°C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility. Laboratory and clinical variables according to the presence of ESBL were analyzed. Results Blood or urine culture was positive in 23 patients. The most common strain was Escherichia coli . Sixteen patients showed ESBL-positive and 18 patients were quinolone-resistant. Thirteen of 16 patients with ESBL-positive strains showed quinolone resistance, and 13 of 18 patients with quinolone resistance were ESBL-positive ( P = .621). Besides imipenem, all ESBL-positive patients were susceptible to amikacin and were highly susceptible to cefoxitin and amoxicillin/clavulanic acid. The prevalence of ESBL-positive strains has tended to increase since 2006. Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization. The progression rate to chronic Prostatitis was significantly higher in ESBL-positive patients (4/16 vs 0/17, P = .044). Conclusion Since 2006, ESBL strains have been increasing, and the presence of ESBL showed more detrimental effects on the clinical course of the patients, resulting in a higher rate of progression to chronic Prostatitis.
W Weidner - One of the best experts on this subject based on the ideXlab platform.
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use of the upoint chronic Prostatitis chronic pelvic pain syndrome classification in european patient cohorts sexual function domain improves correlations
The Journal of Urology, 2010Co-Authors: Vittorio Magri, Florian M E Wagenlehner, Gianpaolo Perletti, Sebastian Schneider, Emanuela Marras, Kurt G Naber, W WeidnerAbstract:Purpose: Patients with chronic Prostatitis-chronic pelvic pain syndrome are difficult to treat due to the unknown etiology and complex clinical presentation. Clinical phenotyping may better correlate with multimodal treatment concepts than a current diagnosis. We evaluated a novel clinical phenotyping system in a database of patients with chronic Prostatitis-chronic pelvic pain syndrome at 2 European institutions and correlated it with patient symptoms. We also investigated the addition of a sexual dysfunction domain in regard to symptom correlation and system internal consistency.Materials and Methods: We retrospectively classified 937 patients from Milan, Italy, and 290 from Giessen, Germany, with chronic Prostatitis-chronic pelvic pain syndrome into a 6-domain phenotyping system, consisting of urinary, psychosocial, organ specific, infection, neurological and muscle tenderness domains, termed UPOINT. Symptom severity was assessed by the National Institutes of Health Chronic Prostatitis Symptom Index an...
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acute bacterial Prostatitis and chronic Prostatitis chronic pelvic pain syndrome andrological implications
Andrologia, 2008Co-Authors: W Weidner, Florian M E Wagenlehner, Marcelo Marconi, Adrian Pilatz, K H Pantke, Thorsten DiemerAbstract:There is a consensus on the diagnostic management of bacterial Prostatitis (acute and chronic). In chronic Prostatitis/chronic pelvic pain syndrome (CP/CPPS) the diagnostic approach remains unclear, because inflammatory and noninflammatory CP/CPPS might be one entity with varying findings over time. The WHO definition of male accessory gland infection does not differentiate between Prostatitis, epididymitis, and other inflammatory alterations of the urethral compartment. The definition therefore cannot be further accepted as a rational tool for the diagnosis of Prostatitis and related diseases in urological andrology. Therapy in infectious Prostatitis is standardised and antibiotics are the primary agents. Andrological implications are well defined, side-effects are minimal. CP/CPPS therapy has the goal to reduce pelvic pain. However, treatment regimens are not as standardised. Andrological side-effects are well defined and mainly due to the functional background of these agents.
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evaluation of acute and chronic bacterial Prostatitis and diagnostic management of chronic Prostatitis chronic pelvic pain syndrome with special reference to infection inflammation
International Journal of Antimicrobial Agents, 2008Co-Authors: W Weidner, R U AndersonAbstract:The evaluation of acute and chronic bacterial Prostatitis and the diagnostic management of chronic Prostatitis/chronic pelvic pain syndrome with special reference to infection and inflammation is well defined. Men with symptoms of acute bacterial Prostatitis (NIH I) have to undergo urine analysis and culture of the urine. An initial imaging of the prostate is suggested to exclude prostatic abscess. In chronic bacterial Prostatitis (NIH II) the 4- and/or the 2-glass test for white blood cell counts and culture are necessary. Culture of semen has a lower sensitivity but is recommended for evaluation in selected men with problems with infertility. Imaging of the prostate is indicated to exclude abscess formations. In patients with chronic Prostatitis/chronic pelvic pain syndrome (NIH III) symptom scoring is mandatory using the NIH-CPSI. The 4- and/or the 2-glass test are suggested to rule out bacterial infections. The routinely done analysis of urine and expressed prostatic secretions for leukocytes is debatable, especially due to the fact that the differentiation between patients with inflammatory and non-inflammatory subgroups of CP/CPPS may not be useful for the daily praxis. Optional investigations include the analysis for leukocytes in the ejaculate. Histopathological and molecular microbiological evaluation of prostatic tissue are investigational tests requiring for evaluation. Routine done serum PSA, routine imaging of the prostate and tests for Chlamydia trachomatis and Ureaplasma are not really proven to provide benefit for the patient. In patients with asymptomatic Prostatitis (NIH IV) is no evaluation necessary unless considering antimicrobial therapy for elevated PSA or infertility.
Jeannette M Potts - One of the best experts on this subject based on the ideXlab platform.
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Prostatitis infection neuromuscular disorder or pain syndrome proper patient classification is key
Cleveland Clinic Journal of Medicine, 2007Co-Authors: Jeannette M Potts, Richard E PayneAbstract: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.
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prospective identification of national institutes of health category iv Prostatitis in men with elevated prostate specific antigen
The Journal of Urology, 2000Co-Authors: Jeannette M PottsAbstract: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...
