Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

Abstract

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3-8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

Tumor necrosis factor-α expression in patients with obstructive benign prostatic hyperplasia is associated with a higher incidence of asymptomatic inflammatory prostatitis NIH category IV and prostatic calcification

“…Whereas prostate calcifications are very frequently observed in patients with chronic bacterial NIH II prostatitis or chronic NIH IIIa and IIIb prostatitis [4,7,13], data are lacking about prostate stones in patients with asymptomatic NIH IV prostatitis and those with obstructive BPH.…”

“…An association between prostatic calcification and PCa or BPH has not been established thus far [3][4][5][6][7][8][9][10]. The exact mechanism underlying the formation of prostatic calcification is still unclear.…”

“…Evidence for the importance of estrogen, by way of increasing interferon-mRNA and interleukin (IL-2, IL-4, IL-6, IL-7, IL-8 IL-15, IL-17) in BPH can be found [6][7][8][9][10]14]. Tumor necrosis factor-a (TNF-a) is an adipokine responsible for systemic inflammatory reactions.…”

Clinical and Biochemical Influence of Prostatic Stones

“…Namely, after 4 weeks of antimicrobial therapy and follow-up, a greater percentage of organisms were continuously eradicated in patients without prostatic calculi compared to patients with prostatic calculi. Similarly, patients without prostatic calculi resulted in significantly higher symptoms improvement compared to those with prostatic calculi [30] . This opens a new field of research of chronic prostatitis and defines the essence of calcification as a bacteria and bacterial resistance, with consequent chronic inflammation in these patients.…”

Computer-Assisted Quantitative Assessment of Prostatic Calcifications in Patients with Chronic Prostatitis

“…Zhao et al [3] described microbiological eradication rates after 4 weeks of appropriate antibiotic treatment and at long-term follow-up (>3 months) of 82.1 and 87.1% in patients without prostate calcifications and of 43.6 and 72.6% in patients with prostate calcifications respectively. In addition, the NIH-CPSI symptom scores after antibiotic treatment were significantly better in patients without prostatic calcifications than in patients with calcifications.…”