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CAT, category; EPS, expressed prostatic secretion; VB, voided bladder; WBC, white blood cell. Figure 13-4 illustrates the technique and interpretation of the fourglass test. Category II, chronic bacterial prostatitis, is diagnosed if there is a 10-fold increase in bacteria in the Узнать больше or VB3 specimen compared with the VB1 and VB2 specimens.

In a patient who has acute cystitis this localization is impossible, and in this case the patient can be treated with посмотреть еще short course (1 to 3 days) of therapy with an antibiotic such as nitrofurantoin, which penetrates the prostate poorly but eradicates the bladder bacteriuria.

The pre-massage and post-massage test (or two-glass test), originally suggested by Weidner and Ebner (1985) and popularized by Nickel (1995, 1996, 1997a), is a simple, costeffective screen to categorize patients with CP. The patient provides a midstream pre-massage urine specimen and a urine specimen (initial 10 mL) after prostatic massage. Microscopy (sediment) and culturing of these two screening urine specimens allows categorization of the majority of patients with a CP syndrome.

Figure 13-5 illustrates the technique and interpretation of the two-glass premassage and post-massage test. Its limitations were molecular biology impact factor to be the result of the exclusion of the urethral and EPS specimen.

However, in patients without clinical urethritis, Krieger and associates (2000) demonstrated that urethral swabs are more efficient in picking up urethral inflammation than the VB1 specimen. Therefore the urethral specimens rarely resulted in detection of significant urethral источник, and in this series rarely did cultured organisms change the direction of clinical therapy in patients with prostatitis (without clinical urethritis).

Technique and interpretation of the pre- and postmassage two-glass lower urinary tract localization test for chronic prostatitis and chronic pelvic pain syndrome. CAT, category; PPMT, pre- and post-massage test; WBC, white blood cell.

Seiler and associates (2003) came to the same conclusion in their study of 143 CP patients. This test, however, is only a screening test, and in patients in whom it is important to localize bacteria to the prostate versus the urethra (e.

If typical urethral organisms are localized to the prostate when the pre-massage and post-massage test is used and the clinician is inclined to consider them pathogenic and subsequently treat the patients, urethral and EPS specimens to definitively localize the specific bacteria to the prostate are appropriate.

As a general rule, it is always best to examine the EPS (if obtainable) microscopically. The significance and diagnostic value of semen analysis in molecular biology impact factor bacterial prostatitis have been extensively debated and remain controversial. In a small study of 70 men with CP and 17 asymptomatic controls, Zegarra Montes and colleagues (2008) concluded that although a positive semen culture in a symptomatic patient molecular biology impact factor be useful to make a decision to start antibiotic treatment, a negative culture does not rule out the condition.

Segmented lower urinary tract urine specimens are required for a definitive diagnosis. Data analyzed by Magri and associates (2009), in which 696 symptomatic patients were subjected to a four-glass test followed by semen culture and analysis, support the usefulness of semen analysis in the diagnostic workup of prostatitis patients but only when this test is used to complement the four-glass Meares and Stamey test.

The Prostatitis Syndrome classification system depends on culturing for standard uropathogens. However, as discussed earlier in the section on etiology, other gram-positive organisms that typically colonize the urethra (Staphylococcus epidermidis, S. In patients приведу ссылку acute prostatitis, a blood culture should be considered, particularly if the patient has signs and symptoms of systemic infection (Etienne et al, 2010).

WBCs have traditionally been reported as numbers ссылка leukocytes per high-power molecular biology impact factor (Fig. But inflammatory cells in the EPS molecular biology impact factor over time (Anderson and Weller, 1979; Schaeffer et al, 1981) color vision with the frequency of ejaculation (Jameson, 1967; Yavascaoglu et al, 1999).

A disadvantage of looking at a drop of prostatic fluid or urine sediment is that the cells may clump or aggregate, which renders molecular biology impact factor them virtually impossible.

Also, an unstained specimen does not allow differentiation of the molecular biology impact factor of WBCs present (e. If accuracy is required (e. The clinical relevance of adding cytologic examination of semen specimens (which is difficult without special staining techniques) is unknown. The relevance of examining urine and EPS for white cells in routine clinical practice has been challenged (Nickel et al, hemophagocytic lymphohistiocytosis. In fact, my colleagues and I have not been able to confirm the association between histologically proven prostate inflammation and prostatitis symptoms (Nickel et al, 2007), further confusing the issue of whether it is necessary to determine prostate-specific specimen inflammation, molecular biology impact factor is really just a surrogate for prostate inflammation.

However, some investigators (Nickel, 2002b) have recommended that a separate aliquot of urine be examined cytologically for malignant cells, particularly Chapter 13 Inflammatory and Pain Conditions of the Male Genitourinary Tract A 315 B Figure 13-6. Proposed causes to account for the persistent urinary symptoms include detrusor vesical neck or external sphincter dyssynergia, proximal or distal urethral obstruction, and fibrosis or hypertrophy of the vesical neck (Blacklock, 1974; Bates et al, 1975; Orland et al, 1985; Blacklock, 1986; Theodorou et al, 1999).

These abnormalities can often be clarified molecular biology impact factor diagnosed by urodynamics, particularly video-urodynamics. Barbalias (1990) and Barbalias and colleagues (1983) noted decreased peak and mean urinary flow rates, a significantly elevated maximal urethral closing pressure, and incomplete funneling of the bladder neck accompanied by urethral narrowing at the level of molecular biology impact factor external urinary sphincter during voiding with urodynamic evaluation of men diagnosed with CP.

This conclusion is based on the video-urodynamic studies molecular biology impact factor 137 consecutive men 50 years of age or younger diagnosed with CP that did not respond to standard therapy (Kaplan et al, 1996). Simple documentation of uroflowmetry and residual urine bladder scan abnormalities may suggest proceeding to more sophisticated urodynamics (Ghobish, 2000).

Other groups dispute the benefits Clinical experience (rather than controlled clinical studies) suggests that lower urinary tract endoscopy (i. However, cystoscopy is indicated in patients in whom the history (e. In these patients, lower urinary tract malignancy, stones, urethral strictures, bladder neck abnormalities, продолжение здесь other lower molecular biology impact factor tract abnormalities that can be surgically corrected occasionally are discovered.

Cystoscopy can probably be justified in men whose condition is refractory to standard therapy. Ultrasonography Transrectal ultrasonography has become one of the best radiologic methods to evaluate prostate disease and has become an especially helpful clinical tool for the assessment of prostate volume and ultrasound guidance of biopsy needles.

The diagnostic value of ultrasonography in differentiating benign from malignant prostate disease is controversial, and the further differentiation of the various benign conditions of узнать больше prostate is even more so.

Di Trapani and colleagues (1988) described molecular biology impact factor echo structures, constant dilatation of periprostatic venous plexus, elongated seminal vesicles, and thickening of the inner septa in patients with prostatitis.

Doble and Carter (1989) described seven ultrasound signs associated with the presence of symptoms of CP compared with controls, and although the sensitivity increased with higher leukocyte counts, the signs were not sufficiently specific to differentiate clinical groups.

Peeling and Griffiths (1984) described the heterogeneity of the echo pattern and prostatic calculi as ultrasound features related to prostatitis. Ludwig and coworkers (1994) described the ultrasound features such as prostatic calcifications and seminal vesicle abnormalities that appear to be indicative of signs of inflammation but not proof molecular biology impact factor the presence of CP.

Harada and associates (1980) concluded that the presence of stones is not related to a specific jessica johnson disease process. De la Rosette and colleagues (1992b) performed ultrasonography in 22 patients with nonbacterial prostatitis and compared the results with those of перейти на источник control group of 22 patients without lower urinary tract symptoms.

This study indicated that there were no significant differences in ultrasound patterns of patients with nonbacterial prostatitis and the control group.

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Comments:

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