Anaerobic bacteria in urine before and after prostatic massage of infertile men

Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.

Changes in white blood cell counts in men undergoing thrice-weekly prostatic massage, microbial diagnosis and antimicrobial therapy for genitourinary complaints

OBJECTIVE

To report changes in the white blood cell (WBC) counts in expressed prostatic secretions (EPS) in men with pelvic symptoms undergoing thrice-weekly prostatic massage combined with antimicrobial therapy.

PATIENTS AND METHODS

The study comprised a retrospective analysis of the records of 35 patients (mean age 45.3 years, range 28-70, SD, 12.03) with pelvic pain, pain in the lower back, obstructive urinary symptoms, irritative urinary symptoms, or sexual dysfunction, who had undergone the same diagnosis and treatment protocol in a genitourinary clinic in Manila, Philippines, from September 1992 to September 1995.

RESULTS

EPS were obtained 347 times in 35 patients (median 9 times per patient, range 6-16). In 26 of the 35 (74%) patients the WBC count in the EPS was < 10 per oil-immersion field (OIF, x1000) at the first prostatic massage. In 34 of 35 (97%) patients the WBC count rose to > or = 10 as prostatic massage continued on a thrice-weekly schedule. The mean (range, SD) initial WBC count in the EPS was 8.4 (1-48, 8.43) and the maximum was 40.9 (6-60, 19.05); the difference between these values was 32.5 (3-57, 18.78; 95% confidence interval 26.1-40.1) and the difference was statistically significant (paired t-test, P < 0.001).

CONCLUSIONS

The classification of patients into those with prostatodynia or prostatitis based on one EPS examination is misleading and thrice-weekly massage of the prostate is better than a single collection of EPS to obtain the most purulent sample for Gram staining and culture.