[Nitrofurantoin for uncomplicated urinary tract infections in men: should it be the first choice?]

Nitrofurantoin is a commonly prescribed antibiotic for uncomplicated urinary tract infections. The Dutch College of General Practitioners guideline recommends the use of this drug for the treatment of uncomplicated urinary tract infections in both male and female patients. Treatment with nitrofurantoin has several advantages. Resistance to this antibiotic is low and does not increase in the hospitalized patient population. Treatment with nitrofurantoin is generally well-tolerated. However, two independent studies estimated that approximately 27% of male patients are undertreated with nitrofurantoin. The main downside of nitrofurantoin is the low blood concentration that leads to insufficient tissue penetration. There is little evidence on how often prostatic tissues are involved in male urinary tract infections. Unrecognized tissue involvement can lead to breakthrough urinary tract infections despite nitrofurantoin treatment. Because of this, the safety of nitrofurantoin for male patients is unknown and treatment with this antibiotic should be administered with caution.

[Nitrofurantoin for urinary tract infections in men: it is possible]

Most uropathogens are sensitive to nitrofurantoin. Urinary tract infections with systemic symptoms cannot be treated with nitrofurantoin. Unfortunately, the frequency of prostate involvement in (suspected) cystitis without anamnestic and physical features of tissue invasion is unknown. Clinical studies are limited to retrospective observational studies in which approximately one third of men received a second course of antibiotics within 60-90 days. Exact interpretation of the retreatment is difficult, but it is certainly not only explained by a failure of nitrofurantoin. In addition, the number of men who come to the emergency room with urosepsis during treatment with nitrofurantoin is probably outweighed by the large number of nitrofurantoin prescriptions. The oral alternative to nitrofurantoin is ciprofloxacin. However, this is undesirable because of side effects, more microbiome disturbance and resistance development. Therefore, nitrofurantoin is a valuable treatment option for a urinary tract infection in men, provided that systemic symptoms are absent.

The Polyphenols as Potential Agents in Prevention and Therapy of Prostate Diseases

In recent years, the progress of science and medicine greatly has influenced human life span and health. However, lifestyle habits, like physical activity, smoking cessation, moderate alcohol consumption, diet, and maintaining a normal body weight represent measures that greatly reduce the risk of various diseases. The type of diet is very important for disease development. Numerous epidemiological clinical data confirm that longevity is linked to predominantly plant-based diets and it is related to a long life; whereas the western diet, rich in red meat and fats, increases the risk of oxidative stress and thus the risk of developing various diseases and pre-aging. This review is focused on the bioavailability of polyphenols and the use of polyphenols for the prevention of prostate diseases. Special focus in this paper is placed on the isoflavonoids and flavan-3-ols, subgroups of polyphenols, and their protective effects against the development of prostate diseases.

Beneficial effects of lipidic extracts of saladette tomato pomace and Serenoa repens on prostate and bladder health in obese male Wistar rats

BACKGROUND

Obesity is associated with increased risk of a number of serious medical conditions, including urological disorders. This study investigated the effect of lipidic extracts of saladette tomato pomace (STP) and Serenoa repens (SR) on the prostate and bladder in a rat obese model induced by high-carbohydrate diet.

RESULTS

High-sucrose-fed rats showed higher prostate weight as well as increased contractility and stromal and epithelial hyperplasia in the prostate. Treatment with STP and SR improved contractility and diminished hyperplasia and hypertrophy in the prostate. Obese animals also showed impaired bladder contractility, but neither extract reversed this deterioration. In the histological study, a disarray in the process of smooth muscle cell proliferation with non-parallel fibers was observed; interestingly, treatment with STP and SR led to improvement in this derangement.

CONCLUSION

These findings indicated impaired contractility and hyperplasia in the prostate and bladder of obese rats induced by high sucrose. STP and SR could enhance prostate function by reducing contractility and hyperplasia and improve smooth muscle fiber structure and decrease cell proliferation in the bladder, suggesting their possible health-beneficial effects on lower urinary tract symptoms. © 2017 Society of Chemical Industry.

[Bacterial prostatitis and prostatic fibrosis: modern view on the treatment and prophylaxis]

Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidase. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men]

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[A Case of Tubercular Prostatic Abscess Following Intravesical Bacillus Calmette-Guerin Therapy]

We report a case of tubercular prostatic abscess. A 65-year-old man had undergone intravesical Bacillus Calmette-Guerin therapy for a non-muscle invasive bladder carcinoma. One year 8 months later, the prostate-specific antigen concentration in serum was elevated (18. 58 ng/ml). Results of magnetic resonance imaging (MRI) of the pelvis led us to suspect a prostatic abscess, and transurethral resection of the prostate for drainage was performed. A culture of fluid obtained from the latter procedure revealed a tubercular prostatic abscess. We administered the antituberculous agents, isoniazid (300 mg) and rifampicin(450 mg) daily, for 6 months. One year after surgery, the patient had no urinary symptoms or evidence of recurrence.

[Application of saw palmetto fruit extract in the treatment of prostate diseases]

Saw palmetto fruit extract (SPE), as a herbal product, is widely used for the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Recent studies show that SPE also has some therapeutic effects on chronic prostatitis, prostate cancer, sexual dysfunction, and so on. This article presents an overview on the application of SPE in the treatment of BPH, prostate cancer, and chronic prostatitis/chronic pelvic pain syndrome, with a discussion on its action mechanisms.

[Experience of the use of drug urorec: efficacy and safety]

The article presents the experience of use of the new superselective alpha-blocker urorec (silodosin) in the treatment of 30 patients with lower urinary tract symptoms aged 49 to 69 years. Patients have received silodosin 1 capsule a day for 2 months. According to the results of study, silodosin has demonstrated high efficacy and an acceptable safety profile. It was shown that silodosin does not increase the risk of hypotension in patients taking antihypertensive medications. Therapy with silodosin had positive and statistically significant impact on subjective and objective symptoms of the disease, which was confirmed by the IPSS-QoL score and uroflowmetry. Silodosin has rapid onset of effect (3-4 days after the start of treatment); it can be used in all patients suffering from BPH and having indications to the administration of alpha-blockers, and does not require correction of doses of antihypertensive drugs in the case of combined appointment.

Fosfomycin for the treatment of prostate infection

A 69-year-old man with diabetes mellitus was diagnosed with a prostate abscess. Although the pathogen was fluoroquinolone-resistant Escherichia coli and the oral administration of trimethoprim-sulfamethoxazole was initiated, the infection recurred after three months. The antibiotic therapy was subsequently changed to intravenous fosfomycin, and the patient's condition promptly improved. Four weeks of fosfomycin therapy was successfully continued without any adverse events. In the era of antibiotic resistance, revival of forgotten drugs is an important issue for clinicians. Fosfomycin can be applied as an alternative option for prostate infections, considering the remaining susceptibility of multidrug-resistant pathogens to fosfomycin and the good pharmacokinetics of this drug in prostatic tissue.

Prostate diseases--role of sex steroids and their inhibitors

The normal prostate as well as prostatic diseases are influenced by androgens. The exact reason for an altered and uncontrolled response to androgens, whether benign as in benign prostate hyperplasia (BPH) or malignant as in the case of prostate cancer (PC), is not known in detail. Nevertheless, restriction of androgen receptor activation by reduction of available androgens is of great clinical value in both diseases. In BPH the inhibition of the conversion of testosterone into 5α-dihydrotestosterone (DHT) by 5α-reductase (5AR) is highly efficient and used in general practice, while the situation in PC is more complex. Specific inhibition of 5AR does not provide as efficient relief of symptoms as general androgen deprivation therapy (ADT), and the use of 5ARI for PC prevention is still under debate. Further, the altered steroid metabolism in castration resistant prostate cancer (CRPC) together with the complex paracrine signalling between different androgen responsive cell types, make the development of more specific drugs targeting androgen receptor signalling both more relevant and challenging.

Prostatic abscess: diagnosis and treatment of an infrequent urological entity

OBJECTIVE

To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity. METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome.

CONCLUSION

Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate.

Cyclosporine treatment of perianal gland adenoma concurrent with benign prostatic hyperplasia in a dog

A 13-year-old, intact male, mixed-breed dog was evaluated for multiple intradermal nodules around the anus. The nodules were diagnosed as perianal gland adenoma based on histopathologic examination. After therapy with cyclosporin A for 5 wk, the perianal masses were moderately shrunken. The dog's condition has remained stable over 6 mo.

Prostatic abscess a diagnostic dilemma

Abscess of the prostate has become increasingly rare due to modern antibiotics and a decreasing incidence of gonococcal infections. It is still difficult to diagnose the disorder on clinical grounds. Diagnosis is often made after Ultrasound examination. We report 2 cases of prostatic abscess and review etiopathogenic factors, clinical findings, diagnosis and treatment of this uncommon entity.

[Methodological approaches to experimental investigation of drugs for the prophylaxis and treatment of prostate gland disorders]

New methodological approaches to preclinical study of the efficiency of potential prostatotropic drugs are suggested on the basis of original research and published data. An algorithm is proposed to investigate specific activity and safety of potential drugs for the prevention and treatment of prostate disorders.

Melioidotic prostatic abscess in Pahang

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative bacillus. Melioidosis can affect many organs, including the prostate. However, prostatic abscess due to melioidosis is uncommon. We describe five cases of melioidosis with prostatic abscess. Four of five patients had diabetes mellitus and had more than one organ involvement. The diagnosis of prostatic abscess in our patients was only made with computed tomography of the abdomen and pelvis. None of our patients underwent surgical drainage and all remained well after treatment with antibiotics, except for one mortality secondary to severe septicaemia.

[Influence of dihydrotestosterone deficit on treatment of prostatic diseases regarding to contemporary methods of prostatic hypertrophy treatments]

In the prostate the enzyme 5alpha-reductase converts testosterone into more active form--dihydrotestosterone (DHT). This hormone strongly influences prostate function and takes part in its pathology Since the connection between androgens and pathology of this gland has been proved, pharmacological inhibition of conversion became one of the therapy strategies both for benign prostate hyperplasia and prostate cancer. Last decade has brought numerous, long term clinical trials which involved numerous men being administered finasteride and other 5alpha-reductase inhibitors in bening prostate hypertrophy (BPH) treatment and prostate cancer (PCa) prevention. The results confirmed main assumptions, however revealed complex androgens and other factors' activity overlapping with the effect of therapy on prostate disease.

Testosterone replacement therapy for the primary care physician

Testosterone replacement therapy (TRT) can have significant beneficial effects in the appropriate hypogonadal male patient. Testosterone deficiency is common in primary care practice and recognition of the signs and symptoms of this abnormality will allow physicians to choose appropriate interventions. The symptoms of clinical hypogonadism include muscle weakness, fatigue, mood changes and a reduced libido. Signs include a reduced muscle mass, osteoporosis, anemia and increased adiposity. While routine screening for testosterone deficiency, determination of testosterone levels in high risk populations, including obesity and diabetes, will help the clinician direct TRT to the patients most likely to benefit from therapy. In this article the syndrome of male hypogonadism is discussed, together with therapeutic choices available to the primary care physician.

Prostatic tuberculosis: case report

CONTEXT

Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients.

CASE REPORT

We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.

Activity of Serenoa repens, lycopene and selenium on prostatic disease: evidences and hypotheses

An increasing number of preclinical data, epidemiological evidences and clinical trials point to a potential role of natural compounds like herbal extracts, carotenoids and specific metals in the prevention and/or treatment of different prostate conditions, like hyperplasia, inflammation, cancer. The present article reviews some of the major and most recent findings on the therapeutic properties of three of the most widely used compounds, i.e. Serenoa repens, lycopene and selenium. Although the mechanism of action of these compounds ought to be further characterized by focused investigation, it appears that a common feature of these agents may be a dual activity on proliferative disorders as well as on inflammatory conditions at the level of the prostate gland.

Systemic blastomycosis diagnosed by prostate needle biopsy

A healthy 51-year-old man presented with a 1-month history of lower urinary tract irritative symptoms. Urinalysis was suggestive of infection, and the patient was treated with multiple antibiotics without relief of symptoms. A urological exam demonstrated abnormal induration of the prostate gland. Biopsy of the prostate gland revealed Blastomyces dermatitidis. In areas where Blastomyces dermatitidis is endemic, clinicians should be aware of the presence of this fungus and possible sites of infection.

[Curcumin in the treatment of prostatic diseases]

The use of turmeric, derived from the root of the plant curcuma longa, for the treatment of various diseases has been described in Ayurveda and in Traditional Chinese Medicine for thousands of years. The active component of turmeric responsible for this activity, curcumin, was identified almost two centuries ago. Extensive research over the last decade has indicated that this polyphenol can both prevent and treat prostatic diseases.

Management of chronic nonbacterial prostatitis/chronic pelvic pain syndrome

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists--which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001--significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment.

Hitting below the belt (Bladder): Botulinum treatment of urethral and prostate disorders

Botulinum toxin type A (BTX-A) has been used to treat urethral and prostatic diseases (off-label uses). Injection of BTX-A into the external sphincter of patients with detrusor external sphincter dyssynergia has been shown to successfully lower postvoid residual volumes and detrusor pressures. Average efficacy is 3 to 4 months, but long-term effects on detrusor leak point pressures or renal function are unknown. Injection of BTX-A into the prostate has shown promising short-term results (< or = 12 months) in improving the symptoms, postvoid residual volumes, maximal urinary flow rates, and prostate sizes in patients with benign prostatic hyperplasia. The mechanisms of action and long-term durability of this treatment modality are unknown. Evidence supporting the use of BTX-A in treating detrusor hypocontractility, pelvic floor dysfunction, postpubovaginal sling retention, urethral stricture, prostatitis, and chronic pelvic pain syndrome in men is preliminary and deserves further evaluation.

[Medical treatment of voiding problems in men]

Lower Urinary Tract Symptoms (LUTS) e.g. in prostatic infravesical obstruction and symptoms of overactive bladder (OAB) in men can be treated effectively with drugs. The current evidence for use of alpha-adrenergic blocking agents, 5-alpha-reductase inhibitors, combination therapy and antimuscarinic agents is reviewed with suggestions for follow-up. The increasing use of alpha-blockers, 5-alpha-reductase inhibitors, or both for symptomatic BPH has led to a significant decrease in the number of operations for BPH in the last decade. Bothersome nocturia due to nocturnal polyuria may be resolved by the administration of a loop-diuretic in the late afternoon.

Emphysematous prostatic abscess: A case report and review of literature

Emphysematous prostatic abscess, namely, is an inflammatory process associated with gas and abscess formation in the prostate gland. It is a rare clinical condition and a few cases have been reported in the literature. We report a case of emphysematous prostatic abscess due to Klebsiella pneumoniae in a 60-year-old man with a 5-year history of diabetes mellitus and a 6-year history of alcoholic liver cirrhosis. Computerized tomography confirmed the clinical diagnosis. We successfully treated the patient with parenteral antimicrobial agents and surgical drainage. The patient was discharged without any voiding difficulty.

The application of botulinum toxin in the prostate

PURPOSE

Botulinum neurotoxin is the most potent naturally occurring toxin known to inhibit various neurotransmitters. Injection of botulinum neurotoxin into the bladder and urethral sphincter has been used to treat bladder hyperactivity and sphincter dyssynergia. Recently botulinum neurotoxin application was extended to prostate disorders. Why would a urologist want to target the prostate?

MATERIALS AND METHODS

We reviewed the literature on the mechanisms of action and clinical efficacy of botulinum neurotoxin treatment of the prostate. In addition to our personal clinical experience and basic research, information was gathered from MEDLINE and published abstracts from international meetings. We also present basic research and discuss the potential mechanism of action of botulinum neurotoxin on the prostate.

RESULTS

There are 8 current peer reviewed publications on the injection of botulinum neurotoxin in the prostate. Cystoscopic transurethral or transperineal/transrectal ultrasound guided techniques have been used. Outcome improvement reported includes decreases in prostate size, prostate specific antigen and residual urine volume, and improvement in the flow rate and symptom score lasting 6 months or longer.

CONCLUSIONS

Botulinum toxin has demonstrated exciting and promising preliminary results for male lower urinary tract symptoms. Translational research suggests novel mechanism of action of botulinum toxin in the prostate for benign prostatic hyperplasia and chronic nonbacterial prostatitis. It may even be considered as adjuvant treatment for prostate cancer. The use of botulinum neurotoxin in the prostate is currently Food and Drug Administration off label and in support of evidence based medicine practices caution should be applied until larger, randomized clinical studies are completed. More basic research is needed to identify the mechanisms by which botulinum toxin affects the prostate.

Estrogens and aspects of prostate disease

Estrogens have long been associated with the processes involved in prostate carcinogenesis, particularly in cancer suppression. However, the synergistic influence of low concentrations of estrogens, together with androgens, in promoting aberrant growth of the gland has also been recognized. As new insights into the complex molecular events implicated in growth regulation of the prostate are revealed, the role of the estrogens has become clearer. The present review considers this role in relation to the pathogenesis of prostate cancer and the potential cancer-repressive influence of the dietary estrogens.

Botulinum-A toxin: an exciting new treatment option for prostatic disease

Recently, botulinum neurotoxin type A (BoNT-A) application in the lower urinary tract has been extended to prostate disorders and we would like to review the literature on the mechanisms of action and clinical efficacy of BoNT-A treatment in the prostate. The information was gathered from MEDLINE, abstracts from recent urological meetings and from personal experience. BoNT has demonstrated promising preliminary results for male prostatic disease and translational research suggests a novel mechanism of action of BoNT in the prostate. It is important to remember that the application of BoNT in the prostate is not approved by the regulatory agencies and caution should be applied until larger randomised clinical studies are completed.

Effects of chronic bacterial prostatitis on prostate specific antigen levels total and free in patients with benign prostatic hyperplasia and prostate cancer

BACKGROUND

Prostatic-specific antigen (PSA), a tumor marker helpful in the diagnosis and follow-up of prostate cancer, may rise due to causes such as prostatitis, chronic benign prostatic hyperplasia (BHP), etc. The aim of this study was to investigate the relationship between prostatitis and the level of total and free prostate-specific antigen in patients with no clinical evidence of prostate cancer.

METHODS

A comprehensive urological examination was performed on 156 patients aged 35-61 years old. All patients have symptoms of prostatitis. Prostate fluid culture was preformed. All patients underwent a course of antibacterial treatment after which the levels of total prostate specific antigen (TPSA) and free prostate specific antigen (FPSA) were evaluated.

RESULTS

An increase in TPSA (> 4 ng/ml) was observed in 14/24 (58.3%) patients with acute prostatitis and in 7/45 (15.5%) and 4/44 (9.1%) in patients with chronic bacterial prostatitis (CBP) and a bacterial prostatitis, respectively. Low blood concentration of TPSA and FPSA were observed after effective antibacterial and anti-inflammatory treatment therapy in most cases.

CONCLUSION

These data suggested that prostatitis must be considered when interpretation of TPSA and FPSA values as tumor marker.

The potential and promise of using botulinum toxin in the prostate gland

Botulinum neurotoxin (BoNT) has been called the 'most poisonous poison' and a potential bioterrorist weapon. However, it is possible to use the elegant and specific activity of this toxin to treat various medical conditions. Recently, the application of BoNT was extended to prostate disorders, and we review published reports on the mechanisms of action and clinical efficacy of BoNT in the prostate. The information was gathered from Medline, abstracts from recent urological meetings, and from personal experience. BoNT has shown promising preliminary results for male lower urinary tract symptoms, and translational research suggests a novel mechanism of action of BoNT in the prostate. Importantly, the application of BoNT in the prostate is not approved by the regulatory agencies and caution should be used until larger randomized clinical studies are completed.

Management of bladder, prostatic and pelvic floor disorders

Since its introduction in the late 1970s for the treatment of strabismus and blepharospasm, botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several other disorders characterized by excessive or inappropriate muscle contractions. Over the years, the number of primary clinical publications has grown exponentially, and still continues to increase. It has been shown that BoNT blocks cholinergic nerve endings in the autonomic nervous system but does not block non-adrenergic non-cholinergic responses mediated by nitric oxide (NO). The present paper reviews a number of recent clinical indications for urological and pelvic floor dysfunctions, such as overactive and neurogenic bladder, non-bacterial prostatitis, benign prostatic hyperplasia, chronic anal fissure, or conditions associated to hyperactivity of the puborectalis muscle during straining. These indications provide a new promising palette of indications for future usage of BoNT in clinical practice.

Identification of the Major Oxidative 3α-Hydroxysteroid Dehydrogenase in Human Prostate That Converts 5α-Androstane-3α,17β-diol to 5α-Dihydrotestosterone: A Potential Therapeutic Target for Androgen-Dependent Disease

Androgen-dependent prostate diseases initially require 5α-dihydrotestosterone (DHT) for growth. The DHT product 5α-androstane-3α,17β-diol (3α-diol), is inactive at the androgen receptor (AR), but induces prostate growth, suggesting that an oxidative 3α-hydroxysteroid dehydrogenase (HSD) exists. Candidate enzymes that posses 3α-HSD activity are type 3 3α-HSD (AKR1C2), 11-cis retinol dehydrogenase (RODH 5), L-3-hydroxyacyl coenzyme A dehydrogenase , RODH like 3α-HSD (RL-HSD), novel type of human microsomal 3α-HSD, and retinol dehydrogenase 4 (RODH 4). In mammalian transfection studies all enzymes except AKR1C2 oxidized 3α-diol back to DHT where RODH 5, RODH 4, and RL-HSD were the most efficient. AKR1C2 catalyzed the reduction of DHT to 3α-diol, suggesting that its role is to eliminate DHT. Steady-state kinetic parameters indicated that RODH 4 and RL-HSD were high-affinity, low-capacity enzymes whereas RODH 5 was a low-affinity, high-capacity enzyme. AR-dependent reporter gene assays showed that RL-HSD, RODH 5, and RODH 4 shifted the dose-response curve for 3α-diol a 100-fold, yielding EC50 values of 2.5 × 10−9m, 1.5 × 10−9m, and 1.0 × 10−9m, respectively, when compared with the empty vector (EC50 = 1.9 × 10−7m). Real-time RT-PCR indicated that L-3-hydroxyacyl coenzyme A dehydrogenase and RL-HSD were expressed more than 15-fold higher compared with the other candidate oxidative enzymes in human prostate and that RL-HSD and AR were colocalized in primary prostate stromal cells. The data show that the major oxidative 3α-HSD in normal human prostate is RL-HSD and may be a new therapeutic target for treating prostate diseases.

Coccidioidomycosis of the prostate: a determination of incidence, report of 4 cases, and treatment recommendations

OBJECTIVE

To describe the incidence of Coccidioides immitis infection of the prostate gland in an endemic area, to describe four new cases discovered, and to propose treatment recommendations for this diagnosis.

METHODS

The pathology reports of all prostate tissue specimens collected at the Arizona Health Sciences Center from February 1, 1994 through January 1, 2000 and the Southern Arizona Veterans' Affairs Health Care System from January 1, 1990 through January 1, 2000 were reviewed.

RESULTS

A total of 3676 pathology reports were reviewed. Forty-four cases of granulomatous prostatitis were identified (incidence=1.2%). Among these, four cases of C. immitis prostatitis were identified (incidence of granulomatous prostatitis=10%; overall incidence=0.1%). Two cases were found at radical retropubic prostatectomy and two were found on prostate needle biopsy. Five months post-radical prostatectomy one man developed symptomatic coccidioidomycosis and died of complications despite treatment with amphotericin B. Another patient who underwent a radical retropubic prostatectomy was treated with oral fluconazole for 14 months immediately after surgery and had a good response. The remaining two patients received no anti-fungal therapy and are being observed.

CONCLUSIONS

Coccidioidomycosis of the prostate is rare. However, when identified, the finding should not be ignored. Patients with symptomatic coccidioidomycosis require immediate anti-fungal therapy. When the diagnosis is an incidental finding and the patient does not manifest symptoms, the degree of tissue violation involved in making the diagnosis influences the need for treatment. Patients with minimal tissue violation (i.e. needle biopsy) can be observed whereas patients with more extensive tissue violation (i.e. prostatectomy) should receive anti-fungal therapy.

Treatment of Prostatic Abscesses by Aspiration of the Purulent Matter and Injection of Tea Tree Oil into the Cavities in Dogs

Ultrasonography-guided transabdominal needle aspiration was carried out to remove 3 to 14 ml of purulent matter from the cavities of prostatic abscesses in 6 dogs, and the same volume of tea tree oil was injected into the cavities to treat the abscesses. The same treatment was repeated 3 weeks later in 4 dogs, and subsequent disappearance of the purulent matter in the cavities and a marked reduction in the volume of the cavities were observed. These findings indicate that the treatment of prostatic abscesses by aspiration of the purulent matter and injection of tea tree oil into the cavities is very effective in dogs.