We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbi...We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg day^- 1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen （PSA） were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction （ED） at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.展开更多
The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacterio...The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.展开更多
To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the ...To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.展开更多
目的分析经尿道前列腺剜除术治疗老年良性前列腺增生的临床疗效。方法选取盐城市第一人民医院泌尿外科2022年9月—2023年3月诊治的老年良性前列腺增生患者78例,均行手术治疗,根据不同术式纳入对照组(39例)与观察组(39例)。对照组行等离...目的分析经尿道前列腺剜除术治疗老年良性前列腺增生的临床疗效。方法选取盐城市第一人民医院泌尿外科2022年9月—2023年3月诊治的老年良性前列腺增生患者78例,均行手术治疗,根据不同术式纳入对照组(39例)与观察组(39例)。对照组行等离子前列腺电切术,观察组行经尿道等离子前列腺剜除术。对比两组的手术指标(手术时间、失血量、前列腺切除重量)、尿动力学指标(残余尿量、最大尿流率)、临床症状[国际前列腺症状评分(International prostate symptom score,IPSS)]、生活质量评分[世界卫生组织编制的生存质量量表(the world health organization quality of Life,WHOQOLBREF)]、手术效果以及并发症(尿道狭窄、假性尿失禁、尿潴留、包膜穿孔)。结果观察组的手术时间、失血量少于对照组,前列腺切除重量大于对照组(P<0.05)。两组术后3个月的残余尿量均减少,最大尿流率均增大(P<0.05);且观察组术后3个月的残余尿量少于对照组,最大尿流率大于对照组(P<0.05)。两组术后3个月的IPSS评分均降低,WHOQOLBREF评分均升高(P<0.05);且观察组术后3个月的IPSS评分低于对照组,WHOQOL-BREF评分高于对照组(P<0.05)。观察组的总有效率高于对照组(P<0.05)。观察组的并发症发生率低于对照组(P<0.05)。结论经尿道前列腺剜除术治疗老年良性前列腺增生的临床疗效较好,可改善手术指标与尿动力学指标、且能减轻患者临床症状、提高生活质量,具有手术时间短、出血少、并发症少的特点。展开更多
文摘We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg day^- 1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen （PSA） were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction （ED） at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.
文摘The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.
文摘To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.
文摘目的分析经尿道前列腺剜除术治疗老年良性前列腺增生的临床疗效。方法选取盐城市第一人民医院泌尿外科2022年9月—2023年3月诊治的老年良性前列腺增生患者78例,均行手术治疗,根据不同术式纳入对照组(39例)与观察组(39例)。对照组行等离子前列腺电切术,观察组行经尿道等离子前列腺剜除术。对比两组的手术指标(手术时间、失血量、前列腺切除重量)、尿动力学指标(残余尿量、最大尿流率)、临床症状[国际前列腺症状评分(International prostate symptom score,IPSS)]、生活质量评分[世界卫生组织编制的生存质量量表(the world health organization quality of Life,WHOQOLBREF)]、手术效果以及并发症(尿道狭窄、假性尿失禁、尿潴留、包膜穿孔)。结果观察组的手术时间、失血量少于对照组,前列腺切除重量大于对照组(P<0.05)。两组术后3个月的残余尿量均减少,最大尿流率均增大(P<0.05);且观察组术后3个月的残余尿量少于对照组,最大尿流率大于对照组(P<0.05)。两组术后3个月的IPSS评分均降低,WHOQOLBREF评分均升高(P<0.05);且观察组术后3个月的IPSS评分低于对照组,WHOQOL-BREF评分高于对照组(P<0.05)。观察组的总有效率高于对照组(P<0.05)。观察组的并发症发生率低于对照组(P<0.05)。结论经尿道前列腺剜除术治疗老年良性前列腺增生的临床疗效较好,可改善手术指标与尿动力学指标、且能减轻患者临床症状、提高生活质量,具有手术时间短、出血少、并发症少的特点。
