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Third International Chronic Prostatitis Network

Does abacterial prostatitis really exist?

F.Guercini1, S.Mazzoli,2 C.Pajoncini,1 A.Salvi,2 M.Porena 1,
1Dept. of Urology, University of Perugia, Italy. 2STD Centre, St. M. Annunziata Hospital, Florence, Italy
Objectives
In the National Institute of Health Classification pros-tatitis syndrome are categorized in clinical practice on the basis of bacteriuria and the number of inflam-matory cells in the prostatic secretion. According to these indications many patients are considered carriers of abacterial prostatitis and are treated as such. The presence of an agent inflecting the prostate cannot however be completely excluded. It could nest in acini or in fibrous-calcifications but still be active and capable of rendering the so-called abacterial prostatitis chronic.
Materials & Methods
We recruited 56 of the last 145 patients referred to our Centre because of prostatitis. The age-range was 18-46 years (mean 32 years). No patient was affected by bacteriuria. In the prostatic secretion all had at least 10 leucocytes per microscopic field according to Stamey’s method (1966). 2-4 weeks before prostatic secretion sampling, urethral swabs showed no patient was positive for Trichomonas vaginalis, Chlamydia tracomatis, Micoplasma hominis, Ureaplasma ureal-yticum, HPV ed Herpes genitalis. Using the transper-ineal route, ultrasound guided needle aspirates were taken from sonographically dishomogenous areas in the prostate. Samples underwent histological analysis and DNA extraction to detect Chlamydia trac-omatis, Neisseria gonorrhoeae and HPV using PCR amplification.
Results
Histological findings were indicative of inflammation in all 56 patients with lymphocyte aggregates being found rarely within the gland (19%) and mostly in the peri-gland area (46%) and stroma (35%). Cultures were positive for aerobic (56%) and anaerobic (23%) agents. Twenty-one patients (38%) presented with more than 2 species of microorganisms and 9 (15%) with more than 3. DNA infected with Chlamydia trachomatis was found in 19 (34%) patients. The 9 samples (16%) with only anaerobic bacteria were associated with a high number of leucocytes in Stamey’s test (>15).
Conclusions
The accuracy of needle sampling under ultrasound guidance using the transperitoneal route excludes false positive results caused by contamination with pathogens in the urethra. The high frequency of positivity for microorganisms detected using these techniques indicates studies on more patients should be performed in order to revise the classi-fication of prostatic syndromes and to define them more accurately.
© 2002 The Prostatitis Foundation
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