Given the repeated visits by anyone who connects from the United Hospitals of Foggia, I decided to open a book of medicine. Today we'll talk dei problemi alla prostata.
Per Prostatite si intende qualsiasi forma di infiammazione della ghiandola prostatica. Poiché le donne sono sprovviste di tale ghiandola si tratta di una sindrome che colpisce esclusivamente il sesso maschile, nonostante ciò le donne possiedono delle microscopiche ghiandole periuretrali, definite ghiandole di Skene, site nell'area prevaginale in prossimità dell'uretra, che sono considerate l'omologo della prostata e possono causare una forte sintomatologia.
La prostatite ha un'incidenza che va dal 7% al 12% a seconda del territorio e delle statistiche. Il termine Prostatite, in senso stretto, si riferisce all'infiammazione istologica (microscopica) glandular tissue of the prostate, yet the term has been used in a vague way to describe a number of clinical conditions relatively different from each other. For groped to remedy this situation, the NIH (National Institutes of Health) in 1999 issued a new classification system.
Following the classification made in 1999 by the NIH, prostatitis has been subdivided into four different categories.
- Category I: Acute prostatitis (bacterial)
- Category II: Chronic Bacterial Prostatitis
- Category III: chronic abatterica Prostatitis / Chronic pelvic pain syndrome (CPPS), pelvic Mioneuropatia.
- the categories: IV: Asymptomatic Prosatite
Category I: Acute prostatitis (bacterial)
Symptoms People who suffer from acute prostatitis chills, fever, back pain and genital area, urinary frequency and urgency often at night, burning and discomfort during urination, tenderness, and a lower urinary tract infection, highlighted as a result of analysis laboratory, the presence of leukocytes and bacteria in the urine. There may be discharge from the penis. A relatively common occurrence is represented by acute retention of urine due to the fact that inflammation causes a narrowing of the first part of the urethra (prostatic urethra). The patient tries to urinate but can not, and severe pain in the lower abdomen. In this case, to drain urine will put a tube that goes from the front wall of the abdomen into the bladder, and leave it until the disease is not cured. It is not recommended because the catheter can be made more severe disease leading to a further irritation prostatic urethra.
Diagnosis
Acute prostatitis is relatively easy to diagnose because all the symptoms suggest an infection. The most common bacteria Escherichia coli, Klebsiella, Proteus, Pseudomonas, Enterobacteriaceae, Enterococcus, Serratia and Staphylococcus aureus. These infections can pose a threat to some patients may require hospitalization with intravenous antibiotics. A haemogram may reveal an increase of leukocytes in the blood. Acute prostatitis rarely leads to septicemia, but may occur in immunosuppressed patients, in which case a high fever and general malaise lead to a blood culture is often positive.
Therapy
The Antibiotics are the first-line treatment in acute prostatitis (Cat I). Antibiotics usually resolve the infection in a very short period of time. Should be used for appropriate antibiotic to the bacterium chosen due to the infection as a result of susceptibility testing. Some antibiotics have a low level of penetration into the prostatic capsule, others, such as ciprofloxacin, penetrate well. Seriously ill patients may require hospitalization, while patients in accordance with acceptable state of health can be treated staying at home in bed, and using painkillers, taking care to maintain good hydration.
Prognosis In most cases the prognosis is positive with a full recovery without adverse consequences later.
Symptoms People who suffer from acute prostatitis chills, fever, back pain and genital area, urinary frequency and urgency often at night, burning and discomfort during urination, tenderness, and a lower urinary tract infection, highlighted as a result of analysis laboratory, the presence of leukocytes and bacteria in the urine. There may be discharge from the penis. A relatively common occurrence is represented by acute retention of urine due to the fact that inflammation causes a narrowing of the first part of the urethra (prostatic urethra). The patient tries to urinate but can not, and severe pain in the lower abdomen. In this case, to drain urine will put a tube that goes from the front wall of the abdomen into the bladder, and leave it until the disease is not cured. It is not recommended because the catheter can be made more severe disease leading to a further irritation prostatic urethra.
Diagnosis
Acute prostatitis is relatively easy to diagnose because all the symptoms suggest an infection. The most common bacteria Escherichia coli, Klebsiella, Proteus, Pseudomonas, Enterobacteriaceae, Enterococcus, Serratia and Staphylococcus aureus. These infections can pose a threat to some patients may require hospitalization with intravenous antibiotics. A haemogram may reveal an increase of leukocytes in the blood. Acute prostatitis rarely leads to septicemia, but may occur in immunosuppressed patients, in which case a high fever and general malaise lead to a blood culture is often positive.
Therapy
The Antibiotics are the first-line treatment in acute prostatitis (Cat I). Antibiotics usually resolve the infection in a very short period of time. Should be used for appropriate antibiotic to the bacterium chosen due to the infection as a result of susceptibility testing. Some antibiotics have a low level of penetration into the prostatic capsule, others, such as ciprofloxacin, penetrate well. Seriously ill patients may require hospitalization, while patients in accordance with acceptable state of health can be treated staying at home in bed, and using painkillers, taking care to maintain good hydration.
Prognosis In most cases the prognosis is positive with a full recovery without adverse consequences later.
Category II: Chronic Bacterial Prostatitis
Symptoms
Chronic bacterial prostatitis is a relatively rare condition (<5% style="font-weight: bold;">
diagnosis of chronic bacterial prostatitis If bacteria are detected in the prostate even though there are no other symptoms. The infection of the prostate is diagnosed as a result of urine culture and / or prostatic fluid which is obtained from the doctor performing a prostate massage. If as a result of prostate massage is not possible to collect excreted urine post prostate massage should still contain some prostatic bacteria. The analysis of the PSA (Prostate specific antigen) may be high despite the absence of malignancy.
Therapy Treatment requires prolonged courses of antibiotics (4-8 weeks), with high penetration of prostatic ghinadola (β-lactam and nitrofurantoin are ineffective). These antibiotics include quinolones (ciprofloxaxina, levofloxacin), sulfonamides (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may benefit from an improvement in symptoms in 80% of patients by using alpha-blockers (tamsulosin, alfuzosin), or prolonged use in termpo of a low dose of antibiotics. The riccorrenti infections may be caused by inefficient urination (BPH or overactive bladder), prostatic calcifications or structural abnormalities may represent a reservoir for recurrent infections. The combination of prostate massage and courses of antibiotics has been proposed as beneficial in the past (Manila Protocol). This practice is not without risks and a recent study has shown to be superior to antibiotics alone. Prognosis
Over time, the rate of improvement is high, exceeding 50%.
Chronic bacterial prostatitis is a relatively rare condition (<5% style="font-weight: bold;">
diagnosis of chronic bacterial prostatitis If bacteria are detected in the prostate even though there are no other symptoms. The infection of the prostate is diagnosed as a result of urine culture and / or prostatic fluid which is obtained from the doctor performing a prostate massage. If as a result of prostate massage is not possible to collect excreted urine post prostate massage should still contain some prostatic bacteria. The analysis of the PSA (Prostate specific antigen) may be high despite the absence of malignancy.
Therapy Treatment requires prolonged courses of antibiotics (4-8 weeks), with high penetration of prostatic ghinadola (β-lactam and nitrofurantoin are ineffective). These antibiotics include quinolones (ciprofloxaxina, levofloxacin), sulfonamides (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may benefit from an improvement in symptoms in 80% of patients by using alpha-blockers (tamsulosin, alfuzosin), or prolonged use in termpo of a low dose of antibiotics. The riccorrenti infections may be caused by inefficient urination (BPH or overactive bladder), prostatic calcifications or structural abnormalities may represent a reservoir for recurrent infections. The combination of prostate massage and courses of antibiotics has been proposed as beneficial in the past (Manila Protocol). This practice is not without risks and a recent study has shown to be superior to antibiotics alone. Prognosis
Over time, the rate of improvement is high, exceeding 50%.
Category III CPPS, Mioneuropatia pelvic
Symptoms
The CPPS is characterized by pelvic pain of unknown cause, that lasts at least 6 months continuously. Symptoms usually have a cyclical nature with periods of improvement followed with others in which there is a resurgence of the same. The pain may be mild or debilitating, and can radiate from the buttocks or rectum, making it difficult to remain seated. Dysuria, myalgia, chronic fatigue, abdominal pain, constant burning inside the penis, urinary frequency and urgency may be present. The urgency and frequency of urination make it appear similar to interstitial cystitis (an inflammation of the bladder rather than prostate cancer). Ejaculation may be uncomfortable or painful due to the contraction of the prostate during the release of seminal fluid while muscle pain and nerve irritation is more common and should be considered a classic sign of CPPS. Some patients report a decrease in libido, sexual dysfunction and erectile dysfunction. The post ejaculatory pain is a symptom that can distinguish patients with CPPS than those with benign prostatic hypertrophy (BPH).
theories regarding the etiology
There are different theories regarding the etiology of CPPPS, among them worth mentioning the autoimmune hypothesis, for which there is little evidence, however, neurogenic inflammation and myofascial pain syndrome. The last two assumptions may have a genesis in local dysfunctions of the nervous system caused by past traumas or a genetic predisposition in some individuals leads to an abnormal contraction of the pelvic floor and unconscious that causes tissue inflammation mediated by substances released by the nervous system (such as substance P). The prostate (and other tissues of the genitourinary: bladder, urethra and testes) can be ignited by the action of the nervous system activation on mast cells in the pelvic nerve endings. This ability of stress to induce inflammation of genitourinary has also been demonstrated experimentally in other mammals. Dr. Anthony Schaeffer, a researcher involved for many years on prostatitis, commenting on an editorial in The Journal of Urology 2003, said: "It is been shown that even if there are pathogenic bacteria within the prostate, as well as in men with chronic bacterial prostatitis, they are not the cause of chronic pelvic pain unless they develop an acute infection of the urinary tract. All of this information would seem to suggest that bacteria do not have a significant role in the development of CPPS. The clinical observation of the reduction of symptoms in patients with CPPS, after antibiotic therapy has been tested in a double-blind controlled study. Given the fact that antibiotics may have an anti-inflammatory effect, it is possible that these types of drugs may provide temporary benefits to patients by reducing inflammation rather than eradicating the bacteria. " A year away from that statement, Dr Schaeffer and his colleagues published a study that showed that antibiotics are basically useless in the event of CPPS. The theory of bacterial infection, which was for years the major explanation for the etiology of CPPS was again diminished in another 2003 study conducted by a University of Washington team led by Dr. Lee and Professor Richard Berger. The study used two groups of individuals, one composed of patients with CPPS and another control with healthy subjects. The analysis of crops in the secretions showed that one third of the subjects in both groups had a WBC same strains of bacteria that had colonized their similar prostate. Since the publication of these studies, the focus of analysis for the CPPS has moved to the neuromuscular bacterial etiology.
possible role of bacteria difficult to culture in the CPPS: There were some doubts concerning the role of microorganisms culture (criptobatteri). Although a team led by Keith Jarvi in \u200b\u200b2001, has reported the isolation of a particular type of bacteria, at the annual meeting of the American Urological Association (AUA), the result was never published in any journal Urology, a sign that the study should not have passed the review process (peer review). This news was published in the incident on Urology Times, a newsletter for urologists. However, after careful studies in PCR have not been able to replicate these findings and medical researchers seem to agree that the CPPS is not caused by an active bacterial infection.
Prostatitis abatterica as a particular form of interstitial cystitis (IC): Some researchers have suggested that the CPPS is a form of interstitial cystitis. A large multicenter randomized controlled trial showed that Elmiron (pentosan polysulfate sodium) is slightly superior to placebo in treating the symptoms of CPPS. Other therapies that all'Elmiron were higher in the treatment of interstitial cystitis, such as quercetin and amitriptyline, can be utili nel trattamento della CPPS.
Diagnosi
Non esistono test diagnostici definitivi per la CPPS. Essa infatti è una sindrome poco conosciuta nonostante rappresenti il 90%-95% delle diagnosi di prostatite. È stata diagnosticata in soggetti di qualsiasi età, con un picco massimo intorno ai 30. La CPPS può essere di tipo infiammatorio (categoria IIIa) o non infiammatorio (categoria IIIb). Nel primo tipo, le urine, lo sperma o il liquido seminale contiene pus (leucociti morti), mentre nel secondo tipo non sono presenti residui di pus o leucociti.. Recenti studi hanno messo in discussione la distinzione tra le due categorie, da quando entrambe hanno dimostrato un'evidenza d'infiammazione considerando markers infiammatori more complex, such as cytokine. In 2006, a Chinese researcher has shown that individuals in categories IIIa and IIIb have the same high level of anti-inflammatory cytokine TGFβ1 and pro-inflammatory cytokine IFN-γ in their prostatic secretions compared with the control group, which explains why the measuring the level of cytokine could be used to diagnose category III prostatitis. In a double-blind study has shown the presence of a slightly higher number of bacteria in the secretions of healthy subjects than affection from CPPS. The traditional test of the four glasses developed by Stamey is not valid for the diagnosis of this condition and location of the inflammation can not be localizzata in nessuna particolare area del tratto genitourinario. Gli individui affetti da CPPS hanno una maggiore probabilità di soffrire della Sindrome della fatica cronica rispetto alla normale popolazione, e di Sindrome del colon irritabile. I livelli di PSA possono essere elevati sebbene non sia presente una neoplasia.
Terapia
Trattamento fisico e psicologico
Per la prostatite abatterica (Categoria III), detta anche CPPS o mioneuropatia pelvica, che rappresenta la maggioranza dei soggetti con diagnosi da "prostatite" un trattamento chiamato Protocollo Stanford, sviluppato nel 1996 dal Professore di Urologia Rodney Anderson e dallo psicologo David Wise della Stanford University, è stato pubblicato in 2005. The protocol is the combination of a "psychological treatment" (the paradoxical relaxation, which is a specific adaptation to CPPS for a progressive relaxation technique developed by Edmund Jacobson during the twentieth century), physiotherapy (based on the identification of trigger points to ' internal pelvic floor and abdominal wall) and stretching exercises that help to achieve greater relaxation of the pelvic floor. Although these studies appear very encouraging, are expected conclusive evidence on the effectiveness of the Protocol as a result of a major randomized, double-blind presents many difficulties when it comes to test the effectiveness of physiotherapy treatment compared with those drug. According to this approach, the CPPS could have as its sole cause of the initial anxiety experienced compulsively. It has been theorized that stress has the ability, in certain susceptible individuals, to raise awareness of the pelvis leading to a vicious cycle of muscle tension that increases with a neurological feedback mechanism (neural wind-up). The present protocol focuses on the relaxation of the pelvic muscles and anal (which usually have trigger points) through internal physiotherapy sessions (by anal) and external massage, as well as progressive relaxation techniques that have the aim of breaking the habit focus of anxiety and stress on the pelvic muscles. Biofeedback techniques that re-teach how to control the pelvic muscles can be useful in case of CPPS. Aerobic exercise can help those who do not suffer from Chronic Fatigue Syndrome and / or acus a worsening of symptoms with exercise. Food allergies
anecdotal evidence suggests that allergies and intolerances may play an important role in exacerbating the CPPS, perhaps through a mechanism mediated by mast cells. In particular, patients with a gluten intolerance or celiac disease reported a significant worsening of symptoms after ingesting gluten. Patients may find it useful to adopt an exclusion diet, which decreases the symptoms leading to an identification of eating problems. Studies are lacking about the relationship between power and CPPS.
Pharmacotherapy
There is a long list of medications taken to treat this syndrome. Alpha blockers (tamsulosin, alfuzosin) seem to have a slight improvement on the obstructive symptoms in patients with CPPS, the duration of therapy, to have a certain degree of effectiveness must be at least three months. Quercetin has demonstrated its effectiveness in a randomized, double-blind, active-control palcebo, with the intake of 500mg twice daily for 4 weeks. Subsequent studies have shown that quercetin is an inhibitor of mast cells, reduces inflammation and stress oxidative in the prostate. Even the pollen extract (Cernilton) has demonstrated its effectiveness in a controlled study. Commonly used therapies which have not been properly evaluated in clinical trials, dietary changes, gabapentin and amitriptyline. Other therapies are ineffective in controlled trials: levaquin (antibiotic), alpha blockers for a period of less than 6 weeks and ablation of the prostate for transurethral (TUNA). At least one study suggests that the multimodal approach (aimed at different objectives, such as inflammation and muscle dysfunction simultaneously) is better than a single therapy in long-term analysis. Prognosis
In recent years, la prognosi per la CPPS è migliorata notevolmente con l'avvento di terapie multimodali, sostanze fitoterapice e protocolli mirati al rilassamento della tensione muscolare attraverso lo scioglimento dei trigger point ed il controllo dell'ansia.
The CPPS is characterized by pelvic pain of unknown cause, that lasts at least 6 months continuously. Symptoms usually have a cyclical nature with periods of improvement followed with others in which there is a resurgence of the same. The pain may be mild or debilitating, and can radiate from the buttocks or rectum, making it difficult to remain seated. Dysuria, myalgia, chronic fatigue, abdominal pain, constant burning inside the penis, urinary frequency and urgency may be present. The urgency and frequency of urination make it appear similar to interstitial cystitis (an inflammation of the bladder rather than prostate cancer). Ejaculation may be uncomfortable or painful due to the contraction of the prostate during the release of seminal fluid while muscle pain and nerve irritation is more common and should be considered a classic sign of CPPS. Some patients report a decrease in libido, sexual dysfunction and erectile dysfunction. The post ejaculatory pain is a symptom that can distinguish patients with CPPS than those with benign prostatic hypertrophy (BPH).
theories regarding the etiology
There are different theories regarding the etiology of CPPPS, among them worth mentioning the autoimmune hypothesis, for which there is little evidence, however, neurogenic inflammation and myofascial pain syndrome. The last two assumptions may have a genesis in local dysfunctions of the nervous system caused by past traumas or a genetic predisposition in some individuals leads to an abnormal contraction of the pelvic floor and unconscious that causes tissue inflammation mediated by substances released by the nervous system (such as substance P). The prostate (and other tissues of the genitourinary: bladder, urethra and testes) can be ignited by the action of the nervous system activation on mast cells in the pelvic nerve endings. This ability of stress to induce inflammation of genitourinary has also been demonstrated experimentally in other mammals. Dr. Anthony Schaeffer, a researcher involved for many years on prostatitis, commenting on an editorial in The Journal of Urology 2003, said: "It is been shown that even if there are pathogenic bacteria within the prostate, as well as in men with chronic bacterial prostatitis, they are not the cause of chronic pelvic pain unless they develop an acute infection of the urinary tract. All of this information would seem to suggest that bacteria do not have a significant role in the development of CPPS. The clinical observation of the reduction of symptoms in patients with CPPS, after antibiotic therapy has been tested in a double-blind controlled study. Given the fact that antibiotics may have an anti-inflammatory effect, it is possible that these types of drugs may provide temporary benefits to patients by reducing inflammation rather than eradicating the bacteria. " A year away from that statement, Dr Schaeffer and his colleagues published a study that showed that antibiotics are basically useless in the event of CPPS. The theory of bacterial infection, which was for years the major explanation for the etiology of CPPS was again diminished in another 2003 study conducted by a University of Washington team led by Dr. Lee and Professor Richard Berger. The study used two groups of individuals, one composed of patients with CPPS and another control with healthy subjects. The analysis of crops in the secretions showed that one third of the subjects in both groups had a WBC same strains of bacteria that had colonized their similar prostate. Since the publication of these studies, the focus of analysis for the CPPS has moved to the neuromuscular bacterial etiology.
possible role of bacteria difficult to culture in the CPPS: There were some doubts concerning the role of microorganisms culture (criptobatteri). Although a team led by Keith Jarvi in \u200b\u200b2001, has reported the isolation of a particular type of bacteria, at the annual meeting of the American Urological Association (AUA), the result was never published in any journal Urology, a sign that the study should not have passed the review process (peer review). This news was published in the incident on Urology Times, a newsletter for urologists. However, after careful studies in PCR have not been able to replicate these findings and medical researchers seem to agree that the CPPS is not caused by an active bacterial infection.
Prostatitis abatterica as a particular form of interstitial cystitis (IC): Some researchers have suggested that the CPPS is a form of interstitial cystitis. A large multicenter randomized controlled trial showed that Elmiron (pentosan polysulfate sodium) is slightly superior to placebo in treating the symptoms of CPPS. Other therapies that all'Elmiron were higher in the treatment of interstitial cystitis, such as quercetin and amitriptyline, can be utili nel trattamento della CPPS.
Diagnosi
Non esistono test diagnostici definitivi per la CPPS. Essa infatti è una sindrome poco conosciuta nonostante rappresenti il 90%-95% delle diagnosi di prostatite. È stata diagnosticata in soggetti di qualsiasi età, con un picco massimo intorno ai 30. La CPPS può essere di tipo infiammatorio (categoria IIIa) o non infiammatorio (categoria IIIb). Nel primo tipo, le urine, lo sperma o il liquido seminale contiene pus (leucociti morti), mentre nel secondo tipo non sono presenti residui di pus o leucociti.. Recenti studi hanno messo in discussione la distinzione tra le due categorie, da quando entrambe hanno dimostrato un'evidenza d'infiammazione considerando markers infiammatori more complex, such as cytokine. In 2006, a Chinese researcher has shown that individuals in categories IIIa and IIIb have the same high level of anti-inflammatory cytokine TGFβ1 and pro-inflammatory cytokine IFN-γ in their prostatic secretions compared with the control group, which explains why the measuring the level of cytokine could be used to diagnose category III prostatitis. In a double-blind study has shown the presence of a slightly higher number of bacteria in the secretions of healthy subjects than affection from CPPS. The traditional test of the four glasses developed by Stamey is not valid for the diagnosis of this condition and location of the inflammation can not be localizzata in nessuna particolare area del tratto genitourinario. Gli individui affetti da CPPS hanno una maggiore probabilità di soffrire della Sindrome della fatica cronica rispetto alla normale popolazione, e di Sindrome del colon irritabile. I livelli di PSA possono essere elevati sebbene non sia presente una neoplasia.
Terapia
Trattamento fisico e psicologico
Per la prostatite abatterica (Categoria III), detta anche CPPS o mioneuropatia pelvica, che rappresenta la maggioranza dei soggetti con diagnosi da "prostatite" un trattamento chiamato Protocollo Stanford, sviluppato nel 1996 dal Professore di Urologia Rodney Anderson e dallo psicologo David Wise della Stanford University, è stato pubblicato in 2005. The protocol is the combination of a "psychological treatment" (the paradoxical relaxation, which is a specific adaptation to CPPS for a progressive relaxation technique developed by Edmund Jacobson during the twentieth century), physiotherapy (based on the identification of trigger points to ' internal pelvic floor and abdominal wall) and stretching exercises that help to achieve greater relaxation of the pelvic floor. Although these studies appear very encouraging, are expected conclusive evidence on the effectiveness of the Protocol as a result of a major randomized, double-blind presents many difficulties when it comes to test the effectiveness of physiotherapy treatment compared with those drug. According to this approach, the CPPS could have as its sole cause of the initial anxiety experienced compulsively. It has been theorized that stress has the ability, in certain susceptible individuals, to raise awareness of the pelvis leading to a vicious cycle of muscle tension that increases with a neurological feedback mechanism (neural wind-up). The present protocol focuses on the relaxation of the pelvic muscles and anal (which usually have trigger points) through internal physiotherapy sessions (by anal) and external massage, as well as progressive relaxation techniques that have the aim of breaking the habit focus of anxiety and stress on the pelvic muscles. Biofeedback techniques that re-teach how to control the pelvic muscles can be useful in case of CPPS. Aerobic exercise can help those who do not suffer from Chronic Fatigue Syndrome and / or acus a worsening of symptoms with exercise. Food allergies
anecdotal evidence suggests that allergies and intolerances may play an important role in exacerbating the CPPS, perhaps through a mechanism mediated by mast cells. In particular, patients with a gluten intolerance or celiac disease reported a significant worsening of symptoms after ingesting gluten. Patients may find it useful to adopt an exclusion diet, which decreases the symptoms leading to an identification of eating problems. Studies are lacking about the relationship between power and CPPS.
Pharmacotherapy
There is a long list of medications taken to treat this syndrome. Alpha blockers (tamsulosin, alfuzosin) seem to have a slight improvement on the obstructive symptoms in patients with CPPS, the duration of therapy, to have a certain degree of effectiveness must be at least three months. Quercetin has demonstrated its effectiveness in a randomized, double-blind, active-control palcebo, with the intake of 500mg twice daily for 4 weeks. Subsequent studies have shown that quercetin is an inhibitor of mast cells, reduces inflammation and stress oxidative in the prostate. Even the pollen extract (Cernilton) has demonstrated its effectiveness in a controlled study. Commonly used therapies which have not been properly evaluated in clinical trials, dietary changes, gabapentin and amitriptyline. Other therapies are ineffective in controlled trials: levaquin (antibiotic), alpha blockers for a period of less than 6 weeks and ablation of the prostate for transurethral (TUNA). At least one study suggests that the multimodal approach (aimed at different objectives, such as inflammation and muscle dysfunction simultaneously) is better than a single therapy in long-term analysis. Prognosis
In recent years, la prognosi per la CPPS è migliorata notevolmente con l'avvento di terapie multimodali, sostanze fitoterapice e protocolli mirati al rilassamento della tensione muscolare attraverso lo scioglimento dei trigger point ed il controllo dell'ansia.
Categoria IV: Prostatite asintomatica
Sintomi
I soggetti non riferiscono disturbi genitourinari, ma leucociti o batteri vengono notati durante esami effettuati per altri scopi (biopsie o check up).
Diagnosi
La diagnosi avviene a seguito di analisi di laboratorio su urine o sperma o a seguito di una ecografia prostatica transrettale (che rimane un esame di scarsa validità nell' identificazione prostatitis) with phase Doppler revealing inflammation in the absence of symptoms.
Therapy
do not need any treatment, although this is taken a standard therapy for patients with infertility and asymptomatic prostatitis, such therapy is based on the assumption of antibiotics and / or inflammation, despite the evidence of their effectiveness is weak. Since the "signs" of an asymptomatic prostatitis can sometimes be mistaken for a prostate cancer may be useful analysis of the relationship between free and total PSA. The result of this simple test has shown, in one study, a significant difference between a tumor and category IV prostatitis.
I soggetti non riferiscono disturbi genitourinari, ma leucociti o batteri vengono notati durante esami effettuati per altri scopi (biopsie o check up).
Diagnosi
La diagnosi avviene a seguito di analisi di laboratorio su urine o sperma o a seguito di una ecografia prostatica transrettale (che rimane un esame di scarsa validità nell' identificazione prostatitis) with phase Doppler revealing inflammation in the absence of symptoms.
Therapy
do not need any treatment, although this is taken a standard therapy for patients with infertility and asymptomatic prostatitis, such therapy is based on the assumption of antibiotics and / or inflammation, despite the evidence of their effectiveness is weak. Since the "signs" of an asymptomatic prostatitis can sometimes be mistaken for a prostate cancer may be useful analysis of the relationship between free and total PSA. The result of this simple test has shown, in one study, a significant difference between a tumor and category IV prostatitis.
Category V:
rompipalle busybodies who do not own the facts!
rompipalle busybodies who do not own the facts!
