Data di Pubblicazione:
2018
Citazione:
Multidisciplinary approach to prostatitis / V. Magri, M. Boltri, T. Cai, R. Colombo, S. Cuzzocrea, P. De Visschere, R. Giuberti, C.M. Granatieri, M.A. Latino, G. Larganà, C. Leli, G. Maierna, V. Marchese, E. Massa, A. Matteelli, E. Montanari, G. Morgia, K.G. Naber, V. Papadouli, G. Perletti, N. Rekleiti, G.I. Russo, A. Sensini, K. Stamatiou, A. Trinchieri, F.M.E. Wagenlehner. - In: ARCHIVIO ITALIANO DI UROLOGIA ANDROLOGIA. - ISSN 1124-3562. - 90:4(2018), pp. 227-248.
Abstract:
The modern clinical research on prostatitis started with the work of Stamey and coworkers who developed the basic principles we are still using. They established the segmented culture technique for localizing the infections in the males to the urethra, the bladder, or the prostate and to differentiate the main categories of prostatitis. Such categories with slight modifications are still used according to the NIH classification: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis. Prostatic inflammation is considered an important factor in influencing both prostatic growth and progression of symptoms of benign prostatic hyperplasia and prostatitis. Chronic inflammation/neuroinflammation is a result of a deregulated acute phase response of the innate immune system affecting surrounding neural tissue at molecular, structural and functional levels. Clinical observations suggest that chronic inflammation correlates with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) and an history of clinical chronic prostatitis significantly increases the odds for prostate cancer. The NIHNIDDK classification based on the use of the microbiological 4- glasses localization test or simplified 2-glasses test, is currently accepted worldwide. The UPOINT system identifies groups of clinicians with homogeneous clinical presentation and is used to recognize phenotypes to be submitted to specific treatments. The UPOINTS algorithm implemented the original UPOINT adding to the urinary domains (U), psycho-social (P), organspecific (O), infection (I), neurological (N), muscle tension and tenderness (T) a further domain related to sexuality (S). In fact sexual dysfunction (erectile, ejaculatory, libido loss) has been described in 46-92% of cases with a high impact on the quality of life of patients with CP/CPPS. Prostatic ultrasound represents the most popular imaging test in the work-up of either acute and chronic prostatitis although no specific hypo-hyperechoic pattern has been clearly associated with chronic bacterial prostatitis and CPPS. Use of a digital-processing software to calculate the extension of prostatic calcification area at ultrasound demonstrated a higher percentage of prostatic calcification in patients with chronic bacterial prostatitis. Multiparametric Magnetic Resonance Imaging (mpMRI) is the current state-of-the art imaging modality in the assessment of patients with prostate cancer although a variety of benign conditions, including inflammation, may mimic prostate cancer and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions. Bacteria can infect prostate gland by: ascending the urethra, reflux of urine into the prostatic ducts, direct inoculation of bacteria through inserted biopsy needles or hematogenous seeding. Enterobacteriaceae are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role of Enterococci has been reported. Many strains of these uropathogens exhibit the ability to form biofilm and multidrug- resistance. Sexually Transmitted Infections (STI) agents, in particular Chlamydia trachomatis and Mycoplasma genitalium, have been also considered as causative pathogens of chronic bacterial prostatitis. On the contrary the effective role in genital diseases of other "genital mycoplasmas" is still a much debated issue. Sexually Transmitted Infections agents should be investigated by molecular methods in both patient and sexual partner. "Next generation" investigations, such as cytokine analysis, cytological typing of immune cells could help stratifying the immune response. Epigenetic dysregulation of inflammatory factors should be inv
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Urology
Elenco autori:
V. Magri, M. Boltri, T. Cai, R. Colombo, S. Cuzzocrea, P. De Visschere, R. Giuberti, C.M. Granatieri, M.A. Latino, G. Larganà, C. Leli, G. Maierna, V. Marchese, E. Massa, A. Matteelli, E. Montanari, G. Morgia, K.G. Naber, V. Papadouli, G. Perletti, N. Rekleiti, G.I. Russo, A. Sensini, K. Stamatiou, A. Trinchieri, F.M.E. Wagenlehner
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