Kronik prostatitin epidemiyolojisi ve tedavisi: Mersin deneyimi

Abstract

Amaç: Prostatit, erkeklerde pelvik ağrı, idrar sorunları ve cinsel işlev bozukluğuna neden olan yaygın bir rahatsızlıktır. Bakteriyel prostatitin teşhisi ve tedavisi zor olabilir. Bu çalışmada, bakteriyel prostatite ampirik tedavinin yanıtını ve tedavi başarısızlığına yol açan risk faktörlerini göstermeyi amaçladık.
Gereç ve yöntem: Bu çalışmaya, kronik prostatit düşündüren semptomları olan 39 erkek dahil edildi. Araştırmacılar, hastaların semptomlarını, kan testlerini, idrar testlerini, prostat muayenelerini ve görüntüleme çalışmalarını değerlendirdi. Ardından hastalara uygulanan çeşitli antibiyotikler yanıtlarını takip ettiler. Tüm hastalara başlangıçta günde 3 kez intravenöz 4,5 g piperasilin-tazobaktam ve günde 2 kez 100 mg doksisiklin tablet oral yoldan verildi. Hasta bu tedaviden önce ertapenem + doksisiklin kullanmışsa önce piperasilin tazobaktam + doksisiklin denenmiş, yanıt alınamayan hastalarda imipenem + doksisikline geçilmiştir. Sayısı az olmakla birlikte ertapenem ve doksisiklin tedavisine yanıt alınamayan bazı hastalarda, doğrudan imipenem ve doksisiklin kombinasyonuna geçildiği de görülmüştür. Yetersiz yanıt alınan vakalarda, tedavi günde 4 kez 500 mg intravenöz imipenem ve günde 2 kez 100 mg doksisiklin tabletlere çıkarıldı. İki kombinasyon tedavisinin işe yaramadığı durumlarda, hastanın tedavisi günde 3 kez 4 gram fosfomisin disodyum ile değiştirildi.
Bulgular: Erkeklerin çoğunda sık idrara çıkma gibi alt üriner sistem semptomları vardı, ancak bazılarında bakteri kültürü pozitif çıkmadı. Erkeklerin yaklaşık %30'unun tedavi sırasında antibiyotiklerinde değişikliğe ihtiyacı oldu. Alt grup analizi, tedavi grupları arasında tekrarlama ve tedavi değişikliği ihtiyacı açısından anlamlı bir fark olmadığını gösterdi (p=0,666 ve p=0,212). Regresyon analizi, tedavi değişikliği ile PSA seviyesi ve prostat hacmi arasında istatistiksel olarak anlamlı bir ilişki olmadığını göstermiştir (sırasıyla p=0,587 ve p=0,083). Tedavi yanıtının prostat boyutu veya PSA seviyeleriyle bağlantılı olmadığı görülmüştür.
Sonuç: Bakteriyel prostatit, yüksek oranda tedavi başarısızlığı ve tekrarlama ile karakterize karmaşık bir durumdur. Tanı ve tedavi stratejilerini iyileştirmek için daha fazla araştırmaya ihtiyaç vardır.

Keywords

• Kronik prostatit
• enfeksiyon
• tedavi süresi
• tedavi başarısı

Supporting Institution

yok

Ethical Statement

Mersin Üniversitesi Etik kurulu (05.7.2023/ 454)

Epidemiology and treatment of chronic prostatitis: Mersin experience

Abstract

Purpose: Prostatitis is a common condition in men, causing pelvic pain, urinary problems, and sexual dysfunction. Diagnosing and managing of chronic prostatitis can be challenging. In this study we aimed to demonstrate the response of empiric treatment to chronic prostatitis and risk factors to treatment failure.
Materials and methods: A total of 39 male patients diagnosed with chronic prostatitis were included in this study. Patients with a history of unsuccessful oral antibiotic therapy for chronic prostatitis were included in the study, whereas patients with urological malignancy or a history of urological interventions were excluded. Researchers evaluated their symptoms, blood tests, urine tests, prostate exams, and imaging studies. They then treated them with various antibiotics and tracked their response. All patients initially received piperacillin-tazobactam at a dose of 4.5 g three times daily and oral doxycycline at a dose of 100 mg twice daily. If the patient had previously received ertapenem plus doxycycline, piperacillin-tazobactam plus doxycycline was administered first; in patients who did not respond, the treatment was switched to imipenem plus doxycycline. Although the number was small, it was observed that some patients who did not respond to ertapenem and doxycycline therapy were switched directly to the imipenem and doxycycline combination.
In cases of inadequate response, treatment was increased to intravenous imipenem at a dose of 500 mg four times daily combined with oral doxycycline 100 mg twice daily.
In cases where both combination regimens were ineffective, the patient’s treatment was switched to fosfomycin disodium at a dose of 4 g three times daily.
Results: While most men presented with lower urinary tract symptoms such as urinary frequency, only a few had positive urine cultures. About 30% of men needed a change in antibiotics during treatment. The subgroup analysis showed that there was no significant difference in treatment groups in terms of recurrence and need for treatment change (p=0.666 and p=0.212). The regression analysis showed that there was no statistically significant association between treatment change and prostate-specific antigen level and prostate volume (p=0.587 and p=0.083, respectively). Treatment response did not seem to be linked to prostate size or prostate-specific antigen levels.
Conclusion: Chronic prostatitis is a complex condition with a high rate of treatment failure and recurrence. More research is needed to improve diagnosis and treatment strategies.

Keywords

• Chronic prostatitis
• infection
• treatment duration
• treatment success

Supporting Institution

None

Ethical Statement

Mersin University Ethics Committee (05.7.2023/ 454)

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