Summary
Infections of the prostate may occur despite the numerous host defences of the male urogenital tract. It is important to distinguish patients with genuine inflammation of the gland from the larger number of men with symptoms but no signs of an inflammatory response (prostatodynia). To define prostatitis, the degree of the inflammatory reaction must first be determined. Increased numbers of leucocytes in expressed prostatic secrections (EPS) are essential for this diagnosis. Careful lower urinary tract studies may then be used to classify the patients into two major groups of bacterial and nonbacterial prostatitis. Chronic bacterial prostatitis is primarily due toEscherichia coli. Gram-positive prostatitis is debatable. In chronic bacterial prostatitis, secretory dysfunction is common. The increased alkalinity of the pH of expressed prostatic secretions is one of the reasons for poor results of antibiotic therapy. Uncommon microorganisms, such asChlamydia trachomatis andUreaplasma urealyticum may be involved in some cases of the “nonbacterial” form. Routine culture for these microorganisms is not recommended.
Zusammenfassung
Infektionen der Prostata entwickeln sich trotz zahlreicher Abwehrmechanismen des Urogenitaltrakts. Entscheidend ist, zwischen Patienten mit echter Prostatitis und der häufigeren Prostatodynie zu differenzieren, wobei letztere an der typischen Symptomatik leiden, ohne eine entzündliche Reaktion der Prostata aufzuweisen. Die Diagnose einer Prostatitis beruht auf der vermehrten Zahl von Leukozyten im Prostatasekret. Sorgfältige Untersuchungen von Urinfraktionen vor und nach Prostatamassage unter Einschluß des Prostatasekrets erlauben dann, die Patienten in zwei Hauptgruppen zu differenzieren — Männer mit bakterieller oder nicht (a-)bakterieller Prostatitis. Haupterreger der chronisch-bakteriellen Prostatitis istEscherichia coli. Die Wertigkeit einer grampositiven Prostatitis ist umstritten. Eine chronisch-bakterielle Prostatitis geht mit einer sekretorischen Dysfunktion einher. Der erhöhte alkalische pH des Prostatasekrets ist eine Ursache für die begrenzten Therapieerfolge antibiotischer Therapieversuche.Chlamydia trachomatis und/oderUreaplasma urealyticum sind ätiopathogenetisch für einige Fälle der nichtbakteriellen Prostatitis zu diskutieren. Eine routinemäßige Diagnostik dieser Mikroorganismen wird nicht empfohlen.
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Weidner, W. Prostatitis — diagnostic criteria, classification of patients and recommendations for therapeutic trials. Infection 20 (Suppl 3), S227–S231 (1992). https://doi.org/10.1007/BF01704386
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DOI: https://doi.org/10.1007/BF01704386