CURRENT APPROACH TO DIAGNOSIS OF CHRONIC PROSTATITIS


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Abstract

Introduction. The problem of chronic prostatitis is still to be resolved. Aim: to compare the frequency of the main symptoms (pain, dysuria, sexual dysfunction) in patients with chronic bacterial and abacterial prostatitis, as well as prostate tuberculosis (PTB); to determine the prevalence of latent infectious prostatitis in patients with chronic abacterial prostatitis (CAP). Materials and methods. A total 73 men who were followed with a diagnosis of chronic prostatitis for at least two years and had a history of at least three exacerbations per year were included in the study. A microbiological study of expressed prostate secretions (EPS) was carried out using both routine and molecular genetic methods. Results. Chronic bacterial prostatitis (CBP) was diagnosed in 27 patients (37.0%). 36.7% of pathogens were resistant to antibiotics. In 46 patients (63%) no microflora was not isolated at the first examination. In some patients with CBP, prostate tuberculosis (PTB) was diagnosed. Thus, in the total cohort of patients, only 17 (23.3%) had isolated CBP, and other 10 (13.7%) had CBP in combination with PTB. All patients with CAP received longidaza rectal suppositories for diagnostic purposes. In 23 men (50.0% of patients with CAP), uropathogens were isolated from EPS after administration of longidaza, and 56.9% of them were resistant to antibacterial drugs. Five patients from this group also had PTB, and 18 (24.6%) had CBP, which was not diagnosed by standard methods. There were no significant differences in the frequency of pain and urinary disorders. However, sexual dysfunction more often developed in patients with CAP and PTB (p<0.05); hemospermia, on the other hand, was not typical for patients with CAP, occurred in few cases with CBP and latent CAP, but was present in two-thirds of patients with PTB. Conclusion. As a mask of CAP, both latent CPB and PTB can present. Although CBP, CAP, latent CBP and PTB have a number of significant differences in the clinical manifestations, no pathognomonic symptoms have been identified for these subgroups of chronic prostatitis. Considering that half of patients with CAP actually have latent CBP, it is necessary to use rectal suppositories of the drug longidaza for diagnostic purposes with repeated analysis of expressed prostate secretions. To identify pathogens, molecular genetic diagnostics should be used along with routine methods. PTB can manifest as chronic bacterial or abacterial prostatitis. It is necessary to carefully study the patient's history, epidemic history, and, if indicated, to perform an appropriate examination to exclude PTB.

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About the authors

E. V Kulchavenya

TB Research Institute of Ministry of Health of Russia; FGBOU VO Novosibirsk State Medical University of Ministry of Health of Russia, Novosibirsk, Russia

Email: urotub@yandex.ru
Ph.D., MD, professor, Chief Researcher at TB Research Institute of Ministry of Health of Russia; professor at the Department of Urology, professor at Department of Tuberculosis of FGBOU VO Novosibirsk State Medical University of Ministry of Health of Russia Novosibirsk, Russia

E. V Brijatuk

TB Research Institute of Ministry of Health of Russia; MC “Almita”

Email: brixhatyuk@rambler.ru
Novosibirsk, Russia

D. P Kholtobin

TB Research Institute of Ministry of Health of Russia; MC «Avicenna»

Email: urology-avicenna@mail.ru
Ph.D., Senior researcher, Head of the Department of Urology Novosibirsk, Russia

A. G Cherednichenko

TB Research Institute of Ministry of Health of Russia

Email: baclab@mail.ru
Head of Bacteriological Laboratory Novosibirsk, Russia

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