RESUMO
AIMS: This prospective study aimed to compare the clinical outcomes between the use of Erbium:YAG (Er:YAG) laser in a nonablative mode, to the use of the pharmacological treatment of oral tadalafil for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: The laser group received two sessions of Erbium:YAG laser, administered intraurethrally in a long, nonablative train of long pulses (SMOOTH™ mode), applied at the level of the male prostatic urethra. Tadalafil group received oral tadalafil at a dose of 5 mg/day, consecutively for 2 months. Effectiveness was assessed using the International Prostate Symptom Score (IPSS) questionnaire, VAS (visual analogue scale) pain score, and maximum urethral flow at follow-up visits up to 12 months after initiating treatment. Adverse effects were recorded after each treatment and follow-up sessions. RESULTS: The results show a significant decrease in the IPSS score in both groups up to the 12-month follow-up. The increase in Q-max was evident up to 3-months follow-up in the tadalafil group and up to 6 months in the laser group. The decrease in the VAS pain score was also significant in both treatment groups, lasting up to 3 months in the tadalafil group and up to 6 months in the laser group. CONCLUSIONS: The nonablative Er:YAG SMOOTH™ laser seems to be a promising treatment for this widely occurring condition. More studies are needed to confirm its safety and efficacy.
Assuntos
Dor Crônica/terapia , Érbio/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Dor Pélvica/terapia , Prostatite/terapia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
É descrito o caso clínico de um homem adulto com diagnóstico de Síndrome dolorosa pélvica crônica relacionada à prostatite (SDPCP), que após tentativa de tratamento alopático convencional com pouco sucesso, inicia abordagem terapêutica homeopática. A Homeopatia é uma racionalidade médica que visa tratar o indivíduo integralmente, utilizando o princípio da semelhança entre a totalidade sintomática do doente e do medicamento a ser utilizado. Foi prescrito omedicamento Colocynthis , preparado de acordo com a farmacotécnica homeopática vigente, após realização da consulta homeopática, repertorização e revisão da matéria médica. Houve resposta efetiva ao tratamento instituído, com desaparecimento dos sintomas da doença e recuperação completa. A Homeopatia mostra-se como alternativa promissora e efetiva no manejo da condição clínica descrita.(AU)
Prostatitis' chronic pelvic pain syndrome is a prevalent condition among men, bringing much suffering and social disability. The conventional therapeutic approach has little effectiveness and many side effects. It is reported a clinical case of the mentioned syndrome where was used the individualized homeopathic management and administered Colocynthis remedy. There was an excellent therapeutic response with complete resolution of symptoms along the follow up period. Presently, Homeophathy has emerged as an useful and promising tool in this pain syndrome's treatment.(AU)
Assuntos
Humanos , Masculino , Adulto , Prostatite/terapia , Colocynthis/uso terapêutico , Colocynthis/farmacologia , Dor Pélvica/terapia , HomeopatiaRESUMO
OBJECTIVE: To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. We included randomized controlled trials in men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the Grading of Recommendations Assessment, Development and Evaluation methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression. RESULTS: We included 38 unique studies in 3290 men with CP/CPPS across 23 comparisons, reporting outcomes mostly at short-term follow-up. Our analysis showed that acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with a sham procedure (mean difference [MD] in total National Institutes of Health - Chronic Prostatitis Symptom Index [NIH-CPSI] score -5.79, 95% confidence interval [CI] -7.32 to -4.26, moderate QoE). Acupuncture may result in little or no difference in adverse events (low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). Lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE), but we found no information regarding adverse events. A physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE), but we found no information regarding adverse events. It was uncertain whether prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE) and we found no information regarding adverse events. Extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE), but these results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). Transrectal thermotherapy, alone or in combination with medical therapy, may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. CONCLUSIONS: Based on the findings with moderate to high QoE, this review found that some non-pharmacological interventions, such as acupuncture and extracorporeal shockwave therapy, are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse events. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Assuntos
Dor Crônica/terapia , Dor Pélvica/terapia , Prostatite/terapia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Masculino , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Prostatite/complicações , Prostatite/diagnósticoAssuntos
Humanos , Masculino , Feminino , Prostatite/complicações , Prostatite/diagnóstico , Prostatite/etiologia , Prostatite/terapiaRESUMO
BACKGROUND: Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. OBJECTIVE: To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. MATERIALS AND METHODS: The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. RESULTS: One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. DISCUSSION: There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. CONCLUSIONS: Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.
Assuntos
Abscesso , Antibacterianos/uso terapêutico , Infecções por Escherichia coli/diagnóstico , Escherichia coli , Infecções Urinárias/tratamento farmacológico , Abscesso/microbiologia , Abscesso/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana Múltipla , Epididimite/microbiologia , Epididimite/terapia , Escherichia coli/metabolismo , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Tempo de Internação , Masculino , México , Pessoa de Meia-Idade , Orquite/microbiologia , Orquite/terapia , Prostatite/microbiologia , Prostatite/terapia , Pielonefrite/microbiologia , Pielonefrite/terapia , Pionefrose/microbiologia , Pionefrose/terapia , Fatores de Risco , Stents , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Adulto Jovem , beta-Lactamases/metabolismoRESUMO
OBJECTIVE: The aim of the study was to investigate the therapeutic efficacy of transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis pain/chronic pelvic pain syndrome. DESIGN: A pretest, posttest randomized double blind design was used in data collection. PARTICIPANT: Twenty-four patients diagnosed with chronic prostatitis- category IIIA and IIIB of the National Institute of Health Chronic Pain (NIH-CP) were referred for physiotherapy from the Urology department. INTERVENTION: Pre treatment pain level was assessed using the NIH-CP (pain domain) index. The TENS group received TENS treatment, 5 times per week for a period of 4 weeks (mean treatment frequency, intensity, pulse width and duration of 60 Hz, 100 microS, 25 mA and 20 minutes respectively). The Analgesic group received no TENS treatment but continued analgesics; the Control group received no TENS and Analgesic but placebo. All subjects were placed on antibiotics throughout the treatment period. OUTCOME MEASURES: Post-treatment pain level was also assessed using NIH-CP pain index. RESULT: Findings of the study revealed significant effect of TENS on chronic prostatitis pain at p < 0.05. CONCLUSION: TENS is an effective means of non-invasive symptomatic management of chronic prostatitis pain.
Assuntos
Dor Pélvica/terapia , Prostatite/terapia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Antibacterianos/uso terapêutico , Doença Crônica , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Medição da Dor , Dor Pélvica/etiologia , Placebos/uso terapêutico , Prostatite/complicações , Síndrome , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The aim of the study was to investigate the therapeutic efficacy of transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis pain/chronic pelvic pain syndrome. DESIGN: A pretest, posttest randomized double blind design was used in data collection. PARTICIPANT: Twenty-four patients diagnosed with chronic prostatitis- category IIIA and IIIB of the National Institute of Health Chronic Pain (NIH-CP) were referred for physiotherapy from the Urology department. Intervention: Pre treatment pain level was assessed using the NIH-CP (pain domain) index. The TENS group received TENS treatment, 5 times per week for a period of 4 weeks (mean treatment frequency, intensity, pulse width and duration of 60Hz, 100µS, 25mA and 20 minutes respectively). The Analgesic group received no TENS treatment but continued analgesics; the Control group received no TENS and Analgesic but placebo. All subjects were placed on antibiotics throughout the treatment period. Outcome measures: Post-treatment pain level was also assessed using NIH-CP pain index. RESULT: Findings of the study revealed significant effect of TENS on chronic prostatitis pain at p < 0.05. CONCLUSION: TENS is an effective means of non-invasive symptomatic management of chronic prostatitis pain.
Assuntos
Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dor Pélvica/terapia , Prostatite/terapia , Estimulação Elétrica Nervosa Transcutânea , Antibacterianos/uso terapêutico , Doença Crônica , Método Duplo-Cego , Ofloxacino/uso terapêutico , Medição da Dor , Dor Pélvica/etiologia , Placebos/uso terapêutico , Prostatite/complicações , Síndrome , Resultado do Tratamento , Adulto JovemRESUMO
São descritos 10 casos de prostatite crônica silenciosa cuja única manifestação é dor ao estímulo prostático direto. O tratamento com 2 g de metronidazol, dose única oral, erradicou os sintomas.