[Diagnosis of chronic prostatitis: urinary cytology following prostatic massage]

The difficulties in the diagnosis of chronic prostatitis depend mainly on anatomical factors. 48 patients were investigated by cytological examination of the urine after prostatic massage. The results were compared with the issues of urethrography, uroflowmetry and bacteriology. Cytological examination was demonstrated as being the simplest and most reliable method for both diagnosis and follow-up after treatment in chronic prostatitis. Three inflammatory groups are defined and commented and a treatment is proposed.

Quantitative culture of ureaplasma urealyticum in patients with chronic prostatitis or prostatosis

We studied 187 men with symptoms and signs of chronic prostatitis or prostatosis and 108 healthy controls. Ureaplasma urealyticum was isolated from 103 (55.1 per cent) of the patients and from 24 (22.2 per cent) of the controls. When quantitative culture of Ureaplasma urealyticum is considered a typical histogram of prostatitis was evident in 36 patients (19.3 per cent) using the Stamey localization technique. In 20 of the 36 patients the etiology was uncertain for various reasons. Evidence was provided that Ureaplasma urealyticum could be considered as the etiologic agent of the disease in at least 16 (8.6 per cent) of the 187 patients with chronic prostatitis studied.

Prostatic secretion leukocyte studies in non-bacterial prostatitis (prostatosis)

Non-bacterial prostatitis is a common affliction among men and lacks objective criteria for clear identification. We studied 43 consecutive patients and 20 normal controls for the presence of bacteria and quantitation of prostatic secretion leukocytes. Significantly greater numbers of macrophages per volume of prostatic secretion were found in the patients. Multiple observations of such increased leukocyte proliferation could be used to establish true prostatic inflammation.

[The importance of ureaplasma urealyticum in non-specific prostato-urethritis (author's transl)]

312 patients with non-specific prostato-urethritis were investigated with a standardised procedure using the four glass test. In 42.3% of patients mycoplasma was isolated which in almost all cases was Ureaplasma urealyticum. Clinically patients were symptom-free after eradication of mycoplasma in cases where previously urea-plasma counts of more than 10,000 CFU/ml prostatic secretion and of more than 1000 CFU/ml urine had been demonstrated. In cases where there were smaller counts of Ureaplasma urealyticum and where Mycoplasma hominis had been demonstrated tetracycline therapy did not lead to cure in any case.

Testosterone excretion in chronic prostatis

Urinary testosterone and epitestosterone were assayed in 60 men: 7 normals and 53 patients with chronic prostatitis (of these 8 patients had prostatis free of complications, 45 had prostatitis with disturbances of generative and copulative functions). In 73.1% of patients considerable reduction of testosterone excretion was revealed. Reduction of testicular endocrine function is in direct correlative dependence on severity of clinical symptoms, duration of disease and form of chronic prostatis. Disturbances of genital hormone metabolism are of considerable importance in case of chronic prostatitis and its complications.

Disposable peak urinary flowmeter estimates lower urinary tract obstruction

Peak urinary flow rate represents the highest flow rate achieved during a single urination and, as such, represents the patient's best effort at micturition. Peak flow rate, correlated with patient age and volume voided, effectively estimates lower urinary tract obstruction. The 63 normal and 368 abnormal male subjects urinated in privacy into a plastic sterile disposable device (the peakometer), which measured peak flow rate and volume voided. These data plus age, ultimate diagnosis and interval since last urination comprised our data base. Percentage distribution of diagnosis in this population was prostatic obstruction 47.3 per cent, stricture 19.3 per cent, normal 14.6 per cent, prostatitis 8.4 per cent, neurogenic bladder 2 per cent and miscellaneous 8.4 per cent. The average peak flow rate for normal male subjects reaches 27.6 ml. per second, which differs significantly from that for patients with prostatic obstruction--9.4 ml. per second, stricture--10.5 ml. per second, prostatitis--16.3 ml. per second and neurogenic bladder--13.9 ml. per second. The peak flow rate decreased progressively as the age of the subjects increased. We measured average decreases of 10 ml. per second peak flow for every 30 years after age 10. Peak flow rate increases as volume voided increases. Requirements of our measuring device combined with urodynamic responses caused us to select 100 ml. voided as the minimum acceptable volume. With volumes more than this any given individual may deviate plus or minus 10 per cent from the true mean peak flow depending upon volume voided. For practical purposes peak flow, age and volume must be considered to categorize voiding by peak flow rate. With these variables 2 graphs that compare peak flow, age and volume may be used to estimate voiding function for a given male patient. Comparison of peak flow rates, volume voided and voiding interval before and after surgical correction of obstruction documented significant increase in volume voided or in interval between voiding. Peak urinary flow rate measurement by this device predicted normality or abnormality with 90 to 95 per cent accuracy. Therefore, this represents a valid screening test but it does not in itself provide the diagnosis of abnormal urination.