- Prostatites
- Diagnostic
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Distinction des prostatites aiguës récidivantes et chroniques
Distinction between recurrent and chronic prostatitis
Andrologie volume 14, pages 58–62 (2004)
Resume
L’E.A.U. (European Association of Urology) a publié en 2001 des recommandations pour la prise en charge des infections du tractus urinaire. Dans le chapitre concernant les prostatites, l’E.A.U. propose notamment de distinguer prostatites aiguës et chroniques en fonction de la durée des symptômes: le diagnostic de prostatite chronique est posé lorsque les symptômes urinaires durent depuis au moins trois mois. Les prostatites aiguës qui se reproduisent (récidivantes donc) ne sont ainsi pas envisagées, alors que leur existence paraît cliniquement très probable, et que la distinction des formes récidivantes et chroniques peut être difficile lors de récidives rapprochées.
L’utilité de la distinction de ces deux formes de prostatite est discutée ici à travers trois questions: est-elle justifiée (existe-t-il des données incontestables dans la littérature)? A-t-elle des conséquences théoriques et pratiques? Est-elle réalisable, particulièrement en «pratique courante»? Ce dernier point est argumenté à l’aide de données personnelles, relevées en pratique de ville. Finalement, il semble justifié de distinguer prostatites aiguës récidivantes et chroniques, mais cette distinction peut être difficile. Elle bute en particulier sur un point: l’affirmation de la désinfection prostatique.
Abstract
The E.A.U. (European Association of Urology) published its Guidelines on Urinary and Male Genital Tract Infections in 2001. In the chapter devoted to prostatitis, epididymitis and orchitis, the E.A.U suggests a classification distinguishing prostatitis (usual clinical picture and demonstrated infection) from chronic pelvic pain syndrome (same clinical picture without demonstrable infection). Prostatitis is divided into three categories: acute bacterial prostatitis (type I), chronic bacterial prostatitis (type II) and asymptomatic inflammatory prostatitis (histological prostatitis, type IV). Type I and II prostatitis are considered here. The E.A.U. guidelines do not mention recurrent prostatitis. The authors discuss whether or not recurrent prostatitis should be distinguished from chronic prostatitis by raising three questions: does the literature provide precise data in favour of this distinction? Does this theoretical distinction have any practical consequences? Is this distinction feasible, especially in general practice?
The Stanford sesearch team (Stamey and Shortliffe) has provided documented bacteriological data demonstrating recurrence of prostatitis with different bacteria in some cases and persistence of the same pathogen in other cases. The main consequence of these two situations concern treatment (which antibiotics? for how long?) On the basis of personal unpublished data, the authors discuss the feasibility of this distinction in general practice. They show that, in the case of several recurrences of prostatitis per year, it may be difficult to distinguish recurrent prostatitis from chronic prostatitis. They also show that the duration of symptoms is not a sufficiently discriminant factor and that bacteriological findings should be considered.
In conclusion, recurrent prostatitis is a particular disease which should be distinguished from chronic prostatitis. The main consequence of this distinction concerns several unresolved questions about the therapy of recurrent prostatitis. In general practice, the distinction may be difficult when only routine bacteriological tests are available. The use of Meares and Stamey’s four glass technique is unusual in this setting, making it difficult to confirm prostatic disinfection.
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Communication au XXo Congrès de la Société d’Andrologie de Language Française, Orléans, 11–13 décembre 2003.
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Benoit, JM. Distinction des prostatites aiguës récidivantes et chroniques. Androl. 14, 58–62 (2004). https://doi.org/10.1007/BF03035469
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DOI: https://doi.org/10.1007/BF03035469