Akut ve kronik bakteriyel prostatit olgularında tedavi yaklaşımları

Prostatit, ürologların günlük hasta pratiklerindeki en can sıkıcı problemlerden birisidir. Fizyopatolojisi tam olarak bilinmemektedir. Prostatit’lerin sınıflandırılmasında, Amerika Ulusal Sağlık Enstitüsü (NIH) konsensus panelinin 1999 yılındaki yeni klasifikasyonu kullanılmaktadır. Yirmi yaş üzeri erkeklerin; %2–12’si hayatlarının belli bir döneminde prostatit semptomları yaşamakta ve bunların da yaklaşık olarak %10’u, bakteriyel prostatit’tir (Akut veya kronik). Akut bakteriyel prostatit, ortaya çıkışı bakımından gürültülü bir tablo oluşturmaktadır. Akut bakteriyel prostatit; genel ürosepsis tablosu ile birlikte ciddi üriner enfeksiyon, irritatif ve obstrüktif işeme semptomları ile karakterizedir ve antimikrobiyal tedaviye hemen cevap vermektedir. Kronik bakteriyel prostatit (CBP) ise, tüm prostatit olgularının %3–4’ünden sorumludur. 50 yaş altı hastalığı olarak bilinse de her yaş grubundan erkek etkilenebilmektedir. Kronik bakteriyel prostatit, genellikle hafif-orta pelvik semptomlar ve aralıklı akut üriner sistem enfeksiyonları ile ilişkilidir. Hastaların %60–80’inde uzun süreli antimikrobiyal tedavi küratif olabilmektedir. İlk basamak tedavisi olarak, Florokinolon grubu ilaçlar verilmektedir. E. Koli ve Enterobacteriasea ailesinin diğer üyelerinin neden olduğu CBP’de bakteriyel eradikasyon, yaklaşık %70’ler civarındadır. Optimal tedavi süresi olarak minimum 4 hafta tedavinin gerekliliği ileri sürülmektedir. Prostatit tablolarının birbirine dönüşme özelliği bulunmaktadır. Akut bakteriyel prostatit hastalarının %10 kadarında kronik bakteriyel prostatit gelişebilmekte ve kronik bakteriyel prostatit hastalarının da yaklaşık %10’u kronik pelvik ağrı sendromuna dönüşebilmektedir.

The treatment approaches in acute and chronic bacterial prostatitis cases

Prostatitis is one of the most annoying problems in urologists’ daily patient practices. Its physiopathology is not fully known. The new classification of the American National Institute of Health (NIH) consensus panel in 1999 is used for the classification of prostatitis. Men over the age of 20; 2-12% of them experience prostatitis symptoms in a certain period of their lives, and about 10% of them are bacterial prostatitis (acute or chronic). Acute bacterial prostatitis creates a noisy picture in terms of its occurrence. Acute bacterial prostatitis; It is characterized by severe urinary infection, irritative and obstructive voiding symptoms together with the general urosepsis table and responds immediately to antimicrobial therapy. Chronic bacterial prostatitis (CBP) is responsible for 3-4% of all prostatitis cases. Although it is known as a disease under 50, men can be affected from any age group. Chronic bacterial prostatitis is often associated with mild to moderate pelvic symptoms and intermittent acute urinary tract infections. Longterm antimicrobial therapy can be curative in 60-80% of patients. As first-line therapy, fluoroquinolone drugs are given. Bacterial eradication in CBP caused by E. Koli and other members of the Enterobacteriasea family is about 70%. It is suggested that a minimum of 4 weeks of treatment is required as an optimal treatment period. Prostatitis tables have the ability to transform into each other. About 10% of patients with acute bacterial prostatitis can develop chronic bacterial prostatitis, and about 10% of patients with chronic bacterial prostatitis can turn into chronic pelvic pain syndrome

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