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INVITED COMMENTARY
Year : 2014  |  Volume : 16  |  Issue : 5  |  Page : 784

Bacteria and the prostate: infertility versus symptoms


Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA

Date of Web Publication13-Jun-2014

Correspondence Address:
Michel A Pontari
Department of Urology, Temple University School of Medicine, Philadelphia, PA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1008-682X.131709

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How to cite this article:
Pontari MA. Bacteria and the prostate: infertility versus symptoms. Asian J Androl 2014;16:784

How to cite this URL:
Pontari MA. Bacteria and the prostate: infertility versus symptoms. Asian J Androl [serial online] 2014 [cited 2021 Aug 5];16:784. Available from: https://www.ajandrology.com/text.asp?2014/16/5/784/131709 - DOI: 10.4103/1008-682X.131709

Vicari et al.[1] present the results of using rifaximn, a nonabsorbable antibiotic, and the probiotic VSL#3 in infertile men with bacteria in the semen and leukocytes in the expressed prostatic secretions (EPS) who were initially cured by antibiotics. Use of this combination reduces the recurrence rate of the infection as well as sonographic evidence of spread to other parts of the reproductive tract. The theoretical basis for simultaneous treatment of the genitourinary and gastrointestinal tract has become more compelling given the evidence of overlapping innervation of the colon and bladder, and influence of inflammation in one organ on the other. [2] These results are very promising and intriguing, but it is very important to keep clear the outcome measures in this study. The outcome parameters were related to the effects on sperm cultures, leukocytes in the EPS and ultrasonographic findings in the seminal vesicles and epididymis. A tender prostate was also considered a positive sign. Symptoms of "prostatitis" as with the National Institutes of Health Chronic Prostatitis Symptom Index were not assessed.

When discussing prostatitis syndromes, one must remember that these are clinical syndromes based on symptoms, primarily pain, and some exclusion criteria, not based on any sonographic findings, or results of culture of semen. [3] Leukocytes in the EPS may be used to distinguish between category IIIA (inflammatory) and IIIB (noninflammatory), but so far there have been no clinical differences found between these two groups. Furthermore, the role of bacteria and inflammation in causing symptoms is unclear, given that men with pelvic pain and those without have equal frequencies of inflammation in EPS and bacteria localized to the prostate. [4] The patients in this study have infertility, which also is not reported as prevalent as men with pelvic pain alone. Therefore, these results must be put into this context. The use of probiotics and rifaximin appears to reduce progression to what the authors define as chronic microbial prostate-vesiculitis or prostate-vesiculo-epididymits. In a population of infertile men, this may well have a benefit to prevent further impairment of sperm quality and preserve fertility. These results do not inform the value of this therapeutic combination on men with pelvic pain, although based on reference, [5] there is the possibility that it could.


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The author declares no competing interests.

 
  References Top

1.Vicari E, La Vignera S, Castiglione R, Condorelli RA, Vicari LO, et al. Chronic bacterial prostatitis and irritable bowel syndrome: effectiveness of treatment with rifaximin followed by the probiotic VSL#3. Asian J Androl 2014; doi: 10.4103/1008-682X.131064.  Back to cited text no. 1
    
2.Pezzone MA, Liang R, Fraser MO. A model of neural cross-talk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders. Gastroenterology 2005; 128: 1953-64.  Back to cited text no. 2
    
3.Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282: 236-7.  Back to cited text no. 3
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4.Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol 2003; 170: 818-22.  Back to cited text no. 4
    
5.Weinstock LB, Geng B, Brandes SB. Chronic prostatitis and small intestinal bacterial overgrowth: effect of rifaximin. Can J Urol 2011; 18: 5826-30.  Back to cited text no. 5
    




 

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