Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

Area of Science:

• Urology
• Infectious Diseases
• Microbiology

Background:

• Chronic bacterial prostatitis (CBP) is a challenging condition often requiring targeted antibiotic therapy.
• The presence of prostatic calculi may impact treatment efficacy in CBP patients.

Purpose of the Study:

• To evaluate the efficacy of culture-specific antibiotic therapy for CBP patients with and without prostatic calculi.
• To assess the impact of prostatic calculi on microbiological eradication, symptom improvement, and relapse rates in CBP.

Main Methods:

• 101 CBP patients (National Institutes of Health category II) were divided into two groups based on transrectal ultrasonography (TRUS) findings: with (n=39) and without (n=62) prostatic calculi.
• All patients received 4 weeks of culture-specific antimicrobial therapy.
• Assessments included expressed prostatic secretions (EPS) and urine cultures, National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and subjective global assessment (SGA) at baseline and follow-up (minimum 3 months).

Main Results:

• Continued microbiological eradication rates at study end were significantly lower in patients with prostatic calculi (43.6%) compared to those without (72.6%) (P<0.01).
• Patients without prostatic calculi showed significantly greater improvement in total NIH-CPSI scores (median decrease from 24 to 11) and its subscores (pain, urinary, quality of life) compared to those with calculi (median decrease from 24 to 19).
• A 50% or greater reduction in NIH-CPSI score was observed in 58.1% of patients without calculi versus 38.5% with calculi (P<0.01).

Conclusions:

• Prostatic calculi significantly impair the antimicrobial efficacy and long-term cure rates for chronic bacterial prostatitis.
• Patients with prostatic calculi experience higher rates of relapse after antimicrobial therapy.
• Culture-specific antibiotic therapy is less effective in CBP patients with prostatic calculi, highlighting the need for alternative or adjunctive treatment strategies.