Wagenlehner F M E, Diemer T, Naber K G, Weidner W
Clinic for Urology and Paediatric Urology, Justus Liebig University, Giessen, Germany.
Andrologia. 2008 Apr;40(2):100-4. doi: 10.1111/j.1439-0272.2007.00827.x.
In only approximately 10% of men with symptoms of chronic prostatitis/chronic pelvic pain syndrome bacterial infection of the prostate can be demonstrated by the Meares and Stamey 4-glass or the pre- and post-prostate massage (PPM) two-glass test. Chronic bacterial prostatitis is mainly caused by Gram-negative uropathogens. The role of Gram-positives, atypicals and anaerobes is still debatable. For treatment, fluoroquinolones are considered the drugs of choice because of their favourable pharmacokinetic properties and their antimicrobial spectrum. As relapse and re-infection are a major problem in chronic bacterial prostatitis, only the results of studies with a follow up period of at least 6 months are meaningful. Analysing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, it becomes, however, obvious that fluoroquinolones differ not only in plasma concentrations, but also in their penetration ability to these sites. Nevertheless, the concentrations at the site of infection of most fluoroquinolones with this indication should be sufficient for the treatment of chronic bacterial prostatitis caused by susceptible pathogens. On the other hand, male accessory gland infection has been linked to male infertility. However, there is still a lack of evidence showing that bacterial prostatitis would have a negative impact on sperm quality.
在仅有约10%有慢性前列腺炎/慢性盆腔疼痛综合征症状的男性中，通过米尔斯和斯塔米4杯试验或前列腺按摩前后（PPM）两杯试验可证实前列腺存在细菌感染。慢性细菌性前列腺炎主要由革兰氏阴性尿路病原体引起。革兰氏阳性菌、非典型菌和厌氧菌的作用仍存在争议。在治疗方面，由于氟喹诺酮类药物具有良好的药代动力学特性和抗菌谱，因此被视为首选药物。由于复发和再感染是慢性细菌性前列腺炎的一个主要问题，因此只有随访期至少为6个月的研究结果才有意义。然而，分析各种氟喹诺酮类药物在前列腺液、精液以及前列腺组织中的浓度后可以明显看出，氟喹诺酮类药物不仅血浆浓度不同，而且它们向这些部位的渗透能力也不同。尽管如此，大多数用于此适应症的氟喹诺酮类药物在感染部位的浓度应足以治疗由易感病原体引起的慢性细菌性前列腺炎。另一方面，男性附属腺体感染与男性不育有关。然而，仍然缺乏证据表明细菌性前列腺炎会对精子质量产生负面影响。
