Progress was made in understanding the mechanism of urinary tract infection during several presentations made at the AUA annual meeting. At the same time, certain assumptions about drug therapy for chronic prostatitis and imaging for UTIs were disproven.

Anthony J. Schaeffer, MD, professor and chairman of the department of urology at Northwestern University's Feinberg School of Medicine, Chicago, discussed the clinical significance of these and other major findings concerning urologic infection and inflammation.

Uropathogenic Escherichia coli in an immortalized human urothelial cell line allows the inflammatory signaling mechanisms to be studied and has the potential of revealing a means of blocking E coli when signaling to control infection.

This finding has the potential to reveal a means of blocking E coli when signaling in order to control infection, according to Dr. Schaeffer.

"What's novel about this particular project is that it uses human cell lines shown to be analogous to human tissue in vivo," he said. "This shows that the E coli could block the ability of cells to respond in the innate immune system—E coli is on the offense."

The researchers also found that this bacterium-cell relationship is active, not passive, Dr. Schaeffer said.

"These two systems are interacting," he said.

If researchers can understand more about the interaction between the bacteria and the host, they may find a method to block the ability of E coli to shut down the host's defense, or to somehow strengthen the host's defense.

A cross-sectional study of 5,821 U.S. men aged 64 years or older shows that prostatitis is common (about 25% of the cohort) and is associated with an increased risk of BPH and prostate cancer. Further study of the disease relationships is warranted.

This study's finding is another example of a bacterium causing an abnormal response and subsequent chronic inflammation, Dr. Schaeffer said. In this case, the abnormal response could lead to other diseases.

"If the inflammation—part of the immune response—goes awry, it can trigger an aberrant response that doesn't shut down, and the chronic response can lead to other diseases," he said, adding that this finding implies the host response and the bacterial interaction with the host are modifiable.

A large study of ciprofloxacin (Cipro) in pediatric patients with complicated UTIs or pyelonephritis generated self-limiting arthropathy in only a minority of patients, showing that fluoroquinolones can be used safely in children.

Dr. Schaeffer said arthropathy can still be a problem with fluoroquinolone use in children, but this research provides increasing evidence that using fluoroquinolones in selected pediatric patients with these conditions is safe.

A study of ciprofloxacin versus tamsulosin (Flomax) versus a combination of the two drugs versus placebo for 6 weeks in men with long-standing chronic prostatitis/ chronic pelvic pain syndrome shows that neither the individual agents nor the combination are effective and does not support empiric treatment.

"The study's negative finding, that men with these advanced conditions don't respond well to these drugs, is unfortunate," Dr. Schaeffer said, adding that there is currently no definitive treatment available for men with this chronic condition.

"But there still could be a place for these drugs in patients with early-onset prostatitis/chronic pelvic pain syndrome."

Uncomplicated UTIs may be more common than the literature suggests, and diagnostic imaging may be unnecessary in men without groin pain, fever, or fewer than three infections.

Traditionally, abnormal urinary tracts were thought the cause of infection.

"In this study, the men evaluated frequently did not have an abnormal urinary tract," Dr. Schaeffer said. "This means that, in selected men, you may not have to aggressively evaluate them by x-ray, whereas physicians traditionally had been inclined to do that to look for an abnormality."

The clinical message is that men presenting for the first time with this complaint may be treated empirically.