Basic research should soon bring urologists entirely new ways to thwart or treat urinary tract infection, which could be welcome eleventh-hour saves from the problem of antibiotic-resistant bacteria.
Meanwhile, research is moving clinicians toward a more holistic approach to treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and clinical trials of drugs and physical therapy should help urologists make better treatment decisions soon, according to Dr. Schaeffer.
"We're beginning to understand that there's an active interplay between bacterium and host," he said. "The bacteria try to paralyze host defenses, and the host tries to alter the bacteria. Understanding these bacteria-host interactions better could allow us to enhance host resistance, for example, instead of trying to treat the infection."
Another important discovery about bladder host defenses has revealed how some uropathogenic Escherichia coli infect the bladder, foil antibiotics, and resist elimination-along with a drug that might thwart that process. In the future, combinations of this drug and other substances that enhance host defense with antibiotics may be key in treating recurrent UTIs.
Emerging concepts about the etiology of CP/CPPS are leading clinicians toward new approaches to therapy.
"Rather than think about pelvic pain as a response of the bladder or response of the prostate as the cause and effect, we're starting to think about all the interactions between organs and how changes in one can affect another," Dr. Schaeffer said.
That interactivity includes the central nervous system, he explained, and several studies will offer a new perspective on the role of the central nervous system and how patients perceive pain, as well as how this knowledge can be used to develop effective pain therapy.
"The advantage will be a more holistic approach, where urologists won't be thinking just about treating prostatitis, but the patient as a whole, trying to improve their coping as well," Dr. Schaeffer explained. "It would be similar to treating hypertension, not just with antihypertensive drugs, but also with helping the patient to lose weight, exercise, control diabetes, and so on."
Before the end of 2007, urologists can look forward to results of two important National Institutes of Health-sponsored trials of drug therapy for prostatitis, one with pregabalin (Lyrica), which is currently indicated for neuropathic pain, and the other with an alpha-blocker. These trials will soon be completed.
In addition, physical therapy as a treatment for pelvic pain in women and men is undergoing an NIH-sponsored trial.
Urologists can look forward to new therapeutic options for all these challenging, often daunting urologic diseases in the not-too-distant future.