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Prostatitis

Prostatitis is an inflammation of the prostate gland. It occurs in several forms. Acute prostatitis most often results from gram-negative bacteria and is easily recognized and treated. Chronic prostatitis, which affects up to 35% of men over age 50 and is the most common cause of recurrent urinary tract infection (UTI) in men, is harder to recognize. Other classifications include granulomatous prostatitis (also called tuberculous prostatitis), nonbacterial prostatitis, and prostatodynia (painful prostate).

Causes

Prostatitis is divided into categories based on cause. Two kinds of prostatitis, acute prostatitis and chronic bacterial prostatitis, are caused by infection of the prostate. Some kinds of prostatitis might be caused when the muscles of the pelvis or the bladder don't work correctly.

Signs and Symptoms

The symptoms of prostatitis depend on the type of disease you have. You may experience everything from no symptoms to symptoms so sudden and severe that they cause you to seek emergency medical care.

Symptoms, when present, can include fever, chills, urinary frequency, frequent urination at night, difficulty in urinating, burning or painful urination, perineal and low-back pain, joint or muscle pain, tender or swollen prostate, blood in the urine, or painful ejaculation.

Other conditions may mimic the symptoms of prostatitis - urethritis , and prostatodynia . Patients with prostatodynia have pain in the pelvis or in the perineum.

Diagnostic tests

A urine culture often can be used to identify the causative infectious organism.

Characteristic rectal examination findings suggest prostatitis (especially in the acute phase).

A firm diagnosis depends on comparison of bacterial growth in specimens. This test requires four specimens: one collected when the patient starts voiding (voided bladder one [VB 1]); another midstream (VB2); another after the patient stops voiding and the doctor massages the prostate to produce secretions (expressed prostate secretions [EPS]); and a final voided specimen (VB3). A significant increase in colony count of the prostatic specimens (EPS and VB3) confirms prostatitis.

In granulomatous prostatitis, demonstration of M. tuberculosis in a urine or tissue biopsy from the prostate confirms the diagnosis.

In nonbacterial prostatitis, smears of prostatic secretions reveal inflammatory cells but often no causative organism. In prostatodynia, urine cultures are negative and no inflammatory cells are present in smears of prostatic secretions. Urodynamic evaluation may reveal detrusor hyperreflexia and pelvic floor myalgia from chronic spasms.

Treatment

Systemic antibiotic therapy, guided by sensitivity studies, is the treatment of choice for acute prostatitis. Aminoglycosides, in combination with penicillins or cephalosporins, may be most effective for severe cases. Cotrimoxazole is given to prevent chronic prostatitis; it's also used to combat infections with Escherichia coli. Other drugs used for E. coli infections include carbenicillin, nitrofurantoin, erythromycin, and tetracycline.

If drug therapy is unsuccessful, treatment may include transurethral resection of the prostate. Successful resection must remove all infected tissue. This procedure may lead to retrograde ejaculation and sterility and is usually not performed on young adults. Total prostatectomy is curative but may cause impotence and incontinence.

Treatment for granulomatous prostatitis consists of antitubercular drug combinations. Minocycline. doxycycline, or erythromycin is used for nonbacterial prostatitis for 4 weeks, but antibiotic therapy isn't repeated if symptoms don't subside.

Supportive therapy includes bed rest, adequate hydration, and administration of analgesics, antipyretics, and stool softeners as necessary. If symptoms are present in chronic prostatitis, treatment may consist of sitz baths and regular sexual intercourse (the patient should use condoms during the treatment phase) or ejaculation to promote drainage of prostatic secretions. Regular prostatic massage for several weeks or months is effective in some patients. Anticholinergics and analgesics may help relieve the symptoms of nonbacterial prostatitis. Alpha-adrenergic blocking agents and muscle relaxants may be used for prostatodynia.



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