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Prostatitis is any form of inflammation of the prostate gland. Because women do not have a prostate gland, it is a condition only found in men. Prostatitis may account for up to 25 percent of all office visits by young and middle-age men for complaints involving the genital and urinary systems.

Signs and Symptoms of Prostatitis

Inflammation of the prostate leads to pain, often during voiding but also in back and rectum. Frequent urination and increased urgency may suggest a cystitis (bladder infection). Ejaculation may be painful, as the prostate contracts during emission of semen.

Diagnosis of prostate symptoms

If prostatitis is suspected, urinalysis may show white blood cells, red blood cells, nitrite positivity and microorganisms. This is mainly so in acute prostatitis and asymptomatic inflammatory prostatitis (see below). In the other types, urinalysis may be unhelpful.

Prostate specific antigen levels may be elevated, although there is no malignancy. In acute prostatitis, a full blood count reveals increased white blood cells. Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis.

Classification of Prostatitis

There are four forms of prostatitis:

  • Acute prostatitis (bacterial)
  • Chronic bacterial prostatitis
  • Chronic prostatitis/chronic pelvic pain syndrome
  • Asymptomatic inflammatory prostatitis

Acute prostatitis

Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. It is treated with an appropriate antibiotic, such as ciprofloxacin.

Chronic bacterial prostatitis

Prostatitis can become chronic, as it is relatively poorly penetrated by antibiotics. The pain symptoms come to the foreground, although episodes of painful micturition may occur. If there is a cyst or abscess that maintains the infection, surgery may be necessary.

Chronic prostatitis/chronic pelvic pain syndrome

According to many researchers, this is a common but poorly understood form of the disease. It is found in men of any age; symptoms go away and then return without warning. Chronic prostatitis/chronic pelvic pain syndrome may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism. In the noninflammatory form, no evidence of inflammation, including infection-fighting cells, is present.

Theories behind the disease include autoimmune and neurogenic inflammation. In the latter, dysregulation of the local nervous system due to past traumatic experiences lead to inflammation that is mediated by substances released by nerve cells.

Asymptomatic inflammatory prostatitis

There is no pain or discomfort but there are white blood cells in the semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.

Therapy for Prostatitis

Antibiotics are the first line of treatment in infectious prostatitis. Prolonged high-dosed courses are often attempted to eradicate infection in chronic prostatitis. Analgesics may be required to control the pain, and some favour physiotherapy to modify the pain response.

Posted by Staff at May 16, 2005 10:13 PM

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