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Prostatitis

Prostatitis is an inflammation or infection of the prostate gland, an organ just below the bladder that produces about 30% of the seminal fluid. It can affect men of all ages, but is most common in men 50 years of age or younger.

Types of prostatitis
  1.  Acute bacterial prostatitis is a bacterial infection of the prostate gland. Patients generally experience sudden and possibly severe symptoms such as fever and chills, along with urination abnormalities. This is because the prostate gland has swollen and pressed on the urethra, making it narrower. Problems include frequent urination, burning sensation, incomplete urination, weak urine stream, difficulty urinating, cloudy urine or blood in the urine. In severe cases, there may be sudden inability to urinate or bloodstream infection.
  2. Chronic bacterial prostatitis is a bacterial infection of the prostate gland, but the symptoms are less severe than the acute type. Symptoms tend to come and go for more than three months. A history of recurrent urinary tract infections (UTIs) is a common symptom. Pelvic pain syndrome is also found in
  3. Chronic prostatitis (chronic prostatitis / chronic pelvic pain syndrome) is the most common type of prostatitis. So far, the mechanism of occurrence has not yet been clearly concluded. With this type of inflammation in the prostate gland, patients mainly suffer from chronic pain in the pelvis prominently in the lower abdomen, testicles, and perineum (the area between your scrotum and rectum) and genitals. Pain after ejaculation has also been reported, possibly with or without urination abnormalities.
  4.  Asymptomatic inflammatory prostatitis is inflammation according to pathology report as detected in prostate biopsy in surgical treatment for enlarged prostate or prostate cancer. Infection-fighting cells are found while the patient has no previous symptoms of prostate inflammation. Research studies so far state that there is no need for treatment.
If the patient has symptoms consistent with prostatitis, the doctor may consider using these tests:
  • Digital rectal examination (DRE) of the prostate gland: In this test, the doctor inserts a finger into the rectum and presses on the prostate gland. Usually it causes no pain but a painful examination could indicate inflammation.
  • Urinalysis, a set of tests of urine and urine culture to check for infection
  • Prostate massage to release expressed prostatic secretions into the urethra: The secretions in the urine collection are then examined. This is part of of Meares-Stamey test and may be necessary to differentiate between chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome. It is a test to see if there is proven inflammation in the prostate gland and if the inflammation is related to bacterial infection. Although it is a standard method, its accuracy may be compromised if the expressed prostatic secretions from the prostate massage are of low amount. The test is also not considered in cases of suspected acute infectious prostatitis.
  • Semen culture: This may help diagnose chronic bacterial prostatitis.
Additional tests
  • PSA blood test: Currently it is not diagnostic and does not indicate prostatitis. However, inflammation of the prostate gland is one of the causes of higher than normal PSA levels. So the doctor may recommend a follow-up test after treatment.
  • Ultrasound imaging: This is useful in cases where infective prostatitis condition has not improved after treatment, to detect the development of a prostate abscess that requires surgical treatment. Prostate size assessment from ultrasound images is not diagnostic of prostate inflammation.
  • As chronic prostatitis (chronic pelvic pain syndrome) is not an infection and may overlap with other pelvic pain conditions. The doctor may thus recommend additional tests to help rule out or confirm the diagnosis.
The use of antibiotics: This depends on the type of bacteria found and the patient's symptoms. If the patient has a high fever, intravenous antibiotics may be considered, and then changed to oral antibiotics when the symptoms improve. For acute bacterial prostatitis, treatment with antibiotics usually takes 2-4 weeks. For chronic bacterial prostatitis, treatment takes 4-6 weeks, or up to 12 weeks.

The treatment of chronic prostatitis (chronic pelvic pain syndrome) is still one of the most difficult urinary tract problems to tackle because the mechanism of occurrence is unclear. Since this type of inflammation is not caused by infection, currently it is still debated if antibiotics is necessary for this group of patients. The standard recommendation is to use the UPOINT system, which clinically classifies a patient's symptoms into six domains, and then to provide individualized treatment accordingly.
Currently, with no evidence of specific risk factors for prostatitis, no recommendations for prevention are available. In the case of both acute and chronic bacterial prostatitis, if the doctor finds that it is related to abnormalities of the urethra or abnormalities in urination, the doctor will always consider treating the underlying causes.
 
Last modify: December 11, 2024

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