Prostatitis - Inflammation Of Prostate

Prostatitis is the term used to refer to inflammation of the prostate, a male gland the size of a walnut located around the urethra, just below the bladder. The prostate is responsible for producing part of the seminal fluid that nourishes and transports sperm. Prostate inflammation can affect men of all ages but tends to be more frequent during the third and fourth decades of life. In the USA approximately 2 million men suffer from this pathology every year.

Prostatitis is one of the most feared clinical conditions for men because it is often associated with annoying urinary symptoms and sexual dysfunction that can manifest itself in various ways.

Classification

According to the National Institute of Health (NIH) prostatitis is classified into four categories:

Acute bacterial prostatitis: it is defined as an acute inflammatory process of bacterial origin that affects the prostate gland. Most patients have bacteriuria, ie bacteria in the urine, so that the microorganism can be easily isolated in the urine culture. It can occur in males of any age and the arrival of bacteria is usually retrograde from the lower urinary tract, sometimes it is related to sexually transmitted infections. The most frequent etiologic agent is a bacterium called Escherichia coli.

Chronic bacterial prostatitis: consists of prostatic inflammation and recurrent infections of the urinary tract. Its origin is related to anatomical or functional alterations of the prostate gland, such as obstructions or reflux.

Chronic nonbacterial prostatitis: consists of chronic inflammation (more than 3 months) of the prostate gland in which no microorganism is identified as a causative agent, it can affect men of any age and is associated with immunological alterations.

Asymptomatic inflammatory prostatitis: It is characterized by the presence of prostatic inflammation (presence of leukocytes in semen or in biopsy) in the absence of symptoms.

Symptomatology

The most common symptoms are pelvic pain which can manifest in the following areas: suprapubic and perineal area (46%), scrotum and testicle (39%), penis (6%), bladder (6%) and low lumbar area (2%).

Patients with prostatitis also usually report symptoms such as difficulty initiating urination, weak urine stream, postvoid drip, urinary urgency, burning when urinating, frequent urination, pain when ejaculating, erectile dysfunction and decreased libido. These symptoms are usually associated with fever and malaise.

Diagnosis

As with all pathologies, the physical examination is very important. Rectal examination is very useful in acute bacterial prostatitis since the prostate is enlarged, very sensitive to palpation and painful.

Doctors usually indicate the performance of urine culture before and after a prostate massage. If the infection is located in the prostate, the number of bacteria isolated will be at least ten times higher in the samples taken after performing the prostate massage. This test must be done before the patient receives antibiotic treatment.

In some cases, the doctor may request imaging studies such as ultrasound or computed tomography to evaluate the structure of the gland and rule out any other pathology such as benign prostatic hyperplasia or prostate cancer.

Treatment

The treatment of prostatitis depends on the underlying cause.

Antibiotics: This is the most commonly prescribed treatment for prostatitis and can be administered orally or intravenously depending on the infection severity. The most commonly used antibiotics are cephalosporins (cefixime, ceftibuten, cephalexin), and fluoroquinolones (ciprofloxacin and levofloxacin). The treatment usually lasts 2 weeks in cases of acute prostatitis and 6-8 weeks in cases of chronic or recurrent prostatitis.

Alpha-blockers: These drugs help to relax the muscle fibers of the urinary tract which allows alleviating the urinary symptoms (urinary urgency, burning when urinating, postvoid drip, etc).

Anti-inflammatories: Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and inflammation.

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