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Prostatitis is the general term that describes inflammation of the prostate. It is a very common condition that affects many men of all ages. There are four different types of prostatitis: acute bacterial, chronic bacterial, chronic non-bacterial and asymptomatic inflammatory.
The diagnosis of acute and chronic bacterial prostatitis is based on the history, clinical examination, palpation of the prostate, as well as laboratory tests: urine/sperm culture, CRP, PSA and prostate ultrasound. In chronic bacterial prostatitis, the urine culture may not detect the bacteria that cause prostatitis. For this reason, the patient is required to have a sperm culture or urine tests (Stamey and Meares).
The diagnosis of chronic non-bacterial prostatitis is made with the exclusion of other types of prostatitis, as it cannot be documented in the laboratory. Symptoms should persist for more than 3 months. As for the diagnosis of asymptomatic inflammatory prostatitis, it is done randomly in the context of a check-up or a biopsy performed for another reason.
It is caused by bacteria found in urine or sperm culture. The patient reports severe symptoms of infection, like high fever with chills, weakness with accompanying frequency, urgency, dysuria, low back pain and pain at the perineum. Patients often have urinary retention because their prostate is swollen due to inflammation.
It has some periods of complete absence of symptoms interrupted by acute recurrent infections by the same bacteria that remain inactive within the prostate. Often it is associated with a poorly or incorrectly treated acute prostatitis. The patient presents with severe pain (especially at the perineum and anus), frequency, urgency and dysuria.
The exact etiology is unclear as no pathogenic bacteria are isolated. The factors that can trigger the prostate are stress, a history of injury, surgery or urinary tract infections. The patient periodically reports discomfort that can detect pain anywhere in the lower abdomen, groin, testicles, penis, perineum, or anus. Erectile dysfunction, premature or painful ejaculation are more rare. The disease usually affects the patient's quality of life and psychology.
It is an asymptomatic inflammation of the prostate gland. Its clinical significance is small because there are no symptoms and the causes are not clear. There may be an increased PSA or abnormal finger examination.
Oral antibiotics or injections and anti-inflammatory drugs are given and good hydration is recommended. The duration of antibiotic therapy is usually between 4-6 weeks, but can be extended. If the bacteria are not restricted, prostatitis can pass into chronic recurrent prostatitis. If urinary retention coexists, a catheter should be inserted (we prefer a suprapubic catheter) to prevent the spread of bacteria.
Antibiotics are the treatment in this case. The type of the antibiotic and duration of the therapy depend on the symptoms, clinical examination, test results, medical history and the number of relapses. Usually the duration of antibiotic therapy is between 4-6 weeks but can be extended up to 12 weeks. In some patients due to multiple relapses with the same bacteria, if they are asymptomatic, it is not necessary to start antibiotics in order not to develop highly resistant bacteria. Otherwise the patient must undergo daily prophylactic treatment indefinitely. Medications that improve urination and anti-inflammatory drugs may also be given.
A combination of treatments is needed to alleviate the symptoms and improve the quality of life. In some cases, prostate massage can help, as well as relaxing the pelvic floor. When psychiatric symptoms coexist, a psychiatrist or psychologist may be needed. Also, a warm bath, drinking plenty of fluids, limiting alcohol, caffeine, spicy and acidic foods, avoiding cycling and a sedentary lifestyle can improve symptoms.
It does not need treatment because it is asymptomatic and there is no infection that needs to be eradicated.
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