Prostatitis: What It Is, How to Cure It

Am Fam Physician. 2000;61(10):3025-3026

See related article on prostatitis.

What is prostatitis?

Prostatitis is common and affects many men at some time. Prostatitis is an inflammation of the prostate gland. When part of your body is inflamed, it is red, hot and sore. Prostatitis can cause many symptoms. It can make it difficult or painful to urinate. It can make you have to urinate more often. It can also give you a fever, low-back pain or pain in your groin (the area where the legs meet your body). It may make you less interested in having sex or unable to get an erection or keep it. Prostatitis is easy to confuse with other infections in the urinary tract.

What is the prostate gland?

The prostate is a gland that lies just below a man’s urinary bladder. It surrounds the urethra like a donut and is in front of the rectum. The urethra is the tube that carries urine out of the bladder, through the penis and out of the body. Your doctor may check your prostate by putting a finger into your rectum to feel the back of your prostate gland.

The prostate gland makes a fluid that provides nutrients for sperm. This fluid makes up most of the ejaculate fluid. We do not yet know all of the ways the prostate gland works.

What causes prostatitis?

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 right.

How is prostatitis treated?

The treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to find out the cause.

An antibiotic is used to treat prostatitis that is caused by an infection. Some antibiotics that might be used are trimethoprim-sulfamethoxazole, doxycycline, ciprofloxacin, norfloxacin and ofloxin. You might have to take antibiotics for several weeks or even a few months. If prostatitis is severe, you might have to go to a hospital for treatment with fluids and antibiotics.

What if my prostatitis is not caused by infection?

Because we do not understand what causes prostatitis without infection, it can be hard to treat. Your doctor might try an antibiotic to treat a hidden infection. Other treatments are aimed at making you feel better. Nonsteroidal anti-inflammatory medicines, such as ibuprofen or naproxen, and hot soaking baths may help you feel better. Some men get better by taking medicines that help the way the bladder or prostate gland work. These medicines include oxybutynin, doxazosin, prazosin, tamsulosin and terazosin.

Can prostatitis be passed on during sex?

Sometimes prostatitis is caused by a sexually transmitted organism, such as chlamydia. However, most cases are caused by infections that are not sexually transmitted. These infections can’t be passed on to sexual partners.

Can prostatitis come back?

Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well. Small amounts of bacteria might “hide” in the prostate and not be killed by the antibiotic. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a long time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.

Should I have my prostate gland taken out if I have prostatitis?

Prostatitis can usually be treated with medicine. Most of the time, surgery is not needed.

Does prostatitis cause cancer?

Although prostatitis can cause you trouble, it does not cause cancer. There is a blood test some doctors use for prostate cancer called the prostate-specific antigen test (called the PSA, for short). If you have prostatitis, your PSA level might go up. This does not mean you have cancer. Your doctor will treat your prostatitis and may check your PSA level again.

Treatment of Prostatitis | AAFP

JAMES J. STEVERMER, M.D., M.S.P.H., AND SUSAN K. EASLEY, M.D.

This is a corrected version of the article that appeared in print.

Am Fam Physician. 2000;61(10):3015-3022

See related patient education handout on prostatitis, written by the authors of this article.

The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection to chronic pain syndromes, in which the prostate gland is inflamed. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias, decreased libido or impotence, painful ejaculation and low-back and perineal pain. Physical examination often fails to clarify the cause of the pain. Cultures and microscopic examination of urine and prostatic secretions before and after prostatic massage may help differentiate prostatitis caused by infection from prostatitis with other causes. Because the rate of occult infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis. If the patient responds to therapy, antibiotics are continued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal anti-inflammatory drugs, alpha-blocking agents, anticholinergic agents or other therapies may provide symptomatic relief.

Prostatitis is inflammation of the prostate gland. In clinical practice, the term prostatitis encompasses multiple diverse disorders that cause symptoms related to the prostate gland. One author has described prostatitis as “a wastebasket of clinical ignorance”¹ because so many poorly characterized syndromes are diagnosed as prostatitis. The spectrum of prostatitis ranges from straightforward acute bacterial prostatitis to complex conditions that may not even involve prostatic inflammation. These conditions can often be frustrating for the patient and the clinician.

Prostatitis is a common condition. In a survey of National Guard members (20 to 49 years of age) using a self-reported diagnosis of prostatitis, a 5 percent lifetime prevalence was noted.² A population-based study of men (40 to 79 years of age) in Olmstead County, Minn., suggests a lifetime prevalence close to 9 percent. The latter study used a medical record review to confirm physician diagnosis of prostatitis. Patients with a previous episode of prostatitis were at significantly increased risk for subsequent episodes.³ In a nationwide review of data from outpatient physician visits, it was noted that 15 percent of men who saw a physician for genitourinary complaints were diagnosed with prostatitis.⁴ Every year, approximately 2 million physician visits include the diagnosis of prostatitis. Despite its widespread prevalence, prostatitis remains a poorly studied and little understood condition.

Diagnosis

Prostatitis is not easily diagnosed or classified. Patients with prostatitis often present with varied, nonspecific symptoms, and the physical examination is frequently not helpful. The traditional diagnostic test for differentiating types of prostatitis is the Stamey-Meares four-glass localization method.⁵ It includes bacterial cultures of the initial voided urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and a postprostatic massage urine specimen (VB3). The VB1 is tested for urethral infection or inflammation, and the VB2 is tested for urinary bladder infection. The prostatic secretions are cultured and examined for white blood cells (more than 10 to 20 per high-power field is considered abnormal). The postmassage urine specimen is believed to flush out bacteria from the prostate that remain in the urethra.

Although widely described as the gold standard for evaluation for prostatitis, this diagnostic technique has never been appropriately tested to assess its usefulness in the diagnosis or treatment of prostatic disease. The expression of prostatic secretions can be difficult and uncomfortable. In addition, the test is somewhat cumbersome and expensive, which may explain its infrequent use by primary care physicians and urologists.^3,6

An alternative diagnostic test, called the pre- and postmassage test (PPMT) has been proposed. Although easier to carry out, this test has also not been validated; in retrospective studies, it performed about as well as the four-glass method. ⁷

The technique is straightforward. The patient retracts the foreskin, cleanses the penis and then obtains a midstream urine sample. The examiner performs a digital rectal examination and vigorously massages the prostate from the periphery toward the midline. The patient collects a second urine sample, and both specimens are sent for microscopy and culture. See Table 1 for interpretation of results of the four-glass test and the PPMT.

Categorizing Prostatitis

Traditionally, prostatitis has been divided into four subtypes based on the chronicity of symptoms, the presence of white blood cells in the prostatic fluid and culture results. These subtypes are acute bacterial prostatitis, chronic bacterial prostatitis, chronic nonbacterial prostatitis and prostadynia.⁵ Although this classification system has been widely used, it has never been validated for diagnostic or therapeutic utility.

At a recent National Institutes of Health (NIH) conference, a new classification system was proposed that could account for patients who do not clearly fit into the old system.^3,8 The subgroups of acute and chronic bacterial prostatitis remain essentially unchanged. Chronic nonbacterial prostatitis and prostadynia have been merged into a new category called chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CNP/CPPS). This category can be subdivided further based on the presence or absence of white blood cells in prostatic secretions. A fourth and final category of asymptomatic prostatitis was added to the classification system. A large-scale study is in progress in an attempt to validate the new classification system. Table 2 compares the two classification systems.

ACUTE BACTERIAL PROSTATITIS

Acute bacterial prostatitis (ABP) may be considered a subtype of urinary tract infection. Two main etiologies have been proposed. The first is reflux of infected urine into the glandular prostatic tissue via the ejaculatory and prostatic ducts. The second is ascending urethral infection from the meatus, particularly during sexual intercourse.¹ The causative organisms are primarily gram-negative, coliform bacteria. The most commonly found organism is Escherichia coli. Other species frequently found include Klebsiella, Proteus, Enterococci and Pseudomonas. On occasion, cultures grow Staphylococcus aureus, Streptococcus faecalis, Chlamydia or anaerobes such as Bacteriodes species.^9–13

Because acute infection of the prostate is often associated with infection in other parts of the urinary tract, patients may have findings consistent with cystitis or pyelonephritis. Patients with ABP may present with fever, chills, low back pain, perineal or ejaculatory pain, dysuria, urinary frequency, urgency, myalgias and varying degrees of obstruction.^9,13

Typically, the prostate gland is tender and may be warm, swollen, firm and irregular. A standard recommendation is to avoid vigorous digital examination of the prostate, because, theoretically, that may induce or worsen bacteremia.

Although no test is diagnostic for acute bacterial prostatitis, the infecting organism can often be identified by culturing the urine.¹³ Initially, antibiotic selection is empiric, but the regimen can be modified once pathogen susceptibilities are available. Patients respond well to most antibiotics, although many cross the blood-prostate barrier poorly. The inflammation caused by ABP may actually allow better penetration of antibiotics into the organ.

It is difficult to interpret the few controlled trials of antibiotic treatment for bacterial prostatitis because of poor case definition, low rates of follow-up and small numbers. Based on case series and laboratory studies of antibiotic penetration in animal models, standard recommendations usually include the use of a tetracycline, trimethoprim-sulfamethoxazole (TMP-SMX [Bactrim, Septra]) or a quinolone. Men at increased risk for sexually transmitted disease might benefit from medications that also cover Chlamydia infection. The most commonly recommended regimens are listed in Table 3. Other medications that are labeled for treatment of prostatitis include carbenicillin (Miostat), cefazolin (Ancef), cephalexin (Keflex), cephradine (Velosef) and minocycline (Minocin).

The duration of therapy has also not been well studied. If the patient is responding clinically and the pathogen is sensitive to treatment, most experts recommend that antibiotic therapy be continued for three to four weeks to prevent relapse, although a longer course is sometimes necessary.¹³ In a limited survey⁷ of primary practitioners and urologists, it was found that most of them use TMP-SMX as the first-line agent in treating prostatitis (of any type). About 40 percent of urologists and 65 percent of primary care physicians treated patients for only two weeks.

Extremely ill patients, such as those with sepsis, should be hospitalized to receive parenteral antibiotics, usually a broad-spectrum cephalosporin and an aminoglycoside. Supportive measures, such as antipyretics, analgesics, hydration and stool softeners, may also be needed.¹³ Some urologists place suprapubic catheters in patients who have severe obstructive symptoms from an acutely inflamed prostate gland.

The possibility of a prostatic abscess should be considered in patients with a prolonged course that does not respond to appropriate antibiotic therapy. The examiner can often detect an abscess as a fluctuant mass on rectal examination. Computed tomography, magnetic resonance imaging or transrectal ultrasonography usually provide an adequate image of the prostate to evaluate for abscess. Transurethral drainage or resection is usually required.

CHRONIC BACTERIAL PROSTATITIS

Chronic bacterial prostatitis (CBP) is a common cause of recurrent urinary tract infections in men. Patients typically have recurrent urinary tract infections with persistence of the same strain of pathogenic bacteria in prostatic fluid or urine. Symptoms can be quite variable, but many men experience irritative voiding symptoms, possibly with pain in the back, testes, epididymis or penis, low-grade fever, arthralgias and myalgias. Many patients are asymptomatic between episodes of acute cystitis. Signs may include urethral discharge, hemospermia and evidence of secondary epididymoorchitis.¹³ Often the prostate is normal on digital rectal examination. No single clinical finding is diagnostic, although urine or prostatic secretion cultures can aid in the evaluation.

Classically, CBP presents with negative pre-massage urine culture results, and greater than 10 to 20 white blood cells per high-power field in both the pre- and the postmassage urine specimen. Significant bacteriuria in the postmassage urine specimen suggests chronic bacterial prostatitis (Table 1).

The efficacy of antibiotic treatment is probably limited by the inability of many antibiotics to penetrate the prostatic epithelium when it is not inflamed. Because the prostatic epithelium is a lipid membrane, more lipophilic antibiotics can better cross that barrier. In laboratory studies of dogs, the antibiotics that reached the highest concentrations in the prostate were erythromycin, clindamycin (Cleocin) and trimethoprim (Proloprim).¹³ Unfortunately, erythromycin and clindamycin have little activity against gram-negative organisms, which are the bacteria most likely to cause CBP.

Based on highly limited studies, TMP-SMX is considered a first-line antibiotic for CBP caused by gram-negative bacteria. The cure rate (over variable periods) has been reported to range from 33 to 71 percent.^14,15 It is thought that the treatment failures are caused by poor antibiotic penetration of the prostate rather than by resistant organisms. In one case series,¹⁶ 400 mg of norfloxacin (Noroxin) taken twice a day for 28 days achieved a cure rate in 64 percent of patients who had failed treatment with TMP-SMX, carbenicillin, or both. In a limited randomized trial of patients with acute and chronic prostatitis, it was found that ofloxacin (Floxin) had a higher cure rate than carbenicillin five weeks after therapy.¹⁷ In a randomized controlled trial with a very short follow-up period, it was shown that norfloxacin had a higher cure rate (92 percent) than TMP-SMX (67 percent) in patients with recurrent urinary tract infections.¹¹ In another randomized controlled trial¹² it was found that minocycline may be more effective than cephalexin. The results of this study were limited because those evaluating clinical outcomes were not blinded to the drug, and the follow-up rate was only 50 percent.¹²

Because of the expense of an extended course of the newer antimicrobial agents, it may be reasonable to try TMP-SMX as a first agent, changing to a fluoroquinolone in the event of antibiotic failure. Some men probably require long-term antibiotic suppression to prevent recurrent urinary tract infections. No studies adequately address how to select these patients or what agent (or dosage) to use, although TMP-SMX and nitrofurantoin (Furadantin) are often recommended.

Rarely, transurethral prostatectomy can be curative if all of the infected prostatic tissue is removed; however, infection often is harbored in the more peripheral tissues. In extreme cases, total prostatectomy may provide a definitive cure, although the potential complications of surgery limit its application in this benign but troublesome disease. ¹³

Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

It has been widely reported that more than 90 percent of men with prostatitis meet the criteria for chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CNP/CPPS).¹⁰ However, these estimates come from urologic referral centers and are likely to over-represent more complex cases and under-represent more straightforward cases of acute and chronic bacterial prostatitis. Because of these referral biases, the true incidence and prevalence of these syndromes are unknown.

The etiology of CNP/CPPS is not understood. It is likely that multiple disorders are being lumped together in this diagnosis. At least some cases represent chronic bacterial prostatitis not diagnosed as such because of limited sampling techniques. In a study¹⁸ using transperineal needle biopsy for culture of prostate tissue, it was found that there is frequently an occult bacterial prostatitis, especially in men with leukocytes in prostatic secretions (52 percent had positive culture of organisms). A variety of other possible etiologies have been proposed in the medical literature. Some authors have noted increased uric acid levels in prostate secretions in men with chronic nonbacterial prostatitis. It has also been proposed that men with CNP/CPPS may have an extra-prostatic cause, such as bladder outflow or pelvic floor muscle disorder. Others have pointed out the similarity between CNP/CPPS and interstitial cystitis or even fibromyalgia. There may well be an overlap of symptoms and etiologies between CNP/CPPS and benign prostatic hypertrophy.⁴ Most of these hypotheses have not been validated and, in general, have not resulted in clinically useful therapies.

Like many such poorly understood conditions, CNP/CPPS remains a challenging syndrome. Patients usually have symptoms consistent with prostatitis, such as painful ejaculation or pain in the penis, testicles or scrotum. They may complain of low back pain, rectal or perineal pain, or even pain along the inner aspects of the thighs. They often have irritative or obstructive urinary symptoms and decreased libido or impotence. As a rule, these patients do not have recurrent urinary tract infections. The physical examination is usually unremarkable, but patients may have a tender prostate.

This syndrome can be differentiated from other types of prostatitis by using the Stamey-Meares localization method. No bacteria will grow on any culture, but leukocytosis (more than 10 to 20 white blood cells per high-power field) may be found in the prostatic secretions. When the PPMT is used, all cultures are negative. The premassage urine has fewer than 10 white blood cells per high-power field, and the postmassage urine contains more than 10 to 20 white blood cells per high-power field (Table 1). The possibility of bladder cancer, which can also cause irritative symptoms, bears consideration.

The treatment of this condition is challenging, and there is limited evidence to support any particular therapy. Given the high rate of occult prostatic infection, an antibiotic trial is reasonable, to see if the patient responds clinically. Because Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis have been identified as potential pathogens, treatment should cover these organisms.

Options for treatment are 100 mg of doxycycline (Vibramycin) or minocycline (Minocin) twice daily for 14 days, or erythromycin at 500 mg four times daily for 14 days.¹³

A small, randomized controlled trial¹⁹ of allopurinol (Zyloprim) found potential benefit, but the study did not have either enough study subjects or adequate design to demonstrate a convincing benefit. Other therapies, such as thrice weekly prostate massage, have been proposed, although the supportive data are limited.²⁰ Transurethral microwave thermotherapy did relieve symptoms in a small, randomized controlled trial.²¹ Diazepam (Valium) worked about as well as minocycline in one small trial²²; however, patients taking diazepam received more courses of antibiotics in follow-up. Other reported, but untested, therapies include biofeedback, relaxation techniques and muscle relaxants.

Hot sitz baths and nonsteroidal anti-inflammatory drugs (NSAIDs) may provide some symptom relief. Some men may notice aggravation of symptoms with intake of alcohol or spicy foods and, if so, should avoid them. In men with irritative voiding symptoms, anticholinergic agents (such as oxybutynin [Ditropan]) or alpha-blocking agents (such as doxazosin [Cardura], prazosin [Minipress], tamsulosin [Flomax] or terazosin [Hytrin]) may be beneficial.¹³ Reassurance can be helpful for these men, and it is important that they know their condition is neither infectious nor contagious and is not known to cause cancer or other serious disorders. Some men benefit from counseling and other approaches helpful in chronic pain syndromes.

Asymptomatic Prostatitis

Information presented at the NIH consensus conference added asymptomatic prostatitis as a new category, partly because of the widespread use of the prostate-specific antigen (PSA) test.

Clearly, symptomatic bacterial prostatitis can elevate the PSA test to abnormal levels.²³ Asymptomatic prostatitis may also elevate the PSA level. In addition, patients who are being evaluated for other prostatic disease may be found on biopsy to have prostatitis. There are no studies elucidating the natural history or appropriate therapy of this condition. It does appear that PSA levels return to normal four to six weeks after a 14-day course of antibiotics.²³ Treatment is routinely recommended only in patients with chronic asymptomatic prostatitis known to elevate the PSA level. In these patients, it may be prudent to treat before drawing subsequent PSA samples.

Recommendations for a General Approach

Although evidence to support them is scarce, the following recommendations are offered. If the history and physical examination suggest prostatitis, physicians may consider a diagnostic test, such as the four-glass test or the PPMT. In most cases, empiric antibiotic therapy is reasonable whether or not the diagnostic test proves a bacterial cause. Common choices include TMP-SMX, doxycycline or one of the fluoroquinolones. Treatment is often recommended for four weeks, although some clinicians use shorter courses. Physicians should encourage hydration, treat pain appropriately and consider the use of NSAIDs, an alpha-blocking agent, or both. If symptoms persist, a more thorough evaluation for CNP/CPPS should be pursued. Some patients may need several trials of different therapies to find one that alleviates their symptoms.

The term prostatitis describes a wide spectrum of conditions with variable etiologies, prognoses and treatments. Unfortunately, these conditions have not been well studied, and most recommendations for treatment, including those given here, are based primarily on case series and anecdotal experience. For these reasons, many men and their physicians find prostatitis to be a challenging condition to treat.

Treatment of prostatitis in men: symptoms, diagnosis, prices for treatment of inflammation of the prostate gland in Moscow

Inflammation of the prostate gland (prostatitis) is a common disease that occurs in more than 80% of men after 30 years. The absence of severe symptoms and unwillingness to consult a doctor leads to dangerous complications and the formation of a chronic form. Regular preventive examinations allow you to identify the disease in the initial stage. IMMA clinics have all the conditions for a comfortable examination and treatment of prostatitis. Competent specialists will help even in the most difficult cases.

In our clinics you can:

• Consult a urologist;
• Complete a course of prostate massage;
• Use the services of a pediatric urologist;
• And much more.

For more details and any questions, please contact the number listed on the website

Features of the structure and location of the prostate cause its susceptibility to infections and inflammatory processes. Erasure of the signs and symptoms of prostatitis leads to imperceptible progression, complications, spread of the affected area to nearby organs. Often men try not to notice the manifestations of the disease, do not want to seek medical help. This behavior contributes to the development of pathogenic processes. The percentage of self-healing in this case is extremely low.

About the prostate gland

The prostate is one of the most important organs of a man, which largely determines the quality of life.

It is a single gland located at the bottom of the bladder. It consists of two lobes connected by an isthmus. The main functions of the prostate:

• the production of a fluid that dilutes the sperm, contributes to the creation of favorable conditions for the activity of spermatozoa;
• controls urination. The prostate is adjacent to the urethra and acts as a sphincter;
• protects the bladder from ascending infection.

Any disorders in the work of the gland will cause problems in the genital area, urination processes. This leads to a sharp decline in the quality of life. Timely treatment of prostatitis in men will allow you to avoid numerous complications and maintain sexual activity for many years.

Symptoms of the disease. What to pay attention to?

Prostatitis in men can occur in two forms: acute and chronic.

Acute prostatitis is characterized by the following clinical picture:

• intoxication of the body, accompanied by fever over 38 degrees, general weakness, nausea;
• severe pain in the groin, radiating to the small of the back;
• difficulty in urination and defecation.

The patient’s condition in this case requires urgent hospitalization and inpatient treatment. In most cases, the disease is completely cured.

Symptoms of chronic or congestive prostatitis are divided into groups:

• painful;
• violations in sexual life;
• problems in the process of urination.

Pain manifestations at the initial stage of the development of the disease are erased, they can appear and disappear unpredictably. Localized in the lower abdomen, spreading to the lumbar and genitals. The intensity may be low, so the patient may not pay attention to the problem.

Important! Pain in the lower abdomen can be a sign not only of prostatitis, but also of other diseases of the urinary, reproductive systems and intestines.

Sexual problems that have arisen are one of the main symptoms of congestive prostatitis. Their manifestations are as follows:

• decrease in sexual desire;
• “erased” orgasm, lack of vivid sensations;
• reduced or no erection;
• pain during ejaculation or ejaculation;
• increased unreasonable nocturnal erection.

The psychological state contributes to the aggravation of problems. A man begins to avoid sexual intercourse, there is a feeling of anxiety, fear, insecurity. Negative emotional background enhances the signs of sexual dysfunction.

Disturbances in the functioning of the urinary system are especially unpleasant. In the initial stages, there is a slight urinary retention during urination, then the symptoms intensify, pain and pain appear, a feeling of fullness of the bladder, frequent urges. Such manifestations are explained by the fact that the enlarged prostate begins to put pressure on the bladder and urethra.

It is necessary to take into account the peculiarity of the manifestation of these signs: the increase in symptoms may stop. For a while, the problem is not felt by the patient. This phenomenon is explained by the compensatory reaction of the bladder muscles. After a short break, the manifestations of the disease return, more often they have a greater intensity.

The development of chronic prostatitis in men can go unnoticed for several months. Late detection threatens with complications, requires the involvement of not only medical, but also surgical methods of treatment.

Important! Congestive prostatitis is often asymptomatic. To detect the disease in the early stages, when it is easier to treat, it is necessary to undergo regular preventive examinations.

The nature of the disease. Risk factors

Symptoms and treatment of prostatitis depend on the true nature of the disease. There are two main causes: an infectious lesion and the occurrence of an inflammatory process.

Proximity of the location of the prostate to the bladder and urinary canal, intestine leads to the penetration of pathogens into the tissue of the gland. A healthy body with a strong immune system is able to successfully resist infection. The prostate becomes a protective barrier against ascending infections that can affect the urinary system. As a result of an unhealthy lifestyle and stagnant processes in the pelvic area, this function is weakened.

Pathogenic organisms enter the prostate via an ascending pathway from the penis, descending from the bladder, through the blood and lymph. Main sources of infection:

• The most dangerous are sexually transmitted infections. Usually they are asymptomatic and cause great harm to the body;
• cystitis;
• colitis;
• systemic infections;
• complications of acute respiratory infections, for example, complications of bronchitis.

The main causes of prostatitis are associated with an unhealthy lifestyle. Heredity and congenital predisposition are rare cases.

Structural features of the vascular system lead to congestion in the pelvic area, blood begins to circulate poorly, tissues do not receive the necessary amount of oxygen, as a result, their resistance to diseases decreases. In addition, the secret of the prostate itself may accumulate, which causes inflammation.

Congestive prostatitis occurs for the following reasons:

• congenital features associated with the structure of blood vessels, insufficient tone, weak venous valves;
• injuries, including damage to the spine and spinal cord;
• physical inactivity;
• diseases of the spine;
• varicose veins, hemorrhoids;
• bad habits;
• hormonal disorders;
• overweight;
• violation of salt balance.

Disturbances in the hormonal background cause changes in the prostate gland: an excess of testosterone provokes its increase, and a lack of testosterone causes dysfunction.

Bad habits cause damage to the vascular system. Alcohol causes narrowing of small blood vessels, and nicotine leads to the death of blood vessels. Poor blood flow contributes to the development of pathological phenomena in the organs, weakening their protective functions.

Physical inactivity, or a sedentary lifestyle, sitting or standing work leads to stagnation of fluid in the pelvic area, the veins are under increased stress, as a result, varicose veins develop, the protective functions of the body decrease, various diseases begin to develop, including inflammation of the prostate gland.

With frequent diarrhea, colitis, insufficient fluid intake, lack of potassium in the body, a violation of the water-salt balance occurs, which adversely affects the condition of the prostate gland.

The causes of infectious prostatitis are promiscuous sexual behavior, frequent change of partner, weak immunity, complications of common infections, hypothermia.

Statistics show the rejuvenation of the disease: signs of prostatitis are recorded in young men and adolescents. This is facilitated by wearing tight clothes and underwear, frequent hypothermia.

Diagnostic measures

During the examination, the doctor, suspecting prostatitis, interviews the patient and performs a rectal examination of the prostate. The procedure does not take much time and is painless. The patient lies on his side, the doctor inserts his index finger into the rectum. The close location of the prostate and intestines allows you to assess its condition. Enlargement of the gland, pain when pressed are signs of prostatitis.

To confirm the diagnosis, blood and urine tests are performed, including for the presence of a bacterial infection, ultrasound of the pelvic organs; study of prostate secretions, analysis of hormonal levels.

Main treatments

The main treatment for prostatitis is drug therapy. Depending on the identified cause, antibiotics are prescribed to fight the infectious agents or anti-inflammatory drugs.

Supplement the main treatment regimen with vitamin complexes, vascular strengthening drugs, hormonal drugs if necessary, immunomodulators. Therapeutic effect is provided by physiotherapy.

Sometimes a course of prostate massage is prescribed, which eliminates congestion, helps to restore the active functioning of the organ, and improves blood circulation. Patient reviews testify to the effectiveness of this type of treatment. The procedure takes no more than five minutes. The most effective massage in the treatment of chronic and congestive prostatitis.

Important! Prostate massage has a number of contraindications. In acute prostatitis, purulent inflammation, malignant tumors, this type of treatment is contraindicated.

Surgical intervention is possible only in extreme cases and is usually performed in elderly patients, since after excision of the affected part of the gland or with its complete removal, a number of serious side effects may appear:

• infertility;
• sexual dysfunction;
• urinary incontinence;
• hormonal disorders.

Timely treatment will allow you to quickly cope with the symptoms of prostatitis, avoid life-threatening and health complications.

Preventive measures

One of the main conditions for remission of congestive prostatitis is a healthy lifestyle. Drug treatment will help to remove the symptoms, but if the true causes are not eliminated, relapses of the disease can be observed for a long time. To stay healthy and avoid chronic diseases, follow these recommendations:

• have a regular sexual life with one partner;
• proper nutrition, avoidance of fatty, salty, fried foods;
• moderate exercise;
• compliance with the daily routine, healthy sleep;
• giving up bad habits. No matter how familiar it may sound, but alcohol and nicotine have an extremely destructive effect on the body as a whole.

avoid shaking, when driving for a long time, take breaks, warm-ups.

What can be done?

To avoid the development of a chronic form of the disease and possible complications, it is necessary to undergo a preventive examination by a urologist twice a year. It is important to take responsibility for choosing a clinic and a doctor. The asymptomatic course of the disease requires careful examination, a complex of studies. All this is possible in IMMA medical clinics. The main advantages of the centers: new high-precision equipment, the possibility of all types of laboratory research, highly qualified specialists, attentive attitude to each patient. A convenient location of the centers and a high level of service will make a visit to the doctor comfortable.

Regular visits to the doctor will not take much time, but will help maintain men’s health for many years.

Author of the material: urologist at the clinic on Pererva Chigoryaev VK

Treatment of infectious prostatitis in Moscow

Infectious prostatitis is caused by the penetration of pathogenic microorganisms into the structures of the gland and their active reproduction. The disease is diagnosed in men of any age. Pathology occurs in acute and chronic form. An acute infectious process begins with pronounced symptoms, such as painful urination, pulling pain in the lower abdomen, and an increase in body temperature. Chronic infectious prostatitis develops for a long time, can be provoked by an untreated acute form, is characterized by stages of remission and exacerbations. Treatment of infectious prostatitis in men should be comprehensive and carried out under the constant supervision of a urologist. If therapy is absent, severe complications develop, up to impotence, infertility, prostate cancer. In the medical center “Medline” you can use the professional services of experienced urologists who will quickly determine the exact diagnosis and select the most effective treatment that will help prevent any complications.

What is infectious prostatitis

Infectious prostatitis is an inflammation of the prostate gland, provoked by pathogenic microflora, which includes:

• bacteria;
• viruses;
• fungi.

The disease is more often diagnosed in mature men over the age of 45. Ways of penetration of infection into the prostate gland are different:

• through the urethra;
• blood flow from other foci of infection;
• through the bladder.

After the penetration of the pathogen into the same prostate, an acute infectious process develops, accompanied by pronounced symptoms. The characteristic signs of infectious prostatitis are:

• drawing, aching pain radiating to the lower abdomen, perineum, anus;
• increased urge to urinate;
• sensation of incomplete emptying of the bladder;
• presence in urine and semen of pathological inclusions: mucus, pus;
• problems in sexual life: lack of erection, untimely ejaculation, inability to achieve orgasm;
• swelling and redness of the penile mucosa.

Uncharacteristic symptoms may also be disturbing, such as:

• increase in body temperature;
• deterioration in general well-being;
• muscle pain;
• causeless fever, chills.

If for 3 – 4 days the pathological symptoms persist, and the causes of its occurrence are not clarified, it is necessary to urgently consult a doctor and take tests. The earlier a problem is identified, the easier and faster it will be possible to get rid of it.

Male prostatitis infections

The root cause that provokes infectious prostatitis is an infection that has penetrated into the tissues of the gland. If the immune system works without failures, it destroys pathogens, preventing them from actively multiplying. But at the slightest failure, the immune system ceases to fully perform its functions, as a result of which the infection penetrates the body almost unhindered and affects target organs.

Factors that can become a trigger for the progression of the inflammatory process are:

• the presence of chronic foci of infection, prone to frequent relapses;
• promiscuity, unprotected sex;
• non-compliance with the rules of personal hygiene;
• hormonal and endocrine imbalance;
• congenital or acquired immunodeficiency;
• hypothermia;
• stress, physical and psycho-emotional overwork;
• inactive lifestyle, which leads to stagnant processes in the pelvic organs;
• abuse of bad habits: alcohol, cigarettes, illegal substances.

Classification

Depending on what type of infection provoked the disease, there are such types of prostatitis:

• Viral. It occurs against the background of human infection with the herpes virus in the presence of the papilloma virus. The disease is almost impossible to diagnose in the early stages, due to the lack of timely treatment, it becomes chronic, which is not completely cured. During the period of remission, the pathogen is in a latent state, without causing any symptoms. But at the time of recurrence and activation of infection with prostatitis in men, itchy vesicles appear on the penis, the prostate gland becomes inflamed, the composition of its secret changes, which can be detected in a laboratory study.
• Bacterial. There are infectious nonspecific, specific and polymicrobial. Infectious nonspecific is most often caused by Escherichia coli, staphylococcus, streptococcus. The pathogen joins and develops in already damaged structures of the gland, therefore it is considered a secondary factor provoking inflammation. Infectious specific prostatitis develops against the background of damage to the tissues of the gland by such pathogens as trichomonas, ureplasma, gonococcus, mycoplasma, tubercle bacillus. In polymicrobial, specific and nonspecific pathogens are combined.
• Fungal. Prostatitis of this variety is mainly caused by yeast fungi of the genus Candida, less often the gland is affected by other types of fungus – Aspergillus, Blastomycetes, Histoplasma capsulatum. A fungal infection refers to a conditionally pathogenic microflora that robs any healthy person in the body. The growth and activity of the pathogen is controlled by the immune system, but at the slightest disruption, the fungi become active, causing acute inflammation. External signs of fungal prostatitis are redness, swelling, itching, white coating on the mucous membrane of the penis.

Taking into account the nature of the course, acute and chronic infectious prostatitis are distinguished. The acute form occurs suddenly, manifests itself with characteristic clinical signs, with timely diagnosis, it can be successfully treated. Chronic infectious prostatitis can develop asymptomatically for years, destroying the structure of the gland and leading to irreversible consequences. The relapsing form cannot be completely cured, but properly selected drug therapy and compliance with the rules of prevention will help prolong remission for many years

Features of the course of the disease

Prostatitis occurring in the acute stage is characterized by a pronounced clinical picture:

• pain in the groin and lower back;
• frequent and painful urination;
• discomfort during intercourse and ejaculation;
• traces of blood in urine;
• fever;
• chills, fever, general malaise.

If treatment is not started in a timely manner, individual lobules of the prostate are affected. In advanced cases, inflammation spreads to the entire tissue of the gland, which leads to an abscess and death of the patient.

In a chronic course, periods of remission are replaced by exacerbations. At the time of relapse, the symptoms resemble an acute course:

• aching, pulling pains in the groin, radiating to the lower back, inner thigh, pubic area;
• frequent, difficult urination;
• decreased potency;
• infertility caused by a decrease in the quality of semen;
• pathological inclusions in the urine: blood, mucus, particles of pus;
• fever.

Diagnosis of infectious prostatitis

Diagnosis and treatment of infectious prostatitis is controlled by a urologist. It is to him that you need to sign up for a consultation if you are worried about suspicious symptoms. At the initial appointment, the doctor will listen to complaints, collect all the necessary information, conduct a digital rectal examination, with which you can quickly obtain information about the state of the prostate gland. If the prostate is enlarged and causes acute pain on palpation, it means that inflammation is progressing in its tissues.

To confirm the diagnosis and determine the type of infectious agent, a referral is given for an additional diagnostic examination, including the following procedures:

• general clinical analysis of urine for leukocytes, protein and bacteria;
• microscopic examination of the ejaculant;
• examination of prostate secretion, urethral swab for leukocytes and the presence of pathogens;
• cytological and bacteriological examination of a urine sample;
• determination of the level of PSA – a specific prostate protein;
• transrectal ultrasound examination;
• cystoscopy.

Based on the results of the tests, the doctor determines the diagnosis, finds out the type of infectious prostatitis, and then selects an individual treatment regimen.

Infectious prostatitis treatment – cost

The cost of treating prostatitis of an infectious nature depends on the degree of neglect of the disease, the therapeutic methods used, the presence of concomitant complications, etc. For the treatment of bacterial prostatitis, broad-spectrum antibiotics are prescribed:

• fluoroquinolones;
• macrolides;
• tetracyclines.

If inflammation of the prostate gland is caused by a fungal infection, drug therapy is based on the use of antifungal drugs:

• Fluconazole;
• “Intraconazole”;
• “Amphotericin”.

Treatment of viral prostatitis is based on the use of antiviral drugs:

• “Acyclovir”;
• “Gerpevir”;
• Zovirax.

In the treatment of all forms of infectious prostatitis, immunomodulators are necessarily prescribed, which restore the protective functions of the body and increase resistance to pathogens. To combat immunodeficiency, the following drugs are used:

• “Interferon”;
• Immunofan;
• Galavit.

Additionally, drugs of the group of non-steroidal anti-inflammatory drugs are prescribed, which have anti-inflammatory, analgesic, antipyretic properties:

• Nurofen;
• “Ibuprofen”;
• “Nimesil”.

To speed up recovery and recovery, as an addition to the main drug therapy, it is recommended to undergo a course of physiotherapy procedures, such as:

• electrophoresis;
• UHF;
• laser or magnetotherapy;
• ultrasound;
• inductothermy;
• mud baths;
• manual prostate massage;
• hirudotherapy;
• acupuncture.

After the condition is completely normal, it is important to adhere to the rules of prevention, which will help prevent re-inflammation of the prostate gland. to prevent infectious prostatitis, it is important to maintain a regular, protected sex life, treat viral and infectious diseases in a timely manner, preventing their transformation into a chronic form, maintain immunity, and lead a healthy lifestyle.

The medical center “Medline” offers a wide range of services for the treatment of acute and chronic infectious prostatitis. Our urologists will provide professional medical assistance to any man who is faced with this unpleasant disease.