Prostate bacterial infection symptoms: Prostatitis – Symptoms and causes

15.01.197616.10.2021 by alexxlab

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Types, Symptoms, Causes, Diagnosis & Treatment

Overview

Chronic Prostatitis: State-of-the-art diagnosis and treatment.

What is prostatitis?

Prostatitis refers to four different conditions that affect the prostate gland. Two types of prostatitis are linked to urinary tract infections (UTIs). Other types are not. Men with prostatitis may have infection, inflammation and/or pain. Adult men of any age can get prostatitis.

Many men who are told they have prostatitis are misdiagnosed and actually have a different condition. There’s a lot of outdated information about prostatitis. It’s important to see a healthcare provider who is up to date on the latest prostatitis research, diagnostic tests and treatments.

What is the prostate gland?

The prostate gland is part of the male reproductive system. It sits below your bladder, in front of the rectum. The urethra (tube that carries urine and semen out of the body) runs through the center of the gland.

How common is prostatitis?

Half of all men have symptoms of prostatitis at some point in their lives. It’s the most common urinary tract issue in men younger than 50. In men over 50, it’s the third most common. More than two million men see a healthcare provider every year for prostatitis symptoms.

What are the types of prostatitis?

Types of prostatitis include:

Acute bacterial prostatitis (category 1): A UTI causes an infection in the prostate gland. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires immediate medical treatment.
Chronic bacterial prostatitis (category 2): Bacteria become trapped in the prostate gland, causing recurrent UTIs that are difficult to treat.
Chronic pelvic pain syndrome, or CPPS (category 3): CPPS is the most common prostatitis type. Prostate gland inflammation occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in the pelvis, perineum (the area between the scrotum and rectum) and genitals.
Asymptomatic inflammatory prostatitis (category 4): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other problems. For example, a semen analysis for infertility may detect asymptomatic inflammatory prostatitis. This type doesn’t need treatment.

Is prostatitis a sign of prostate cancer?

Prostatitis is benign (not cancerous). It doesn’t increase your risk of prostate cancer. However, inflammation from prostatitis sometimes raises the level of prostate-specific antigens (PSA) in blood — just like prostate cancer does. Further tests can help determine what’s causing elevated PSA levels.

What are the complications of prostatitis?

Men with acute bacterial prostatitis may develop sepsis. This widespread inflammation can be life-threatening. It requires immediate medical treatment.

Antibiotics can cause an upset stomach. Men with chronic bacterial prostatitis may need lots of antibiotics to treat recurring infections. Some people develop antibiotic resistance, making treatment ineffective.

Asymptomatic inflammatory prostatitis can lower sperm count, affecting fertility.

Symptoms and Causes

What causes prostatitis?

Different types of prostatitis have different causes. Risk factors for chronic pelvic pain syndrome (CPPS), the most common type, aren’t clear. Potential contributors to CPPS include:

Autoimmune diseases.
Pelvic floor muscle spasms.
Stress.

Potential causes of bacterial forms of prostatitis include:

Bladder infections or bladder stones.
Surgery or biopsy requiring use of a urinary catheter.
Prostate stones.
Urinary retention (not emptying the bladder completely).
UTIs.

What are the symptoms of prostatitis?

Prostatitis symptoms vary depending on the type and cause. People with asymptomatic inflammatory prostatitis don’t have any symptoms.

Men with chronic pelvic pain syndrome or chronic bacterial prostatitis may experience:

Pain in the penis, testicles or perineum (area between the testicles and rectum). The pain may radiate to the lower back.
Frequent urge to urinate.
Painful urination (dysuria).
Weak urine flow or urine stream that starts and stops.
Painful ejaculation or pain during intercourse.
Blood in semen (hematospermia).
Erectile dysfunction.

Acute bacterial prostatitis causes a fever and chills.

Diagnosis and Tests

How is prostatitis diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam.

Less invasive tests for prostatitis may include:

Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to check the prostate gland for pain and swelling. This exam may include prostate massage to collect a sample of seminal fluid.
Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
Blood test: A blood test measures PSA, a protein made by the prostate gland. High levels may indicate prostatitis, BPH or prostate cancer.

More invasive tests for prostatitis include:

Cystoscopy: A cystoscopy can look for other urinary tract problems but does not diagnose prostatitis. Your provider uses a cystoscope (a pencil-sized lighted tube with a camera or viewing lens on the end) to view inside the bladder and urethra.
Transrectal ultrasound: Men with acute bacterial prostatitis or chronic bacterial prostatitis that doesn’t improve with antibiotics may get a transrectal ultrasound. A slender ultrasound probe inserted into the rectum uses sound waves to produce images of the prostate gland. This test can show prostate gland abnormalities, abscesses or stones.

Management and Treatment

How is chronic pelvic pain syndrome (CPPS) managed or treated?

Prostatitis treatments vary depending on the cause and type. Asymptomatic inflammatory prostatitis doesn’t require treatment.

For chronic pelvic pain syndrome (CPPS), your healthcare provider may use a system called UPOINT to classify symptoms into six categories. Your provider uses multiple treatments at the same time to treat only the symptoms you’re experiencing.

Approximately 80% of men with CPPS improve with the UPOINT system. The system focuses on these symptoms and treatments:

Urinary: Medications, such as tamsulosin (Flomax®) and alfuzosin (Uroxatral®), relax muscles around the prostate and bladder to improve urine flow.
Psychosocial: Stress management can help. Some men benefit from counseling or medications for anxiety, depression and catastrophizing (over-reaction to minor stresses common in people with chronic pain).
Organ: Quercetin and bee pollen supplements may relieve a swollen, inflamed prostate gland.
Infection: Antibiotics kill infection-causing bacteria.
Neurologic: Prescription pain medicines, such as amitriptyline (Elavil®) and gabapentin (Gralise®), relieve neurogenic pain. This pain can include fibromyalgia or pain that extends into the legs, arms or back.
Tenderness: Pelvic floor physical therapy may include myofascial release (gentle massage to ease tension on tight pelvic floor muscles). This therapy can reduce or eliminate muscle spasms.

How are bacterial forms of prostatitis managed or treated?

Antibiotics can kill bacteria that cause bacterial types of prostatitis. Men with acute bacterial prostatitis may need 14 to 30 days of antibiotics, starting with IV antibiotics in the hospital. Rarely, men need surgery to drain an abscess on the prostate.

Treating chronic bacterial prostatitis is challenging. You may need up to three months of antibiotics to sterilize the prostate. If the prostate can’t be sterilized, low-dose antibiotics can be used long term to prevent recurrences. Some men need surgery to remove prostate stones or scar tissue in the urethra. Rarely, surgeons remove part or all of the prostate gland (prostatectomy).

Prevention

How can I prevent prostatitis?

Prompt treatment for UTIs may keep the infection from spreading to the prostate. If you have pain in your perineum when sitting, see a provider. You can take steps to address this problem before it leads to chronic pelvic pain syndrome.

Outlook / Prognosis

What is the prognosis (outlook) for people who have prostatitis?

Antibiotics can cure acute bacterial prostatitis. These medications also ease chronic bacterial prostatitis symptoms in approximately 30% to 60% of men. Up to 80% of men with chronic pelvic pain syndrome feel better after receiving appropriate treatments for their symptoms using the UPOINT system. Men with asymptomatic inflammatory prostatitis don’t need treatment.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

Blood in your urine or semen.
Difficulty urinating.
Frequent urination (incontinence).
Pain during urination or intercourse.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

What type of prostatitis do I have?
What is the best treatment for this type of prostatitis?
What are the treatment risks and side effects?
How can I avoid getting prostatitis again?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?

A note from Cleveland Clinic

Prostatitis is a common problem that affects many men. Unfortunately, there’s a lot of confusion about the disease. People (including some healthcare providers) use the word prostatitis to describe four different conditions. There isn’t a one-size-fits-all treatment for prostatitis, which is why an accurate diagnosis is so important.

Types, Symptoms, Causes, Diagnosis & Treatment

Overview

Chronic Prostatitis: State-of-the-art diagnosis and treatment.

What is prostatitis?

What is the prostate gland?

How common is prostatitis?

What are the types of prostatitis?

Types of prostatitis include:

Acute bacterial prostatitis (category 1): A UTI causes an infection in the prostate gland. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires immediate medical treatment.
Chronic bacterial prostatitis (category 2): Bacteria become trapped in the prostate gland, causing recurrent UTIs that are difficult to treat.
Chronic pelvic pain syndrome, or CPPS (category 3): CPPS is the most common prostatitis type. Prostate gland inflammation occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in the pelvis, perineum (the area between the scrotum and rectum) and genitals.
Asymptomatic inflammatory prostatitis (category 4): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other problems. For example, a semen analysis for infertility may detect asymptomatic inflammatory prostatitis. This type doesn’t need treatment.

Is prostatitis a sign of prostate cancer?

What are the complications of prostatitis?

Men with acute bacterial prostatitis may develop sepsis. This widespread inflammation can be life-threatening. It requires immediate medical treatment.

Asymptomatic inflammatory prostatitis can lower sperm count, affecting fertility.

Symptoms and Causes

What causes prostatitis?

Different types of prostatitis have different causes. Risk factors for chronic pelvic pain syndrome (CPPS), the most common type, aren’t clear. Potential contributors to CPPS include:

Autoimmune diseases.
Pelvic floor muscle spasms.
Stress.

Potential causes of bacterial forms of prostatitis include:

Bladder infections or bladder stones.
Surgery or biopsy requiring use of a urinary catheter.
Prostate stones.
Urinary retention (not emptying the bladder completely).
UTIs.

What are the symptoms of prostatitis?

Prostatitis symptoms vary depending on the type and cause. People with asymptomatic inflammatory prostatitis don’t have any symptoms.

Men with chronic pelvic pain syndrome or chronic bacterial prostatitis may experience:

Pain in the penis, testicles or perineum (area between the testicles and rectum). The pain may radiate to the lower back.
Frequent urge to urinate.
Painful urination (dysuria).
Weak urine flow or urine stream that starts and stops.
Painful ejaculation or pain during intercourse.
Blood in semen (hematospermia).
Erectile dysfunction.

Acute bacterial prostatitis causes a fever and chills.

Diagnosis and Tests

How is prostatitis diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam.

Less invasive tests for prostatitis may include:

Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to check the prostate gland for pain and swelling. This exam may include prostate massage to collect a sample of seminal fluid.
Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
Blood test: A blood test measures PSA, a protein made by the prostate gland. High levels may indicate prostatitis, BPH or prostate cancer.

More invasive tests for prostatitis include:

Cystoscopy: A cystoscopy can look for other urinary tract problems but does not diagnose prostatitis. Your provider uses a cystoscope (a pencil-sized lighted tube with a camera or viewing lens on the end) to view inside the bladder and urethra.
Transrectal ultrasound: Men with acute bacterial prostatitis or chronic bacterial prostatitis that doesn’t improve with antibiotics may get a transrectal ultrasound. A slender ultrasound probe inserted into the rectum uses sound waves to produce images of the prostate gland. This test can show prostate gland abnormalities, abscesses or stones.

Management and Treatment

How is chronic pelvic pain syndrome (CPPS) managed or treated?

Prostatitis treatments vary depending on the cause and type. Asymptomatic inflammatory prostatitis doesn’t require treatment.

Approximately 80% of men with CPPS improve with the UPOINT system. The system focuses on these symptoms and treatments:

Urinary: Medications, such as tamsulosin (Flomax®) and alfuzosin (Uroxatral®), relax muscles around the prostate and bladder to improve urine flow.
Psychosocial: Stress management can help. Some men benefit from counseling or medications for anxiety, depression and catastrophizing (over-reaction to minor stresses common in people with chronic pain).
Organ: Quercetin and bee pollen supplements may relieve a swollen, inflamed prostate gland.
Infection: Antibiotics kill infection-causing bacteria.
Neurologic: Prescription pain medicines, such as amitriptyline (Elavil®) and gabapentin (Gralise®), relieve neurogenic pain. This pain can include fibromyalgia or pain that extends into the legs, arms or back.
Tenderness: Pelvic floor physical therapy may include myofascial release (gentle massage to ease tension on tight pelvic floor muscles). This therapy can reduce or eliminate muscle spasms.

How are bacterial forms of prostatitis managed or treated?

Prevention

How can I prevent prostatitis?

Outlook / Prognosis

What is the prognosis (outlook) for people who have prostatitis?

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

Blood in your urine or semen.
Difficulty urinating.
Frequent urination (incontinence).
Pain during urination or intercourse.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

What type of prostatitis do I have?
What is the best treatment for this type of prostatitis?
What are the treatment risks and side effects?
How can I avoid getting prostatitis again?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?

A note from Cleveland Clinic

Types, Symptoms, Causes, Diagnosis & Treatment

Overview

Chronic Prostatitis: State-of-the-art diagnosis and treatment.

What is prostatitis?

What is the prostate gland?

How common is prostatitis?

What are the types of prostatitis?

Types of prostatitis include:

Acute bacterial prostatitis (category 1): A UTI causes an infection in the prostate gland. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires immediate medical treatment.
Chronic bacterial prostatitis (category 2): Bacteria become trapped in the prostate gland, causing recurrent UTIs that are difficult to treat.
Chronic pelvic pain syndrome, or CPPS (category 3): CPPS is the most common prostatitis type. Prostate gland inflammation occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in the pelvis, perineum (the area between the scrotum and rectum) and genitals.
Asymptomatic inflammatory prostatitis (category 4): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other problems. For example, a semen analysis for infertility may detect asymptomatic inflammatory prostatitis. This type doesn’t need treatment.

Is prostatitis a sign of prostate cancer?

What are the complications of prostatitis?

Men with acute bacterial prostatitis may develop sepsis. This widespread inflammation can be life-threatening. It requires immediate medical treatment.

Asymptomatic inflammatory prostatitis can lower sperm count, affecting fertility.

Symptoms and Causes

What causes prostatitis?

Different types of prostatitis have different causes. Risk factors for chronic pelvic pain syndrome (CPPS), the most common type, aren’t clear. Potential contributors to CPPS include:

Autoimmune diseases.
Pelvic floor muscle spasms.
Stress.

Potential causes of bacterial forms of prostatitis include:

Bladder infections or bladder stones.
Surgery or biopsy requiring use of a urinary catheter.
Prostate stones.
Urinary retention (not emptying the bladder completely).
UTIs.

What are the symptoms of prostatitis?

Prostatitis symptoms vary depending on the type and cause. People with asymptomatic inflammatory prostatitis don’t have any symptoms.

Men with chronic pelvic pain syndrome or chronic bacterial prostatitis may experience:

Pain in the penis, testicles or perineum (area between the testicles and rectum). The pain may radiate to the lower back.
Frequent urge to urinate.
Painful urination (dysuria).
Weak urine flow or urine stream that starts and stops.
Painful ejaculation or pain during intercourse.
Blood in semen (hematospermia).
Erectile dysfunction.

Acute bacterial prostatitis causes a fever and chills.

Diagnosis and Tests

How is prostatitis diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam.

Less invasive tests for prostatitis may include:

Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to check the prostate gland for pain and swelling. This exam may include prostate massage to collect a sample of seminal fluid.
Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
Blood test: A blood test measures PSA, a protein made by the prostate gland. High levels may indicate prostatitis, BPH or prostate cancer.

More invasive tests for prostatitis include:

Cystoscopy: A cystoscopy can look for other urinary tract problems but does not diagnose prostatitis. Your provider uses a cystoscope (a pencil-sized lighted tube with a camera or viewing lens on the end) to view inside the bladder and urethra.
Transrectal ultrasound: Men with acute bacterial prostatitis or chronic bacterial prostatitis that doesn’t improve with antibiotics may get a transrectal ultrasound. A slender ultrasound probe inserted into the rectum uses sound waves to produce images of the prostate gland. This test can show prostate gland abnormalities, abscesses or stones.

Management and Treatment

How is chronic pelvic pain syndrome (CPPS) managed or treated?

Prostatitis treatments vary depending on the cause and type. Asymptomatic inflammatory prostatitis doesn’t require treatment.

Approximately 80% of men with CPPS improve with the UPOINT system. The system focuses on these symptoms and treatments:

Urinary: Medications, such as tamsulosin (Flomax®) and alfuzosin (Uroxatral®), relax muscles around the prostate and bladder to improve urine flow.
Psychosocial: Stress management can help. Some men benefit from counseling or medications for anxiety, depression and catastrophizing (over-reaction to minor stresses common in people with chronic pain).
Organ: Quercetin and bee pollen supplements may relieve a swollen, inflamed prostate gland.
Infection: Antibiotics kill infection-causing bacteria.
Neurologic: Prescription pain medicines, such as amitriptyline (Elavil®) and gabapentin (Gralise®), relieve neurogenic pain. This pain can include fibromyalgia or pain that extends into the legs, arms or back.
Tenderness: Pelvic floor physical therapy may include myofascial release (gentle massage to ease tension on tight pelvic floor muscles). This therapy can reduce or eliminate muscle spasms.

How are bacterial forms of prostatitis managed or treated?

Prevention

How can I prevent prostatitis?

Outlook / Prognosis

What is the prognosis (outlook) for people who have prostatitis?

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

Blood in your urine or semen.
Difficulty urinating.
Frequent urination (incontinence).
Pain during urination or intercourse.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

What type of prostatitis do I have?
What is the best treatment for this type of prostatitis?
What are the treatment risks and side effects?
How can I avoid getting prostatitis again?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?

A note from Cleveland Clinic

Urology | Prostatitis Causes & Symptoms

Prostatitis is one of the most common prostate conditions in young and middle-aged men. Prostatitis shares many of the same signs and symptoms as BPH and prostate cancer, but these are sometimes accompanied by fever, chills, lower back pain or pelvic pain, as well as discharge through the urethra. Prostatitis can come on suddenly with severe effects, or become a chronic problem with symptoms reappearing and resolving themselves at random.

What are the different types of prostatitis?

The following classifications of prostatitis are offered by the National Kidney and Urologic Disease Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

Acute bacterial prostatitis

The least common of all types of prostatitis, acute bacterial prostatitis occurs in men at any age and often with sudden and severe symptoms, most commonly difficulty or extremely painful urination. Other symptoms of acute bacterial prostatitis include fever, chills, lower back pain, pain in the perineum (genital area between the legs), frequent urination, burning during urination, and/or urinary urgency at night, coupled with aches and pains throughout the body. Acute bacterial prostatitis is easy to diagnose, so it’s important that you seek treatment promptly.

Chronic bacterial prostatitis

Fairly uncommon but difficult to treat, chronic bacterial prostatitis is a recurrent infection of the prostate with similar but less intense symptoms than acute bacterial prostatitis. Symptoms of chronic bacterial prostatitis generally last longer and often fever is absent, unlike during an acute infection.

Chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome is the most common form of the disease but also one of the least understood forms of prostatitis. Symptoms may resolve and then reappear without warning. The infection may be considered inflammatory or noninflammatory. An inflammatory infection is diagnosed when urine, semen and other secretions are absent of a known infecting organism, but do contain infection-fighting cells. Noninflammatory infections are those in which infection and infection-fighting cells are both absent.

Asymptomatic inflammatory prostatitis

Asymptomatic inflammatory prostatitis may be diagnosed when infection-fighting cells are present, but common symptoms of prostatitis, such as difficulty with urination, fever, and lower back and pelvic pain, are absent. A diagnosis of asymptomatic inflammatory prostatitis is often made during an examination for other conditions, such as infertility or prostate cancer.

What causes prostatitis?

Prostatitis is an infection that usually occurs when bacteria enters the prostatic ducts or as a result of a backward flow of infected urine.

Prostatitis is not contagious and is not considered a sexually transmitted disease, though it can result from several different sexually transmitted diseases.

Who’s at risk for prostatitis?

Although any man can develop prostatitis at any age, there are some conditions that put you at greater risk for developing this condition:

recent bladder infection, urinary tract infection or other infection elsewhere in the body
injury or trauma to the perineum (the area between the scrotum and the anus)
abnormal urinary tract anatomy
enlarged prostate
rectal intercourse
recent procedures involving the insertion of a urinary catheter or cystoscope

What Are the Signs and Symptoms of Prostatitis?

Prostatitis has a few unique signs and symptoms that differ slightly from prostate cancer and BPH. Prostatitis is sometimes accompanied by fever, chills, lower back pain or pelvic pain, as well as discharge through the urethra. Each individual’s symptoms may vary, so you should see your doctor for a proper diagnosis.

The most common symptoms of prostatitis are:

frequent and urgent need to urinate
burning sensation during urination
weak urine flow
pain or throbbing sensations in the rectal or genital area
fever and chills (usually present with an acute infection only)
lower back and/or pelvic pain
discharge through the urethra during bowel movements
sexual dysfunction and/or loss of sex drive

The symptoms of prostatitis may resemble other medical conditions or problems. Always promptly consult your doctor for a diagnosis.

Learn more about signs and symptoms of prostate conditions.

How is prostatitis diagnosed?

Due to the different types of prostatitis, effective treatment depends heavily on an accurate diagnosis. In addition to a complete medical history and physical examination, diagnostic procedures for prostatitis may include the following:

Digital rectal examination (DRE):

A procedure in your doctor inserts a gloved finger into the rectum to examine the prostate for lumps, soft spots, hard spots or other abnormalities that could be a sign of a prostate condition.
Prostate massage:

Your doctor may also perform a prostate massage to drain fluid into the urethra for analysis. Prostate massage is most commonly performed when your doctor suspects inflammation or infection usually associated with prostatitis.
Urine or sperm culture:

A urine or semen culture involves specimen collection for later lab analysis. A urine culture is often used in collaboration with prostate massage to collect urine and prostatic fluid to analyze for the presence of white blood cells and bacteria that may mean you have prostatitis.
Cystoscopy:

A cystoscopy (also called cystourethroscopy) is similar to a colonoscopy but for the urinary tract rather than the digestive tract. A cystoscopy is an examination in which a flexible tube is inserted into the bladder through the urethra, giving your your doctor an inside view of your bladder and urinary tract. A cystoscopy can detect tumors, structural abnormalities, obstructions and stones and help diagnose certain prostate conditions.

Learn more about how prostate conditions can be diagnosed

Treatment for prostatitis

Treatment varies for different types of prostatitis:

Acute bacterial prostatitis:

Treatment of acute bacterial prostatitis usually involves taking antibiotics for two to three weeks, depending on the extent of the condition. Treatment is usually effective for acute bacterial prostatitis, but it is critical to take the full course of medication to prevent the development of antibiotic-resistant bacteria even when symptoms are absent. Pain relievers may also be prescribed as needed and patients may be advised to increase fluid intake. Hospitalization may be necessary in the most severe cases.
Chronic bacterial prostatitis:

Treatment of chronic bacterial prostatitis usually involves antibiotic medication for four to 12 weeks. This type of prostatitis is difficult to treat and recurrence is possible. If the infection doesn’t respond to shorter term antibiotics, long-term, low dose antibiotics may be prescribed. Hospitalization and/or surgery may be necessary in the most severe cases.

Your doctor will also tailor your specific treatment for prostatitis based on:

your age, overall health and medical history
extent of the condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

Always consult your doctor for more information regarding the treatment of prostatitis.

Prostatitis | Prostate Cancer UK

Chronic pelvic pain syndrome (CPPS)

CPPS is the most common type of prostatitis – around 19 out of every 20 men (90 to 95 per cent) with prostatitis have it. You might also hear it called chronic non-bacterial prostatitis, chronic abacterial prostatitis or prostate pain syndrome. Chronic means long-lasting.

Men with CPPS usually have symptoms for three months or longer. Even after treatment, you may still have prostatitis for a long time. It might come and go, causing occasional episodes of severe pain, sometimes known as flare-ups.

What causes it?

Nobody knows for certain what causes CPPS. Unlike other types of prostatitis it isn’t usually caused by a bacterial infection. There could be a number of causes, which makes it difficult to diagnose and treat.

There are also a number of things that might trigger it, including:

urine getting into the prostate
previous infections in or around the prostate
an infection that doesn’t show up in tests
problems with nerves, so that they send pain signals to the brain even when there’s nothing physically wrong
stress, anxiety or depression
problems with the pelvic floor muscles (the muscles that support your bladder and bowel and help to control urination).

Some research shows a link between stress, anxiety and depression and CPPS. But this doesn’t mean that CPPS is all in your head. If you’re feeling stressed or depressed, this may cause physical symptoms that trigger CPPS, or make symptoms worse.

There’s some evidence that CPPS may be linked to other conditions such as chronic fatigue syndrome, which causes severe tiredness, and irritable bowel syndrome (IBS), which causes bowel problems.

Some men with CPPS have symptoms of these conditions too. There’s also some evidence that in a small number of men, CPPS may be caused by a sexually transmitted infection. But we need more research to know for sure.

Chronic Prostatitis | Symptoms and Treatment

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can be sudden-onset (acute) or persistent (chronic). It can also be caused by an infection (infective) or be non-infective. Less than 1 in 10 cases of prostatitis are due to bacterial infection.

For the diagnosis of chronic prostatitis, symptoms need to have been present for at least three months. In acute prostatitis, symptoms usually come on and go away much more quickly.

About 9 in 10 men with chronic prostatitis have chronic prostatitis/chronic pelvic pain syndrome (CPPS). About 1 in 10 men with chronic prostatitis have chronic bacterial prostatitis.

Symptoms

Men with chronic bacterial prostatitis tend to have symptoms that wax and wane:

During a flare-up, you can have pain and discomfort. You feel this mainly at the base of your penis, around your anus, just above your pubic bone and/or in your lower back. Pain may spread to your penis and testicles (testes). Passing stools (faeces) can be painful.
You may also have symptoms from a urine infection, such as pain when you pass urine, passing urine frequently or an urgent desire to pass urine.
These symptoms are similar to the symptoms of acute bacterial prostatitis. However, men with a flare-up of chronic bacterial prostatitis tend to be less ill than those with acute prostatitis. For example, a high temperature (fever) is less likely and you are less likely to have general aches and pains.
If you have chronic bacterial prostatitis, your symptoms will generally ease when treated with antibiotics. However, unless the antibiotics completely clear the infection from the prostate gland, you are at risk of the infection coming back (flaring up) again.
In between flare-ups, you may have some mild residual pain and some mild urinary symptoms (such as passing urine frequently or an urgent desire to pass urine).

The symptoms of chronic prostatitis/chronic pelvic pain syndrome include:

Pain – this is usually around the base of the penis, around the anus, in the lower tummy (abdomen) and in the lower back. Sometimes the pain spreads down to the tip of the penis and/or into the testicles (testes). Pain is the main symptom in chronic prostatitis. The pain may vary in severity from day to day.
Urinary symptoms – such as mild pain when you pass urine, an urgent desire to pass urine at times, some hesitancy when trying to pass urine, a poor urinary stream.
Sexual problems – you may experience difficulty in getting an erection (impotence), ejaculation may sometimes be painful and some men have worse pain (as described above) after having sex.
Other symptoms – you may feel tired and have general aches and pains.

What is the prostate gland?

Cross-section diagram of the prostate and nearby organs

The prostate gland is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut. The urethra is the tube that passes urine from the bladder and it runs through the middle of the prostate. The prostate helps to make semen but most semen is made by another gland (the seminal vesicle).

Causes

Chronic prostatitis is actually quite common. About 2 men in 10 will have chronic prostatitis at some point during their lives. Chronic prostatitis most commonly affects men between the ages of 30-50 but men of any age can be affected.

What causes chronic bacterial prostatitis?

Chronic bacterial prostatitis is a type of infective prostatitis. It is caused by a persistent (chronic) infection with a germ (a bacterial infection) of the prostate gland. A man with chronic bacterial prostatitis will usually have had recurring urine infections. Chronic bacterial prostatitis is usually caused by the same type of germs (bacteria) that causes the urine infections. The prostate gland can harbour infection and therefore recurring infections can occur. Chronic bacterial prostatitis is not a sexually transmitted infection.

What causes chronic prostatitis/chronic pelvic pain syndrome (CPPS)?

Chronic prostatitis/CPPS is a persistent (chronic) discomfort or pain that you feel in your lower pelvic region – mainly at the base of your penis and around your anus. It is usually diagnosed if you have had pain for at least three months within the previous six months. The cause of this type of chronic prostatitis is not fully understood.

Diagnosis

Examination of your prostate gland. Your doctor may examine your prostate gland, using a gloved finger in your back passage (rectum). Your prostate gland may be tender on examination in chronic prostatitis. However, this is not so in every case.
A urine sample is usually taken to rule out urine infection. This is especially important for chronic bacterial prostatitis although, in between flare-ups, there may be no signs of infection.
Further tests of your kidneys and urinary tract. If your doctor suspects that you have chronic bacterial prostatitis, they may suggest that you have further tests to rule out any problem with your urinary tract that may have contributed to (or caused) the infection. For example, an ultrasound scan of your kidneys to look for any abnormalities.
Tests to exclude other causes for your symptoms, including:
- Some swab or urine tests to exclude a sexually transmitted infection which can produce similar symptoms to chronic prostatitis. Note that chronic prostatitis is not a sexually transmitted infection itself.
- Other tests may be advised to rule out other conditions of your prostate or nearby organs if your symptoms are not typical. For example, sometimes your doctor may suggest a blood test to exclude other problems with your prostate gland.

If your doctor suspects that you have chronic prostatitis, they may refer you to a specialist (usually a urologist) for further assessment. If you are referred to a specialist, a sample of fluid (‘secretions’) from the prostate may be collected to rule out infection in your prostate. To do this, a doctor can gently massage your prostate, with a gloved finger in your rectum. By doing this, fluid from the prostate is pushed out into the urethra and comes out from the penis to be collected and tested for germs (bacteria). If you have CPPS, no bacteria are found in the prostate fluid or urine.

Treatment

The treatment of chronic prostatitis can be difficult. However, in most people, symptoms improve over months or years.

If your GP suspects that you have chronic prostatitis, as mentioned above, they will usually refer you to a specialist for further assessment. In the meantime, your GP may suggest one or more of the following whilst you are waiting for your appointment with a specialist:

Painkillers such as paracetamol or ibuprofen may ease the pain.
Laxatives may be helpful if it is painful or difficult to pass stools.
Antibiotics are recommended if your doctor thinks you have chronic bacterial prostatitis. The antibiotic course should last for 2-4 weeks. Antibiotics are usually advised if you have had a urinary tract infection or an episode of acute prostatitis within the previous year. This is to be absolutely sure that no infection is present.

Reassurance and explanation are also sometimes helpful. Some people worry that they may have a serious disease such as prostate cancer. Worry and anxiety can make symptoms worse. Therefore, it may be useful to know that you have chronic prostatitis and not some other disease. However, you will have to accept that pain or discomfort are likely to continue for some time.

Treatments that a specialist may suggest

Various treatments have been tried for chronic prostatitis. They may benefit some people but so far there are few research studies to confirm whether they help in most cases. They are not ‘standard’ or routine treatments but a specialist may advise that you try one.

For chronic bacterial prostatitis, possible treatments may include the following:

A longer course of antibiotics. If the specialist suspects that you have chronic bacterial prostatitis and your symptoms have not cleared after a four-week course of antibiotics, they may suggest a longer course. Sometimes a course of up to three months is used.
Removal of the prostate (prostatectomy) may be considered if you have small stones (calculi) in the prostate. It is not clear how much this may help but it has been suggested that these small stones may be a reason why some people have recurrent infections in chronic bacterial prostatitis. However, this is not commonly carried out and is not suitable in everyone. Your specialist will advise.

For chronic prostatitis/CPPS, possible treatments may include the following:

Antibiotics – these may be tried initially, although the evidence for their effectiveness is limited. It may be that some antibiotics have anti-inflammatory properties as well or that they may clear some germs (bacteria) that are difficult to find when your urine is tested.
Alpha-blockers – are medicines that are used to treat prostate gland enlargement. They relax the muscle tissue of the prostate and the outlet of the bladder. There are several different brands. There is some evidence that they help in CPPS and one may be worth a try.
Other medicines – for example, bioflavonoids (such as quercetin) and finasteride (a medicine which may ‘shrink’ the prostate).
Stress management – this and other pain-relieving techniques are sometimes tried to help cope with the persistent pain.

What is the outlook?

It is difficult to give an outlook (prognosis). Your symptoms may last a long time, although they may ‘come and go’ or vary in severity. Painkillers can keep discomfort to a minimum.

Most men diagnosed with chronic prostatitis/CPPS tend to have an improvement in their symptoms over the following six months. In one study, about a third of men had no further symptoms one year later. In another large study, one third of men showed moderate to marked improvement over two years.

Treatment of Bacterial Prostatitis | Clinical Infectious Diseases

Abstract

Prostatitis is characterized by voiding symptoms and genitourinary pain and is sometimes associated with sexual dysfunction. Up to 25% of men receive a diagnosis of prostatitis in their lifetime, but <10% have a proven bacterial infection. The causes and treatment of nonbacterial prostatitis are largely unknown, but bacterial prostatitis is caused by infection with uropathogens, especially gram-negative bacilli, although infection is sometimes due to gram-positive and atypical microorganisms. Acute bacterial prostatitis is easily diagnosed (by abrupt urogential and often systemic symptoms, along with bacteriuria) and treated (by systemic antibiotic therapy). Chronic bacterial prostatitis is characterized by prolonged or recurrent symptoms and relapsing bacteriuria; diagnosis traditionally requires comparing urinary specimens obtained before with specimens obtained after prostatic massage. Treating chronic bacterial prostatitis requires prolonged therapy with an antibiotic that penetrates the prostate (ie, one with high lipid solubility, a low degree of ionization, high dissociation constant, low protein binding, and small molecular size). We review recent pharmacological and clinical data on treating bacterial prostatitis.

Prostatitis is a common syndrome that usually presents with voiding symptoms (irritative or obstructive) and pain (genitourinary, pelvic, or rectal) and is sometimes associated with sexual dysfunction (eg, ejaculatory discomfort and hematospermia). Characteristic features include a high prevalence, substantially impaired quality of life, and frequent recurrences [1]. Although some cases are clearly infectious, most men who receive a diagnosis of prostatitis have no evidence of a genitourinary bacterial infection and the cause is usually unknown [2]. Disagreement persists over how to define prostatitis, including debates over the relative importance of various clinical, microbiological, and histopathological findings [3]. Advances in the past decade, however, have spurred better-designed clinical trials and generated more robust evidence regarding treatment.

One major change was the development of a National Institutes of Health (NIH) consensus definition and classification system (Table 1) [4, 5]. This scheme, although limited by the lack of a reliable comparison standard, clarified that a small minority of men with prostatitis have bacterial infection (ie, acute bacterial prostatitis [ABP; category I] or chronic bacterial prostatitis [CBP; category II]) [6]. The rest have nonbacterial prostatitis. If symptomatic, they have chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS)—either IIIA, which is an inflammatory condition defined by leukocytes in the semen or postprostatic massage specimens, or IIIB, which is a noninflammatory disorder. A new syndrome, asymptomatic inflammatory prostatitis (category IV), is defined by an abnormal semen analysis, elevated prostate-specific antigen (PSA), or incidental findings of prostatitis on examination of a biopsy specimen. The second advance was developing and validating an NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) [7]. This questionnaire scores disorders relating to pain, voiding, and quality of life. The maximum total score is 43, and a decrease of 4–6 points (or 25%) correlates with clinically significant improvement [8]. The NIH-CPSI has proved to be useful for epidemiological studies and for assessment of patients over time [9].

The greatest area of uncertainty in treating prostatitis concerns the approach to nonbacterial prostatitis. This review, however, will focus on treatment of bacterial prostatitis and will only briefly discuss nontreatment issues or nonbacterial disorders. Because of the familiarity of the prostatitis categories, we will generally refer to them by their classical (rather than NIH) designations. Our recommendations are derived from a comprehensive review of the literature and our combined clinical experience.

Epidemiology

Prostatitis is the most common urological diagnosis in men <50 years of age and is the third most common diagnosis among those 150 years of age [10]. Approximately 10% of men have chronic prostatitis-like symptoms; of these men, ∼60% have sought medical help [1, 11]. The lifetime probability of a man receiving a diagnosis of prostatitis is >25% [12, 13], and prostatitis accounts for ∼25% of men’s office visits for genitourinary complaints [14]. Reported rates of prostatitis are similar in North America, Europe, and Asia [15]. In addition to discomfort, prostatitis syndromes are responsible for substantial physical and emotional distress [16, 17] and financial costs [14].

Pathophysiology

The prostate gland has several natural defenses against infection, including the production of antibacterial substances and mechanical flushing of the prostatic urethra by voiding and ejaculation [18]. However, poor drainage of secretions from peripheral ducts or reflux of urine into prostatic tissue may lead to inflammation, fibrosis, or stones. Most bacterial prostatitis probably follows a urinary tract infection (UTI), especially with uropathogens that demonstrate special virulence factors [19]. Risk factors for developing prostate infection include urinary tract instrumentation, having a urethral stricture, or urethritis (usually due to sexually transmitted pathogens).

ABP, which accounts for <1% of cases of prostatitis, is likely caused by infected urine ascending the urethra to intraprostatic ducts. The 10% of cases that follow genitourinary instrumentation generally occur in older patients, have a higher risk of recurrence or prostatic abscess, and are more often caused by non-Escherichia coli species [20]. Despite antibiotic prophylaxis, ∼2% of men develop ABP after transrectal prostate biopsy, especially after repeat procedures [21]. CBP complicates a minority of cases of ABP and often occurs without a previous acute infection. The formation of either bacterial biofilm or prostatic calculi favors chronic, treatment-resistant infection [22]. Histopathological findings in bacterial prostatitis are poorly defined, with infection primarily in the acinar rather than the interstitial spaces [22] and primarily luminal rather than parenchymal.

Clinical Presentation and Diagnostic Evaluation

ABP typically presents abruptly with voiding symptoms and distressing but poorly localized pain and is often associated with systemic findings (eg, malaise and fever) [5]. Clinicians should enquire about urogenital disorders, recent genitourinary instrumentation, and new sexual contacts. Only ∼5% of men with ABP develop CBP, and ∼2% develop a prostatic abscess. CBP usually presents with more-prolonged (⩾3 months) urogenital symptoms. The hallmark is relapsing UTI (ie, UTIs due to the same organism), but <50% of patients with CBP have this history [23]. Between symptomatic UTIs, patients may be asymptomatic, despite ongoing prostatic infection.

Physical examination should include obtaining vital signs and examining the lower abdomen (seeking a distended bladder), back (seeking costovertebral-angle tenderness), genitalia, and rectum. Digital prostate palpation in ABP can cause discomfort and can potentially induce bacteremia but is safe if done gently. In ABP, the gland is typically tender, swollen, and warm, whereas in CBP, there may be some tenderness, softening (“boggyness”), firm induration, or nodularity.

Few laboratory tests are diagnostically useful in evaluating possible prostatitis. Any patient at risk should be screened for sexually transmitted infections. All patients with possible prostatitis need a urinalysis and urine culture. Urine dipstick testing (for nitrites and leukocytes) in ABP has a positive predictive value of ∼95%, but a negative predictive value of only ∼70% [24]. Blood cultures and a complete blood count are useful in ABP. For patients with possible CBP, the 4-glass test is considered to be the diagnostic criterion standard. Diagnosis is based on finding substantially lower leukocyte and bacterial counts in voided bladder urine specimens from the urethra (VB1) and bladder (VB2), compared with counts in post-prostatic massage voided urine (VB3) or expressed prostatic secretions (EPS). Adding a culture of ejaculated semen improves the diagnostic utility of the 4-glass test [25, 26], but semen cultures are positive more often than are cultures of VB3 or EPS in men with nonbacterial prostatitis [27]. The 4-glass test is cumbersome, inadequately validated, and rarely performed, even by urologists [28, 29]. It may be diagnostically helpful on first presentation, but its value is limited in previously treated patients with chronic symptoms. A simpler 2-glass test (comparing pre- with post-prostatic massage urine specimens) provides similar results [30]. Leukocyte counts in expressed prostatic secretions do not correlate with the severity of symptoms in men with CP/CPPS [31].

Evaluating patients with chronic prostatitis should usually include administering the NIH-CPSI and perhaps measuring urinary flow rate and post-void residual urine; only selected patients need further urodynamic or imaging studies [32]. Culturing prostatic tissue obtained by biopsy is neither sensitive (because infection is focal) nor specific (because ∼25% of prostatectomy specimens are culture positive) [33]. PSA levels are elevated in ∼60% of men with ABP, 20% of men with CBP, and 10% of men with nonbacterial prostatitis [34]; a decrease after antibiotic therapy (which occurs in ∼40% of patients) correlates with clinical and microbiological improvement [35]. Various imaging studies can detect a suspected prostatic abscess. Figure 1 shows our approach to evaluating a patient with possible prostatitis.

Causative Pathogens in Prostatitis

Aerobic gram-negative bacilli are the predominant pathogens in bacterial prostatitis. E. coli cause 50%–80% of cases; other pathogens include Enterobacteriaceae (eg, Klebsiella and Proteus, which account for 10%–30% of cases), Enterococcus species (5%–10% of cases), and nonfermenting gram-negative bacilli (eg, Pseudomonas species; <5% of cases). Some debate the role of gram-positive organisms other than enterococci [36, 37], but most accept Staphylococcus and Streptococcus species as pathogens [37–39]. The increasing prevalence of gram-positive pathogens may represent changing disease epidemiology (perhaps related to fluoroquinolone therapy) or acceptance of their pathogenicity by health care providers. Limited data suggest that obligate anaerobes may rarely cause chronic prostatitis [40].

Some cases of prostatitis are caused by atypical pathogens [34]. A large prospective study of men with chronic prostatitis found that 74% had an infectious etiology; the most common isolates were Chlamydia trachomatis (37% of cases) and Trichomonas vaginalis (11%), whereas 5% of patients had infection due to Ureaplasma urealyticum [41]. Classical bacterial uropathogens were found in 20% of patients, and more patients with these pathogens, compared with patients with nonbacterial pathogens, had prostatic specimens with leukocytes [41]. Other possible prostatitis pathogens include Mycoplasma genitalium, Neisseria gonorrhoeae, Mycobacterium tuberculosis, various fungi, and several viruses [34].

Treatment of Bacterial Prostatitis

The approach to treating bacterial infection of the prostate largely centers on appropriately selected antibiotic therapy. The best approach to treating nonbacterial prostatitis (NIH categories III and IV) is less clear.

Overview of antibiotic therapy. Treatment of bacterial prostatitis is hampered by the lack of an active antibiotic transport mechanism and the relatively poor penetration of most antibiotics into infected prostate tissue and fluids. Most antibiotics are either weak acids or bases that ionize in biological fluids, which inhibits their crossing prostatic epithelium (Figure 2) [23]. Only free, non-protein-bound antibiotic molecules enter tissues. Ordinarily, substances with molecular weights of <1000 pass through openings (fenestrae) between capillary endothelial cells, but prostate capillaries are nonporous. Passage of a drug through prostatic capillary endothelium and prostatic epithelium is enhanced by a high concentration gradient, high lipid solubility, low degree of ionization, high dissociation constant (pKa; allowing diffusion of the unionized component into the prostate), low protein binding, and small molecular size [42]. A pH gradient allows electrically neutral molecules to pass through membranes, become ionized, and be trapped. Although ion trapping may increase prostatic drug concentration, the charged fraction has an unclear antimicrobial role. Fluoroquinolones are zwitterions that have a different pKa in an acidic versus an alkaline milieu, allowing concentrations in the prostate to be 10%–50% of concentrations in serum [43].

Normal human prostatic fluid has a pH of ∼7.3; in individuals with CBP, the prostatic fluid may become markedly alkaline (mean pH, 8.34) [44]. Many early studies of prostatic antibiotic penetration used dogs, which generally have acidic prostatic fluid. Human studies have mostly used adenoma tissue derived from prostate resection. These uninfected samples of mixed tissues and fluids with varied pH levels generally have antibiotic concentrations that exceed those in plasma. In humans, alkaline drugs (eg, trimethoprim and clindamycin) undergo ion trapping, which leads to high prostatic concentrations. Acidic drugs, such as beta-lactams, achieve lower levels, but more drug is in the active unionized state.

Fluoroquinolones have emerged as the preferred antibiotics for treating bacterial prostatitis, and several have been approved by the US Food and Drug Administration (FDA) for this indication. Compared with concentrations in plasma, drug levels are generally higher in urine, similar in seminal fluid and prostatic tissue, and lower (albeit therapeutic) in prostatic fluid [43, 44]. One concern with these agents is the growing problem of fluoroquinolone resistance, which generally requires treatment with a third-generation cephalosporin (eg, ceftazidime or ceftriaxone) or a carbapenem (eg, imipenem or ertapenem) [45]. Table 2 provides information on other antibiotics that may be useful for treating bacterial prostatitis, based on pharmacodynamic data, case reports, or FDA approval for treating UTIs.

Although penicillin G achieves poor prostatic concentrations, piperacillin has good levels and has been used successfully to treat CBP. Cephalosporins, despite being weak acids with low lipid solubility, can attain therapeutic levels in prostatic fluid or tissue (Table 2). Aztreonam, imipenem, and some aminoglycosides can attain levels in prostatic tissue that exceed the minimum inhibitory concentrations of most Enterobacteriaceae. Prostatic concentrations of minocycline and doxycycline are at least 40% of the corresponding serum concentrations. Erythromycin—and probably other macrolides, as well—can develop high prostate concentrations. Clindamycin and trimethoprim readily enter prostatic fluid, and levels of these drugs in prostatic fluid may exceed levels in plasma. The prostatic concentration of sulfamethoxazole is much lower, raising doubts that it synergizes with trimethoprim. Nitrofurantoin prostatic levels are likely nontherapeutic. Table 3 outlines the advantages and disadvantages of commonly used antimicrobial agents for the treatment of CBP.

Antibiotic therapy for ABP. For systemically ill patients with ABP, parenteral antibiotic therapy is preferable, at least initially. Most antibiotic agents penetrate the acutely inflamed prostate, but experience favors empirical treatment with a broad-spectrum beta-lactam drug—either a penicillin (eg, piperacillin- tazobactam) or a cephalosporin (eg, cefotaxime or ceftazidime)—perhaps combined with an aminoglycoside for patients who are severely ill or who have recently received antibiotic therapy. Clinicians should consider local drug-resistance patterns in choosing antibiotics, especially with the emergence of extended-spectrum beta-lactamase-producing strains in complicated UTIs [21], and should adjust therapy on the basis of culture results. Clinically stable patients may be treated with oral therapy (usually a fluoroquinolone). Duration of therapy for ABP is usually 2 weeks, although it can be continued for up to 4 weeks for severe illness or treatment of patients with concomitant bacteremia.

Two recent studies provide insights on treating ABP. A multicenter retrospective survey revealed that community -acquired infections were 3 times more common than nosocomial infections; E. coli remained the predominant pathogen, but nosocomial infections were more often caused by Pseudomonas aeruginosa, enterococci, or Staphylococcus aureus, and these organisms were associated with higher microbiological and clinical failure rates [46]. A similar study found a high rate of ciprofloxacin- resistant pathogens and that nosocomial acquisition or prior instrumentation were associated with increased antibiotic resistance and higher rates of clinical failure [47]. Ancillary measures for ABP include ensuring adequate fluid intake and urinary drainage.

Antibiotic therapy for CBP (category II) or inflammatory nonbacterial (category IIIA) prostatitis. CBP should be treated with 4–6 weeks of antibiotic therapy. When persistent infection is caused by infected prostate stones or other types of genitourinary pathology, patients who have shown some response may benefit from more-prolonged antibiotic therapy [48]. In contrast with treatment of ABP, treatment of CBP can usually be delayed until culture and susceptibility results are available. Fluoroquinolones are the preferred drugs, except when resistance to these agents is confirmed or strongly suspected. Overall rates of clinical and microbiological response for CBP treated with fluoroquinolones are 70%–90% at the end of therapy, but only ∼60% after 6 months [38]. Clinical and microbiological response rates are similar in those whose prostatic specimens grow either well-accepted uropathogens or coagulase-negative Staphylococcus or Streptococcus species [39]. Giving repeated courses of antibiotics is generally unwise. Surgically removing infected prostatic stones may help when other measures fail. Some case reports suggest apparent benefit from direct injection of antimicrobials into the prostate, but the evidence is insufficient to recommend this approach. Long-term suppressive therapy with low doses of oral antibiotics (eg, trimethoprim- sufamethoxazole) may reduce symptomatic recurrences, but evidence is lacking.

Although <10% of men who receive a diagnosis of prostatitis have a proven bacterial infection, approximately one-half are treated with antibiotic therapy [49]. Clinicians often treat nonbacterial prostatitis because of concern over missing infections that are due to pathogens that are difficult to culture, and because many apparently uninfected patients appear to respond to treatment. Most treatment studies have been poorly designed, but several, including randomized controlled trials, note improved symptoms in ∼50% of patients with CP/CPPS treated with a fluoroquinolone [50]. In one study, however, patients with CP/ CPPS who had received multiple prior treatments (including treatment with antimicrobials) had similar symptom response rates (20%–30%) after 6 weeks of therapy with either fluoroquinolones or placebo [23]. In the subset of patients who had been symptomatic for a shorter duration and had not recently received antibiotics, the response rate was as high as 75% [23]. One prospective study involving men with CP/CPPS found that the percentage of patients who responded to antibiotic therapy was similar for those with and those without bacterial prostatitis [3]. This may be at least partly related to the fact that some antibiotics (eg, macrolides and tetracyclines) have direct antiinflammatory effects.

There is no validated test of cure for bacterial prostatitis. If the patient’s symptoms resolve after therapy, we would usually not treat asymptomatic bacteriuria, if present. If symptoms that are thought to be related to prostatitis persist, culture-directed antibiotic therapy with a more prolonged course, higher dosage, or different agent should be considered.

To interrogate the literature on the possible value of antibiotic therapy for chronic prostatitis (bacterial or presumed nonbacterial), we identified studies published in the previous decade that reported rates of either symptom improvement or microbiological eradication (Table 4). All but 1 of the studies used an oral fluoroquinolone for treatment of at least some of the patients, and the duration of therapy was typically ∼4 weeks; the comparator arms varied. In all 8 trials involving patients with CBP, the patients experienced significant symptomatic and microbiological improvement (usually defined by improved prostate symptom scores and infection eradication) with antibiotic therapy. Of the 5 trials that involved patients with CP/ CPPS treated with antibiotics, 2 showed no advantage for fluoroquinolone therapy over placebo. Thus, these studies show clear benefit from fluoroquinolone therapy for CBP but not for CP/CPPS.

Older studies have shown that longer (⩾6 weeks) duration of therapy with trimethoprim-sulfamethoxazole for probable CBP is more effective than a shorter duration of therapy. Outcomes in treating CBP with trimethoprim-sulfamethoxazole, however, are not as good as those with fluoroquinolones [51]. Our recommendations for treatment of ABP and CPS are shown in Table 5. A single, limited (<6-week) course of antibiotic therapy may be appropriate for some patients with CP/ CPPS patients but repeated courses are not.

Because antibiotics are not helpful for most cases of nonbacterial prostatitis, many nonantibiotic agents and procedures have been recommended, most of which are inadequately studied. Recently published expert recommendations, based on data from prospectively designed, randomized, placebo-controlled trials that enrolled a well-defined population of men with CP/ CPPS and employed the NIH-CPSI, offer some guidance [50]. Adding an alpha blocker to antibiotic therapy appears to improve symptomatic outcomes, especially for patients with newly diagnosed disease and patients who are alpha blocker naive [52], but there is no support for 5-alpha reductase inhibitor therapy. Anti-inflammatory drugs are rarely effective alone but may help some patients as part of multi-modal therapy. There is no definitive evidence of efficacy for most other conventional or alternative medications [52]. Few controlled trials support various non-pharmacological treatments, such as repetitive prostatic massage, physical therapy, acupuncture, biofeedback, or local heat [53]. In a well-designed systematic study, no more than one-third of patients with CP/CPPS had even modest improvement during 1 year of follow-up [54]. Finally, no surgical procedure, whether minimally invasive or more extensive, has proven to be effective for treating prostatitis [53].

Conclusions

Considering the high prevalence of symptoms attributed to prostatitis and the many studies conducted during the past 50 years that have attempted to define its causes and optimal treatments, it is surprising how little we know about this syndrome. Although bacterial prostatitis constitutes a small minority of cases, we now have good data on the causative pathogens and a better understanding of the most appropriate antimicrobial treatment regimens. Fluoroquinolones are currently the major weapon in our therapeutic arsenal, but growing resistance to these agents will require that we find others that adequately penetrate the prostate (and are perhaps active in the presence of biofilm) to effectively treat CBP. Moving this “stuck” field forward will require developing accurate diagnostic tests to differentiate bacterial prostatitis from nonbacterial syndromes and new antimicrobials that demonstrate efficacy in properly designed clinical trials.

Acknowledgments

Potential conflicts of interest. B.A.L. has received research funding from Merck and Pfizer and has served as a consultant to Pfizer, Ortho- McNeil, Cubist, and Wyeth-Ayerst. I.B. has received honoraria for serving on advisory boards from Pfizer and has received lecture fees from Pfizer and Nordic Pharma. C.T.H.: no conflicts.

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Figures and Tables

Figure 1.

Diagnostic algorithm for evaluating patient with possible prostatitis. CP/CPPS, chronic prostatitis/chronic pelvic pain syndrome; CT, computed tomography; MRI, magnetic resonance imaging; NIH-CPSI, National Institutes of Health Chronic Prostatitis Symptom Index.

Figure 1.

Figure 2.

Illustration of ion trapping of antibiotics within prostatic tissue. Prostatic fluid is separated from capillary blood by the lipid-containing biologic membranes of the capillary endothelium and the cuboidal prostatic epithelial cells. Prostatic capillary endothelial cells lack secretory and active transport mechanisms, and they form tight intracellular junctions, preventing the passive diffusion of small molecules through intercellular gaps. Most antibiotics are either weak acids or bases that ionize in biological fluids. Lipid-soluble, uncharged antibiotics (AbH) can passively diffuse across these membranes and the prostatic interstitium, thus tending toward equal concentrations in each compartment. Acidic or basic drugs are also in equilibrium with their electrically charged dissociated forms (Ab⁻), but the charged forms are unable to pass through the membranes. The extent of dissociation of a drug is governed by its pKa and the pH of its local environment. Weakly acidic antibiotics dissociate to a greater degree in the alkaline environment of the chronically infected prostatic fluid (pH 8.3) than in the plasma (pH 7.4), leading to an increased total drug concentration (AbH + Ab⁻) within prostatic fluid relative to the plasma.

Figure 2.

Table 1.

Classification of Prostatitis According to Classical and Newer National Institutes of Health (NIH) Categories Based on Prostatic Localization Studies for White Blood Cells (WBC) and Bacteria

Table 1.

Classification of Prostatitis According to Classical and Newer National Institutes of Health (NIH) Categories Based on Prostatic Localization Studies for White Blood Cells (WBC) and Bacteria

Table 2.

Antibiotics with Pharmacological Data, Clinical Case Report(s), or a License to Support Their Use for Treatment of Bacterial Prostatitis

Table 2.

Antibiotics with Pharmacological Data, Clinical Case Report(s), or a License to Support Their Use for Treatment of Bacterial Prostatitis

Table 3.

Selecting an Antibiotic for Treatment of Chronic Bacterial Prostatitis

Table 3.

Selecting an Antibiotic for Treatment of Chronic Bacterial Prostatitis

Table 4.

Antibiotic Treatment Trials of Chronic Prostatitis, 1999–2009

Table 4.

Antibiotic Treatment Trials of Chronic Prostatitis, 1999–2009

Table 5.

Recommended Antibiotic Therapy for Various Types of Bacterial Prostatitis

Table 5.

Recommended Antibiotic Therapy for Various Types of Bacterial Prostatitis

90,000 Prostatitis. Causes, diagnosis, treatment – Articles

One of the most common diseases among men tells the urologist V.V. Opalev

Disease PROSTATITIS is diagnosed in more than 80% of sexually mature men, of which about 30% is detected in the age group from 20 to 40 years. If we refer to statistical studies, then we can say that prostatitis is detected in every 10 patients

Prostatitis is an inflammation of the prostate gland called the prostate.The prostate gland is a minor part of the male reproductive organs. It is located under the bladder, around its neck. The fact is that the urethra passes through the prostate, that is, the prostate is located around the urinary tube. As a result of this, with an enlarged prostate, the urinary canal is compressed, which interferes with the passage of urine.

In men over 35, the prostate is often enlarged. This is a typical occurrence. Most of the diseases in men over 50 are just a consequence of a malfunction of the genitourinary system, that is, as a result of inflammation of the prostate gland.It must be remembered that the more prostate gland, the more urine will be blocked, thereby the body will be more and more poisoned by this urine

Causes of prostatitis:

The main cause of prostatitis is an impaired blood circulation, which leads to an enlarged prostate. The cause of impaired blood circulation is a sedentary lifestyle, as well as high weight.
Bacterial prostate inflammation, STD
Injuries to organs and soft tissues of the small pelvis, impaired blood circulation are often the cause of prostatitis.As a rule, most of all this concerns drivers, whose work is associated with occupational hazards – constant vibrations, shaking, increased load on the muscles of the perineum.
Frequent hypothermia and low physical activity, the presence of chronic diseases of the genitourinary sphere or hormonal imbalance, urinary retention and irregular sexual activity also contribute to the development of the disease.

The presence of inflammation in the rectum or urethra often causes a secondary infection of the prostate gland – in an ascending pattern, if microbes rise up from the external urethral canal, or in a descending pattern, when microbes enter the prostate from infected urine.
Chronic constipation is also a predisposing factor for the development of prostatitis. Constant stool disturbances can lead to inflammation in the prostate.
The immune system plays an important role in the development of this disease. Due to bad habits, emotional experiences, malnutrition, physical overwork, immunity weakens, and the human body becomes vulnerable to infectious pathogens of various kinds, including those that cause inflammation of the prostate gland.

So, if you add up what has been said:

What is prostatitis? is an infectious or non-infectious inflammation of the prostate gland (or prostate gland). Only men have a prostate. It was created in order to produce fluid that men secrete during sex. The gland looks like a ring (about 3 cm in diameter) that is located around the urethra (the tube that draws urine from the bladder through the penis to the outside) and is located just below the bladder.

What causes prostatitis? – Prostatitis can be acute or chronic. Acute prostatitis is usually associated with bacterial inflammation, while chronic prostatitis can occur without a bacterial infection.

What are the symptoms of prostatitis? – Symptoms vary depending on the form.

▪️Men with acute prostatitis usually complain about:
– Fever
– Chills
– Intoxication (lethargy, weakness, malaise)
– Muscle pain
– Pain when urinating
– Groin pain
– Cloudy urine

▪️ Men 90,033 with chronic prostatitis sometimes have no symptoms at all.Sometimes they have the following:

– Pain when urinating
– Feeling that they often go to the toilet
– Sudden feeling that you really want to write (with an emphasis on and)
– Groin pain
– A slight increase in temperature (up to 38 degrees).

Should I see a doctor with these symptoms? – Mandatory if you have:
– Severe groin pain
– Problems with urination
– Fever or chills

What tests need to be taken to confirm the diagnosis? – There is an analysis of the secretion of the prostate gland, however, but not perfect.They pass it in the following way: the doctor performs a massage of the prostate gland through the rectum, stimulating the production of secretions that come out directly from the penis and are collected from a sterile tube. If secretion does not occur, then the patient is asked to urinate and the primary urine is collected. Unfortunately, this analysis does not always reveal the disease. It will also be important to do an ultrasound of the prostate gland to exclude adenoma (benign tumor) of the prostate.

How is prostatitis treated? – Antibiotics are mainly prescribed.The right antibiotic depends on the type of prostatitis and the bacteria (if any) that are causing it. If the effect of antibiotics is observed within 24-48 hours (in the form of a decrease in temperature, an improvement in well-being), then this means that it has approached, after which it must be taken for 6 weeks in order to surely destroy the pathogen; if there is no effect from antibiotics after 48 hours from the moment of appointment, it is changed to another one. If antibiotics do not help, the patient is likely to have chronic prostatitis without a bacterial infection.In this case, other treatments are used, such as physiotherapy, prostate massage, and lifestyle changes.

At the TERVE clinic we offer the following programs for the diagnosis and treatment of chronic prostatitis, erectile dysfunction

Complex of examination “Men’s health”

Consultation and examination of a urologist
TRUS of the prostate
(PSA) general
General urinalysis
Prostate secretion analysis

Treatment of chronic prostatitis and erectile dysfunction

Vacuum therapy (AIR)
Thermotherapy and Magnetic Therapy (INTRAMAG)
Prostate massage
Electrostimulation and electrophoresis

90 097 90 000 Only for men: just about prostatitis

There are many pseudo-medical speculations and contentious myths around prostatitis, which are primarily associated with misconceptions about the cause of this disease.

Three myths about prostatitis

Prostatitis is known to be classified as follows:

Type I – acute bacterial prostatitis

Type II – chronic bacterial prostatitis

Type III – chronic nonbacterial prostatitis (chronic pelvic pain syndrome)

Type IV – asymptomatic inflammatory prostatitis

Myth # 1 is a common misconception that most chronic prostatitis is directly caused by infection, and therefore, with any exacerbation, some urologists prescribe expensive tests to expose malicious bacteria, followed by the appointment of shock doses of antibacterial drugs.

In fact, bacteria are responsible for only 5-10% of cases. Whereas the lion’s share of prostatitis (chronic pelvic pain syndrome) is due to other reasons: autoimmune, chemical irritation due to urine flow into the prostate, psychosomatic, etc., and in practice, in most cases, these reasons cannot be identified in each individual case.

Myth No. 2 says that bacterial prostatitis is caused by ureaplasmas, mycoplasmas, Trichomonas, chlamydia – in general, a set of sexually transmitted infections that are preferred for urological examination.

In reality, these infections never cause bacterial prostatitis. Along with others, there are theories that the listed genital infections can trigger inflammatory types of chronic pelvic pain, along with viruses, anaerobic bacteria, certain staphylococci, etc., however, studies have clearly shown that their direct role in maintaining the pathological process is not, and therefore no antibiotics are recommended for chronic pelvic pain.

Despite this, many doctors, and not only Russian ones, continue to ignore the data of evidence-based studies and prescribe antibacterial drugs to most of their patients.

As for 5-10% of prostatitis, which are actually caused by bacteria, almost all of them are caused by the introduction of intestinal microflora into the prostate gland. In most cases (80%), E. coli is the culprit for bacterial prostatitis.

This bacterium has evolved with us in such a way that it has learned to prosper not only in the composition of the normal intestinal flora, but also in the urinary tract, where in some genetically susceptible individuals it can behave in no way friendly, causing in particular bacterial prostatitis in men and cystitis in women.Since our immunity is not particularly actively fighting the “native” E. coli, the urogenital infections caused by it become chronic.

Another 20% of bacterial prostatitis is caused by Pseudomonas aeruginosa, Klebsiella, Proteus, enterococci and other bacteria that are always present in the normal flora of our body. Only in such, by no means frequent, cases of acute and chronic bacterial prostatitis should antibacterial drugs be prescribed.

Mycoplasmas with ureaplasmas are, as a rule, commensals, i.e.That is, conditionally pathogenic bacteria, and therefore, if your doctor associates your prostatitis with them, and even unreasonably prescribes antibiotics against these infections at each exacerbation, contact another specialist for a second opinion.

Myth No. 3 is a popular misconception in Russia that diseases such as prostatitis or cystitis are caused by hypothermia. Don’t sit on the cold! – experts advise, – you will earn prostatitis!

As you already understand, the cause of prostatitis is not hypothermia.Although it should be noted that with a certain psychological attitude, fostered in Russians from early childhood, even innocent drafts and a feeling of discomfort experienced in the cold cause the release of a large amount of stress hormones that can in a certain way “weaken” the immune system, as a result of which the already existing the patient has a chronic bacterial process.

In people with psychosomatic pelvic pain, this myth itself can trigger an exacerbation if the patient is convinced of the importance of the cold factor.

No panacea

Acute bacterial prostatitis is relatively easy to treat. The main thing here is not to self-medicate! Not all antibacterial drugs penetrate the prostate, and besides, fecal bacteria can be resistant to many drugs, and therefore they must be sown and tested for sensitivity to antibacterial drugs. With the correct selection of the drug, acute prostatitis can be overcome, as a rule, in 4-6 weeks.

Chronic bacterial prostatitis is more difficult to treat, because with chronic inflammation, the environment inside the prostate gland becomes more alkaline, which further complicates the diffusion of antibiotics into the diseased organ. Thus, the list of available agents is narrowed, while with their repeated use, bacteria resistance to them grows.

Non-bacterial prostatitis , which accounts for up to 95% of all prostatitis, is not easy to treat.Therefore, all treatment is aimed at relieving symptoms with the next exacerbation. At the same time, the patient should be aware that such a disease has a long-term chronic nature, and there are no methods or means for its complete cure.

Not realizing this reality, patients often become disillusioned with doctors, move from one specialist to another, experiencing all sorts of, as a rule, very expensive and, what is important, ineffective and even completely useless methods of treatment.

Since psychosomatic disorders occupy a large share in the structure of chronic pelvic pain syndrome, the placebo effect from many popular drugs and physiotherapy procedures cannot be ignored. As for the official medical opinion, there is no panacea here due, first of all, to the very heterogeneity of pelvic pain – different reasons provide for different approaches to treatment.

Medicines, means and methods

For chronic prostatitis, doctors often prescribe:

Medicines in the alpha-blocker group , which by relaxing certain muscle fibers can relieve pain when urinating.

Medicines from the group of non-steroidal anti-inflammatory drugs (ibuprofen, aspirin, etc.), which can also relieve pain.

Prostate massage . It is very popular in Russia and really brings relief to some patients. However, its effectiveness is disputed by many experts.

Physiotherapy (warming up) – a method based on thermal microwave action in the area of the prostate. It is also a very popular treatment method.However, there is still not enough data to clearly prove that its effect is significantly superior to that of placebo.

Psychotherapy . It is effective for many patients, since mental suffering in chronic prostatitis can be more significant than physical. Unfortunately, in Russia this area of medicine is not developed, and therefore it is not easy to find a good psychotherapist for such cases.

Alternative medicine offers many of its remedies, such as:

Acupuncture .There is very little good research on this method so far, and therefore it is too early to say that “needles” are really more effective than placebo.

Supplements and herbal medicine . Formulas of such preparations include extracts of various plants, minerals and vitamins (zinc, selenium, vitamins E and D are especially often used). Despite the fact that almost all patients with chronic prostatitis resort to such remedies, their effectiveness remains highly questionable. Some encouraging data have been accumulated on the bioflavonoid quercetin, which is found in green tea, onions and other plants, but the plants themselves do not contain enough of this substance for a clinical effect, and therefore quercetin is used in the form of concentrated dietary supplements.

Independent measures:

Warm bath . Gives a good reflex effect in many patients during exacerbation of pelvic pain.

Avoid alcohol, caffeinated drinks, spicy pi cabbage soup.

Use soft seat cushions or flat cushion to avoid pressure on the prostate during prolonged sitting .

During exacerbations, it is better to abandon the bike . Outside of exacerbations, wear special cycling shorts with a built-in padded padding and a soft, wide saddle.

Be healthy!

The opinion of the author may not coincide with the position of the editorial board

Prostatitis: symptoms and treatment in Odintsovo

Treatment of prostatitis.

In order to start talking about the treatment of prostatitis, you need to understand what it is.

Prostatitis is an inflammation of the prostate gland of various etiologies. Such a diagnosis is often found in men over 25-30 years of age.

Main manifestations of the disease:

– a feeling of discomfort in the pelvic area, penis, rectum, scrotum;

– increased urge to urinate, especially at night

– exacerbation of the feeling of urge to urinate

– disruption of the reproductive system (deterioration of erection, quality of sex) – ishuria (urinary retention)

– hematuria (presence of blood in urine)

The prostate gland is

In other words, the prostate is an important glandular-muscular organ of the male reproductive system.Located in the front of the pelvis, under the bladder. It is an auxiliary system of the body.

Functions:

– Secretion of the liquid part of the semen

– involuntary sphincter of the urethra

– participates in the regulation of the movement of sperm during orgasm – storage place of semen

– synthesis of enzymes (enzymes). For example, alpha reductase helps convert testosterone to dehydrotestosterone (DHT), which in turn is responsible for controlling sex drive

Factors contributing to the onset of prostatitis:

1.In the occurrence of any disease, a weakening of the body’s defense system plays a special role. This is facilitated by hypothermia, a sedentary lifestyle, chronic fatigue, stress, unhealthy diet, regular lack of sleep, excessive strength training (most often found in athletes), etc., all of this can cause a decrease in immunity.

2. Often a key place in the development of prostatitis is a bacterial infection developing in the prostate gland.

3.Also, a lasting occurrence of prostatitis can be stagnation in the tissues of the prostate, disrupting the capillary blood flow, which causes an increase in lipid peroxidation (indicates the occurrence of an inflammatory process), edema, exudation (secretion) of prostate tissues and creates conditions for the development of infection.

Classification

There are several forms of prostatitis:

1. Acute bacterial prostatitis. Depending on the stage, it may be accompanied by symptoms such as: frequent or difficult and painful urination, fever up to 39-40 ° C, pain in the perineum.

2. Chronic bacterial prostatitis develops for a long time as a result of inadequate previous treatment or no treatment at all. The prostate has no pain receptors, so why is pain felt? The pelvic organs are abundantly innervated. Involvement in the inflammatory process of the nerve pathways leads to the appearance of weak, aching, or intense, pain, radiating to the sacrum, scrotum, perineum, and sometimes to the lumbar region. There is a feeling of incomplete emptying of the bladder due to compression of the urethra by the swollen prostate gland.

3. Abacterial prostatitis, a rare form of prostatitis in which symptoms of prostatitis are present, but the infection cannot be diagnosed.

4. Asymptomatic inflammatory form. The diagnosis is established by a random examination by a urologist (an increased number of leukocytes in the semen).

Symptoms:

1. Frequent or difficult urination, feeling of incomplete emptying of the bladder.

2. Pain of various nature (aching, pulling, sharp, weak) in the lumbosacral region, in the perineum.

3. Nocturia (frequent urination at night).

4. Psychological disorders. Constant pain and stress lead to sleep disturbances, aggression, and fatigue.

5. Violation of sexual activity due to a decrease in the quality of erection. 6. Discharge from the urethra.

In order for a specialist to prescribe an adequate, effective treatment for a patient with symptoms of prostatitis, it is required to perform an obligatory minimum of examination.

Delivery of analyzes.

To confirm the diagnosis, it is necessary to undergo laboratory and instrumental research methods:

– general blood test

– general and bacteriological analysis of urine

– microscopy of gland secretion or the first portion of urine obtained after prostate massage

– culture of prostate secretion, culture from the urethra – Transrectal ultrasound examination of the prostate – Uroflowmetry

– ultrasound of the kidneys and bladder

Which specialist should I go to for prostatitis-like symptoms?

The first person to contact is a urologist.He conducts diagnostics, prevention and treatment of diseases of the urinary and male reproductive systems. Andrologist is also one of the specialists in prostate treatment.

Treatment of prostatitis.

In the treatment of prostatitis, there are several stages with the use of drugs and physiotherapy procedures.

Drug therapy.

1. Antibiotic therapy.

2. Anti-inflammatory drugs.

3. Antidepressants (strictly on the recommendation of a specialist).

Treatment with drugs must be prescribed by a specialist! Do not self-medicate and watch your health!

Non-drug treatments.

Magnetic laser therapy, shock wave therapy, prostate massage, thermotherapy.

Additional prophylaxis during treatment periods.

It is important, in addition to the use of drugs and physiotherapy, to pay special attention to the way of life. With inflammation of the prostate gland, it is necessary to monitor nutrition, not to consume spicy foods, limit alcohol, and also give up bad habits, perform specialized gymnastics aimed at improving blood flow in the small pelvis.

New approaches to disease control.

The modern method for the treatment of prostatitis is considered to be shock wave therapy (shock wave therapy). The result is achieved by using acoustic waves that restore metabolism and effectively fight the clinical manifestations of pathology. Shockwave therapy is indispensable for enhancing blood supply. It is important to note that this method is not carried out at home and at the first stages can cause increased pain.

Prices for the treatment of prostatitis in our clinic.

Treatment of the disease is a laborious process. Often, an integrated approach is required to eliminate the disease. Proven methods are combined with new scientific solutions.

1. Reception of the chief physician, urologist-andrologist, specialist in oncourology, AA Sinyagin. – 2000 rudders

2. Outpatient urologist appointment – RUB 1500

2.1 Massage of the prostate gland with taking prostate secretions for analysis – 900 rubles

2.3 Therapeutic massage of the prostate gland (1 session) – 750 rubles

2.4 Taking a smear from the urethra – 300 rubles

3. Ultrasonic research methods

3.1 ultrasound of the kidneys 1500 r

3.2 ultrasound of the urinary bladder 650 r

3.3 TRUS of prostate 2000

3.4 Transabdominal ultrasound of the prostate 1500

3.5 Ultrasound of the scrotum 1500

3. Uroflowmetry with measurement of residual urine 1500

4. Laboratory diagnostic methods

Prostatitis – symptoms, treatment – Medical Center

Prostatitis – an inflammatory process that occurs in the tissue of the prostate gland

Prostatitis, unlike prostate adenoma, can occur in young men at the age of 20, while adenoma is not earlier than 40.

The prostate surrounds the urethra and is an organ located in front of the rectum and above the bladder. Therefore, with inflammation, various problems with urination occur.

Classification of prostatitis

Acute bacterial
Chronic bacterial
Chronic non-bacterial
Asymptomatic inflammatory prostatitis

Chronic prostatitis is much more common than acute.Infectious prostatitis is the most common form of the disease in people under 35 years of age. Most often it is the intestinal association of microbes, as well as sexually transmitted infections

Abacterial (non-infectious prostatitis ) causes increased prostatic pressure, muscle pain in the pelvic region, a sedentary lifestyle associated with venous congestion, autoimmune disorders.

The main symptoms presented by patients are pain in the lower abdomen and perineum, urinary disorders (frequent or difficult urination).With an exacerbation of chronic bacterial prostatitis, in addition to the symptoms described above, pain in the root of the penis appears, which can spread to the testicles. In the presence of an infection, cramps during urination, as well as a painful act of defecation

Asymptomatic prostatitis syndrome of chronic pelvic pain, can be accompanied by psychological and sexual disorders (fatigue, erectile dysfunction, pain after sex).

With a history of chronic prostatitis, it is necessary to visit a doctor regularly (once a year).

Proved AUA (American Society of Urology 2014) that a sluggish form of asymptomatic chronic prostatitis for more than 15 years leads to prostate cancer.

The following types of care for prostatitis are provided in our clinic

Medication
Physiotherapy: laser, ultrasound, ultratone, magnetotherapy.
Prostate massage
Instillation of drugs into the prostatic urethra

Remember with self-treatment you can provoke tissue degeneration and cause cancer.

If you have had or are experiencing the symptoms described, please contact our clinic. A qualified urologist within 20-30 minutes will conduct a specialized examination, including ultrasound diagnostics and prescribe high-quality, effective treatment.

Prostatitis: Diagnosis and Treatment | Remedium.ru

Often in patients with a presumptive diagnosis of prostatitis, especially of a chronic form, a more thorough examination reveals other pathological conditions of the prostate gland, urethra, as well as any neurological pathology or pathology of the pelvic organs, causing symptoms similar to those of prostatitis.Such diagnostic difficulties are due to the lack of clear clinical criteria for establishing the diagnosis of prostatitis, as well as a wide variety of subjective, sometimes nonspecific complaints of patients.

The main etiological factor of bacterial prostatitis is recognized as an infection of the urinary tract, however, using standard research methods, an infectious agent is detected only in 5-10% of cases (Weidner W., 1991), it is also likely that autoimmune disorders are associated with damage to both parenchymal and interstitial tissue prostate gland.The etiology of chronic pelvic pain syndrome ( CPPS ), a chronic prostatic pain syndrome in which bacterial agents or even inflammatory changes are not detected, has not yet been completely resolved. Lower urinary tract infection is assumed to be one of the main causes of its occurrence, however, there is growing evidence in favor of the autoimmune theory and chemical inflammation of the prostate in connection with intraprostatic reflux of urine (W. J. G. Hellstrom, 1987; A.A. Ghobish, 2000). The increased activity of T cells on sperm plasma detected in these patients may indicate an autoimmune mechanism of CPPS (G. R. Batstone, 2002). The cause of CPPS can also be damage to the intervertebral discs of the lumbar spine, tumors of the small pelvis or spinal cord, entrapment of the pudendal nerve (D. A. Shoskes, 1999). Thus, today CPPS is considered to be a polyetiological disease.

Depending on the duration of the symptoms, acute prostatitis (AP) and chronic prostatitis (CP) are distinguished, with the latter symptoms persisting for more than 3 months.Chronic bacterial prostatitis is the most common cause of recurrent urinary tract infections in men (Krieger J.N., 1998).

The most common classification of prostatitis at the present time is the classification proposed by the US National Institutes of Health (NIH, 1995), it is a modification of the classification of Meares and Stamey (1968) and includes:

– Category I – Acute bacterial prostatitis (OP),

– Category II – chronic bacterial prostatitis (CP),

– Category III – chronic abacterial prostatitis (chronic pelvic pain syndrome (CPPS)), – IIIA – inflammatory chronic pelvic pain syndrome, – IIIB – non-inflammatory chronic pelvic pain syndrome (prostatodynia),

– Category IV – asymptomatic inflammatory prostatitis (histological prostatitis).

There are currently no reliable epidemiological data on the prevalence of prostatitis in Russia. According to foreign literary sources, the prevalence of prostatitis ranges from 4 to 14%, and the overall incidence is 3.1-3.8 per 1,000 people per year (TD Moon, 1997; Mc. Naughton Collins M., 1998; RO Roberts , 1998; A. Mehik, 2000; JH Ku, 2001; JC Nickel, 2001). The structure of individual categories of prostatitis is as follows: acute bacterial prostatitis is 5-10%; chronic bacterial prostatitis – 6-10%; chronic abacterial prostatitis – 80-90% (H.Brunner et al., 1983; J.J. Rosette et al., 1993; M. Roberts et al., 1997).

The most frequent complaints of patients with prostatitis are pain or discomfort of varying intensity, most often localized in the perineum, complaints of pain in the testicles, scrotum, penis, suprapubic region, and in the lower back are possible. One of the signs is pain during ejaculation (R. B. Alexander, 1996; J. C. Nickel, 1996; D. A. Shoskes 2004). Common lower urinary tract symptoms include urge to urinate, difficulty urinating, painful urination (Alexander R.B., 1996). Acute bacterial prostatitis can occur as a serious infection, accompanied by high fever and symptoms of intoxication and requiring intensive antibiotic therapy in a hospital setting. The next group of symptoms is various sexual disorders (A. Mehik, 2001). Long-term symptoms can stimulate the onset of psychological disorders, thereby reducing the quality of life of patients (L. Keltikangas-Jarvinen, 1989; J. J. De la Rosette, 1993; A. Mehik, 2001).

The main tasks of diagnostic measures for prostatitis are: first of all – confirmation of the diagnosis of “prostatitis”, determination of the category of the disease according to the NIH classification, determination of the phase, stage of the pathological process and complications of the disease.

Clinical examination of the patient should include examination and palpation of the external genitalia, perineum, groin, lower abdomen and digital rectal examination. During a clinical examination, it is important to make a differential diagnosis with other diseases of the genitourinary system and rectum, to assess the condition of the pelvic floor muscles.In the case of acute prostatitis, digital rectal examination reveals an edematous and painful prostate gland; in other forms of prostatitis, the prostate gland may not be palpably changed. In patients with CPPS, the prostate gland is usually normal on palpation, but spasm of the external sphincter of the anus and tenderness in the paraprostatic region may be noted.

The scope of the necessary laboratory and instrumental research methods should be determined by the urologist individually for each specific patient.A urinalysis is done to screen for urinary tract infections and hematuria. The four-glass test, proposed by E. Meares and T. Stamey in 1968, remains important in the diagnosis of prostatitis, allowing to differentiate any category of prostatitis according to the NIH classification, as well as urethritis (Mc. Naughton Collins M., 2000). A simpler test with the study of pre- and post-massage urine portions in persons without urethritis (J. C. Nickel, 1997) is recommended as a first-line test for screening for prostatitis, since the sensitivity and specificity of this test is 91%.A significant amount of bacteria in the urine portion before prostate massage is a sign of urinary tract infection or acute bacterial prostatitis, and the predominance of bacteriuria in the post-massage portion of urine indicates chronic bacterial prostatitis. In the absence of bacteria in the urine, the detection of leukocytes of more than 10 in the field of view during microscopy of centrifuged urine of the post-massage portion indicates the presence of inflammatory CPPS (III A), and the absence of bacteria and leukocytes – non-inflammatory CPPS (III B).

Quantitative culture and microscopy of urine and prostate secretions can reliably establish the diagnosis of bacterial prostatitis. The causative agents with proven etiological significance are mainly enterobacteria – Escherichia coli, Klebsiella spp., Proteus mirabilis, Enterococcus faecalis, as well as Pseudomonas aeruginosa. The role of staphylococci, streptococci, as well as Chlamidia trachomatis, Ureaplasma urealiticum, Ureaplasma hominis, Corynebacterium spp.in the development of prostatitis remains controversial (Weidner W., 1991; Schneider H., 2003), however, the exclusion of sexually transmitted infections is recommended in the complex of standard examination of a patient with prostatitis (Clinical guidelines EAU, 2010). In patients with immunodeficiency or HIV infection, prostatitis can be caused by other, more rare pathogens, for example, Mycobacterium tuberculosis, Histoplasma capsulatum, Candida spp. etc.

The level of prostate-specific antigen (PSA) in patients with prostatitis can be increased, if there are signs of inflammation, the PSA level returns to normal after a 4-week course of antibiotic therapy in about 50% of cases, in this regard, re-determination of the PSA level should be delayed at least for 3 months (Carver B.S., 2003; Bozeman C.B., 2002). In the case of a persistent increase in PSA levels, a prostate biopsy is considered to exclude prostate cancer.

Transrectal ultrasound (TRUS) is recommended to clarify the size and condition of the prostate. Despite the absence of specific ultrasound signs of CPPS, calcifications and calculi of the prostate are often detected in such patients, as well as increased blood flow during Doppler examination (N. F. Wasserman, 1999).Determination of the volume of residual urine and uroflowmetry are recommended in the presence of symptoms of urinary dysfunction, suspected bladder outlet obstruction. In case of suspicion of dysfunctional urination, patients are shown to conduct a comprehensive urodynamic study, including a pressure / flow study with simultaneous registration of the activity of the striated urethral sphincter and the intraurethral pressure profile, but this study is not advisable for routine examination of patients with prostatitis (Clinical guidelines EAU, 2010) …The diagnosis of interstitial cystitis can be made by a voiding diary assessment, cystoscopy, and bladder biopsy. If bladder cancer is suspected, it is recommended to include urine analysis for atypical cells and cystoscopy into the diagnostic complex (J. C. Nickel, 2002).

The main role in the treatment of bacterial prostatitis is assigned to antimicrobial drugs. Indications for antibiotic therapy are considered by most experts to be acute and chronic bacterial prostatitis, chronic abacterial prostatitis (category III A), if there is clinical, bacteriological and immunological evidence of prostate infection.In the case of severe acute bacterial prostatitis, parenteral administration of high doses of bactericidal drugs, for example, 3rd generation cephalosporins, penicillins or fluoroquinolones, is recommended; a combination of these antibiotics with aminoglycosides is possible. If the patient’s condition improves, treatment can be continued with oral administration of drugs, the duration of therapy is 2-4 weeks (Clinical guidelines EAU, 2010). The first choice drugs are antibiotics from the group of fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin), the advantage of which is a wide spectrum of action and the ability to high concentrations in the tissue and secretions of the prostate (Bjerklund Johansen TE, 1998; JK.G. Naber, 1999). Higher efficacy of fluoroquinolones in comparison with other groups of antibiotics in the treatment of prostatitis has been proven in a number of comparative studies (W. Weidner, 1991; K. G. Naber, 2000).

In CKD and CPPS, antibiotic therapy is prescribed for a period of 2 weeks, then antibiotic therapy continues with a positive culture test performed before the start of therapy or with positive clinical dynamics against the background of the started treatment. The total duration of taking antibacterial drugs should be 4-6 weeks.Prescribing antibiotics for CPPS is considered justified, as there may be a bacterial infection that is not detected by conventional research methods (Krieger JN, 1996; Krieger JN, 2000). If intracellular microorganisms are suspected, tetracyclines or erythromycin are preferred (Johansen TE, 1998).

The use of alpha-blockers in patients with prostatitis is based on the theory of dysfunctional urination, leading to intraprostatic reflux of urine.In addition, with the use of alpha-blockers, there is an improvement in the blood flow of the prostate due to a decrease in pressure in the tissue of the gland during relaxation of its smooth muscles (A. Mehik, 2003). According to modern concepts, the appointment of alpha-blockers is an effective method of treating patients with prostatitis, including those with CPPS.

The use of a 5α-reductase inhibitor in the treatment of CPPS patients is based on a proven reduction in bladder outlet obstruction and intraprostatic reflux of urine by reducing the size of the prostate, reducing the pressure in the prostate tissue and improving its microcirculation.(J. Downey, 2002), which provides some improvement in the condition of patients.

Preparations of plant and animal origin (vitaprost, afala, lycorophyte, prostamol, prostaplant, prostagut, and many others), which have an organotropic effect on the prostate gland, have proven themselves in the complex therapy of various forms of prostatitis, as well as as a means of preventing exacerbations.

The effect of non-steroidal anti-inflammatory drugs (NSAIDs) is due to their inhibitory effect on the synthesis of prostaglandins.Currently, reliable studies of the effectiveness of these drugs in the treatment of prostatitis are not enough, the question of the use of NSAIDs in patients with prostatitis, including CPPS, should be decided individually in each case (M. A. Pontari, 2002).

Surgical treatment in patients with prostatitis should be avoided, except for drainage of prostate abscesses. Suprapubic bladder drainage may be indicated in some patients with ABP and urinary retention, and the positive effect of transurethral resection of the prostate and transurethral needle ablation has also been noted in patients with severe persistent symptoms and ineffectiveness of conservative therapy (Darenkov AF, 1989; Lee KC, 2002).

Thus, at present, the problem of diagnosis and treatment of various forms of prostatitis, especially categories III A – III B, remains extremely relevant, complex and requires further clinical research.

Prostatitis: symptoms, treatment, symptoms, diagnosis and treatment | Alpha

Prostatitis is an inflammation of the tissues of the prostate gland. The disease can occur suddenly (acute prostatitis) or have a chronic course. Prostatitis is diagnosed in men of different ages, but most patients are elderly people after 50 years.The urologist is engaged in the treatment of the disease.

Causes of prostatitis

By the nature of inflammation, a distinction is made between infectious and non-infectious prostatitis.

The infectious form of the disease is caused by E. coli, enterobacter, pseudomonas, gonococci, chlamydia. In medical practice, inflammation of the prostate due to Mycobacterium tuberculosis is described. Pathologies of an infectious nature are most often diagnosed in young men under 35 years old.

Causes of non-bacterial prostatitis:

Chronic stress, fatigue.
High prostatic pressure.
Autoimmune reactions in which the body’s own cells attack the prostate tissue.
Heavy physical activity.
Obesity, diabetes mellitus.
Low physical activity.
Hypothermia.
Injuries to the pelvic organs.
Chronic constipation.
Decreased immunity for various reasons.
Age-related changes in prostate tissue.

Prostatitis symptoms

Inflammation of the gland from an early stage is manifested by discomfort in the perineum, in the lower back, and urination disorder. A common symptom of prostatitis is chronic pelvic pain syndrome. The clinical picture of the disease is pronounced, but the infectious agent is not detected.

As the gland grows, the degree of compression of the lower urinary tract increases. The characteristic symptoms of prostatitis develop:

Frequent urge to urinate.
Incomplete emptying of the bladder even when “straining”.
Cutting, sharp pain when urinating.
General weakness due to lack of sleep.
Potency disorder.

Types of prostatitis

In clinical practice, the classification of the American Institute of Health is used. The system identifies 4 forms of inflammation:

Type I – acute infection. Symptoms develop suddenly and increase rapidly.There may be blood in the urine and ejaculate. Acute bacterial prostatitis is rarely diagnosed, but if detected at an early stage, the disease is effectively treated and does not lead to complications.
Type II – chronic infection. Recurrent prostatitis. Symptoms are mild, but occur intermittently. In advanced cases, it is very difficult to achieve complete recovery. The doctor’s task is to get a stable long-term remission.
Type III – chronic prostatitis of non-bacterial origin.No infectious agent was found. The third type also includes chronic pelvic pain syndrome. In the presence of secret leukocytes after massage of the prostate, they speak of type IIIA. If the cells are absent, type IIIB prostatitis is diagnosed – the most common form of the disease that develops for no obvious reason.
Type IV is asymptomatic inflammation. Benign enlargement of the prostate has no manifestations. In rare cases, an increase in the level of leukocytes is found in the general blood test.Type IV pathology is usually diagnosed with a biopsy of the gland.

Types of prostatitis according to the characteristics of the course of the disease:

Bacterial. As mentioned above, inflammation is caused by a pathogenic microbe that can enter the prostate through the ureter, with the flow of blood or lymph.
Calculus. Concrements are formed in the tissue of the gland. Calculous prostatitis develops in elderly patients who have not treated chronic inflammation or urolithiasis for a long time.
Stagnant. Prostatitis is characterized by impaired blood flow in the small pelvis. The development of inflammation as a result of stagnation of the secretion is possible. The pathology of this type is diagnosed with prolonged abstinence or complete absence of sexual activity in the patient.
Purulent. It develops from an acute bacterial form, accompanied by a high fever, severe pain in the perineum. An admixture of pus appears in the urine. Without quality treatment, an abscess and lymphadenitis may develop in the prostate.

Disease diagnosis

The examination of the patient begins with an appointment with a urologist. The doctor collects an anamnesis of the disease: he asks to describe the symptoms, tell how long ago the signs of inflammation appeared and how pronounced they are. The presence of provoking factors or genetic predisposition is of great importance.

After interviewing the patient, a digital rectal examination of the gland is started. The doctor determines the contours, sizes, anatomical location of the prostate, its structure.If necessary, the secret is taken for analysis immediately at the reception.

The set of surveys also includes:

Analysis for sexually transmitted infections.
General clinical studies of blood, ejaculate.
Urine culture for bacteriology.
Ultrasound of the pelvic organs with the determination of residual urine.
Transrectal ultrasound of the prostate gland.

Prostatitis treatment

It is forbidden to take medicines on your own and use alternative methods without the approval of a doctor.Improperly selected therapy can worsen the patient’s condition. Effective treatment of prostatitis is always a set of measures assigned to a specific patient.

Drug therapy includes:

Antibacterial drugs. The course of treatment for prostatitis is 4-6 weeks, with a chronic course of the disease, medications are taken longer. You can be treated on an outpatient basis, subject to strict adherence to the doctor’s recommendations. In severe cases, the patient is hospitalized and given intravenous antibiotics.Important: before prescribing the drug, the doctor determines the type of pathogen. If necessary, a study is carried out for the sensitivity of the pathogen to antibiotics.
Alpha blockers. Special remedies relieve spasm of the muscles of the ureters and bladder. The patient’s urination is normalized, pain syndrome decreases.
Non-steroidal anti-inflammatory drugs (NSAIDs). Medicines in this group reduce swelling and pain. Under the influence of NSAIDs, symptoms are relieved fairly quickly.

In the complex treatment of prostatitis, physiotherapy is effective. After relieving the exacerbation, the patient is prescribed microwave thermotherapy, electrical stimulation with modulated currents. Massage of the gland gives a positive result.

Asymptomatic prostatitis does not need to be treated. The man is shown observation and regular preventive examinations.

In the absence of positive dynamics against the background of the treatment, the patient is prescribed an operation.Surgery is also indicated when an overgrown prostate is blocking the outflow of urine.

The doctor selects the optimal surgical technique:

Transurethral resection. All affected tissues are excised.
Prostatectomy. The prostate gland and the inflamed structures around it are completely removed.

Diagnostics and treatment of prostatitis in Moscow

Doctors of the clinic “Alfa-Health Center” will help you to undergo high-quality diagnostics and cure prostatitis.Our offices are equipped with modern high-precision equipment for a thorough examination of patients. Do not delay a visit to the doctor – make an appointment when the first symptoms appear. The clinic’s phone number is listed on the website.

90,000 Diseases of the prostate gland in dogs

The prostate gland is a bipartite, rounded organ located in the pelvic cavity above the bladder neck. In young dogs, the prostate is usually located in the pelvic cavity, in dogs over two years old, it is displaced into the abdominal cavity.

Of the diseases of the prostate gland, benign hyperplasia and prostatitis (acute and chronic forms), cysts are most often found in dogs. Abscesses and tumors of the prostate are less common.

Clinical signs of prostate diseases are very similar and may include hematuria, urethral discharge, pain during bowel movements, and a change in the shape of the stool (ribbon-like stool). Fever and anorexia, up to vomiting and weakness of the pelvic limbs, occurs with abscess and acute prostatitis.If these signs are manifested, the animal should be taken to the clinic for examination and differential diagnosis of prostate diseases.

Prostatitis is an inflammation of the prostate gland caused by bacterial contamination.

Contribute to the development of prostatitis cysts, hyperplasia against the background of the influence of sex hormones, a decrease in the tone of the prostate gland, as well as the presence of urinary tract infections, chronic cystitis.The infectious agent enters the gland from the urethra through the ascending type of infection. With a healthy organ and the presence of local defense mechanisms, retrograde growth of bacteria is usually excluded. It is also possible and the hematogenous way of spreading the infection of the prostate gland. Most often, the tissues of the prostate gland are affected by bacteria such as E. coli (E. coli). When seeding washes or prostate secretions, both gram-negative and gram-positive microorganisms are detected.At the same time, mycoplasmas prevail, and Brucella Canis is less often detected (most often it spreads by the hematogenous route). Clinically, prostatitis can manifest itself in different ways depending on its form. Acute prostatitis can be accompanied by vomiting, anorexia, and general animal weakness. Serous-hemorrhagic discharge from the urethra is observed, as well as an altered and unnatural (stiff) gait when walking. On examination and palpation (rectal examination), there is an increase in the prostate gland, soreness.Chronic prostatitis can be asymptomatic, and frequent recurrences of urinary tract infections are possible. As a rule, it does not cause a painful reaction.

Diagnostics includes anamnesis, clinical signs, ultrasound data, in rare cases, a specific cultivation method is used. Treatment includes long-term antibiotic therapy with specific antibiotics that are able to penetrate the tissues of the prostate gland and achieve the required bactericidal concentrations.As a rule, antibiotics of the fluoroquinol group and macrolides are used. Treatment is long-term, at least 6 weeks, or more if necessary.

Benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a natural consequence of animal aging. It is more common in males over 6 years old that are not regularly mated. With age, under the influence of sex hormones (androgens and estrogens), the prostate gland enlarges, and vascularization (the number of blood vessels) also increases, as a result of which dogs often develop prostate cysts.Since BPH is a natural process, there is usually no clinical sign in males. Rarely, there may be serous-hemorrhagic discharge from the urethra between urination. There may be changes in the color and transparency of urine, it may be dark, brown, cloudy. Possible painful sensations during bowel movements, changes in the shape of feces (with an increase in the prostate to such a size that it mechanically compresses the rectum). Rarely, retention and painful urination may occur.A rectal examination by a doctor often reveals a symmetrical enlargement of the prostate, however, it is mobile and painless. In the presence of intraprostatic or paraprostatic cysts, asymmetry can be detected. Diagnostics includes the presence of clinical symptoms, anamnesis and additional research methods, primarily ultrasound. On the scan, the prostate is enlarged, dense echostructure, may be homogeneous, may include anechoic rounded structures of various diameters (cysts).The most effective treatment for BPH is castration, which can quickly return an enlarged prostate to normal. Next comes atrophy of the prostate tissue, as hormonal stimulation of epithelial growth stops. Alternative treatments with hormonal drugs, which are used to treat prostatitis in humans, are not scientifically justified in dogs and are also too expensive.

Prostate abscesses are a serious medical condition that can threaten the life of an animal.The lethal outcome even with timely treatment can be 50%! Abscesses occur when an ascending infection from the urinary tract enters, in violation of the normal protective mechanisms of the prostate, which usually prevent the retrograde spread of bacteria. Para- and intraprostatic cysts, as well as long-term bacterial chronic prostatitis and recurrent infections of the urinary tract and bladder, can often be a predisposing factor.

Clinical symptoms in dogs are manifested in depression, painful defecation, shortness of breath against the background of pain syndrome, refusal to feed, vomiting and diarrhea, increased body temperature due to intoxication of the body, and the development of septic shock is possible.Hemorrhagic or purulent-mucous discharge from the urethra is also observed. On examination by a doctor and palpation, an enlarged prostate of an uneven shape, painful in various areas, is revealed. Ultrasound is also used as an additional research method. Scans reveal an enlarged prostate gland with multiple cavities filled with anechoic contents; during puncture, as a rule, purulent and hemorrhagic contents are revealed. If this diagnosis is confirmed, the animal urgently needs hospitalization and surgical treatment.Purulent cavities are opened, the contents are removed, sanitized, drainages are installed. At the same time, long-term antibacterial therapy with specific antibiotics is prescribed, infusion therapy is carried out in parallel in order to reduce intoxication and replenish the loss of body fluid against the background of dehydration.

Paraprostatic cystosis. Represents multiple (more than two) thin-walled formations, usually filled with serous fluid. The etiology is not fully understood, according to foreign colleagues, these formations may be rudimentary remnants of the Müllerian canal.

These cysts can form from the capsule of the prostate gland, or from the walls of the bladder. At the same time, they often reach enormous sizes, shift into the abdominal cavity, or far into the pelvic cavity. At the same time, clinically, they may not appear in any way for a long time, until they reach such sizes that they will mechanically squeeze and displace the rectum, bladder and other organs of the abdominal and pelvic cavities. Differential diagnosis consists in taking anamnesis, conducting an ultrasound scan, excluding ascites and abdominal neoplasms.Treatment is performed surgically, cysts are excised. If surgical intervention is impossible, it is recommended to drain the cyst and fill it with an omentum. In any case, long-term antibiotic therapy and symptomatic treatment are subsequently prescribed.

Adenocarcinoma of the prostate is a neoplasm that is rare in domestic animals, both cats and dogs. The exact cause of this pathology is unknown. Dogs of medium and large breeds are more often affected.Castration, as a rule, does not affect the development of a prostate tumor, however, according to foreign colleagues, castrated and old animals are at risk. Metastases of adenocarcinoma of the prostate gland can spread to the external and internal lymph nodes, lumbar vertebrae, and can also be localized in the pelvic bones. With a metastatic process, pain syndrome, a change in gait may occur. With the generalization of the process, metastases affect the large intestine, bladder, lungs, and muscles of the pelvic region.A tumor of the prostate gland with an increase in its size can mechanically squeeze the urethra and rectum, which can provoke acute urinary retention, hydronephrosis, as well as constipation and severe pain during bowel movements. According to foreign researchers, many prostate tumors are actually a consequence of urethral cancer that spreads to the prostate gland. With the onset and progression of prostate cancer, dogs are often depressed, refuse food, dramatically lose weight, often there is weakness of the pelvic limbs, painful defecation and urination, acute urinary retention (dysuria), and hemorrhagic urethral discharge is possible.Palpation reveals a painful, hard and immobile prostate gland rectally and abdominally.

Diagnosis is based on clinical findings, medical history, and additional studies. Ultrasound diagnostics reveals an enlarged prostate, uneven contours, focal and heterogeneous changes in the echostructure of the parenchyma. With a puncture biopsy and cytological examination of the altered tissue of the prostate and regional lymph nodes, the diagnosis of a neoplasm is confirmed.Treatment is, depending on the degree of the oncological process, surgery for the purpose of prostatectomy, radiation therapy. These methods are effective in the early stages of the disease, in the absence of a metastatic process. However, such treatment is often accompanied by complications and high mortality. Castration and treatment with hormones do not affect the course of the disease.

So, based on the above-described possible diseases of the prostate gland, it follows that the symptoms in animals are often the same and it is not always possible to recognize the full severity of the problem immediately.