Prostatitis; chronic

Causes and Risks:
Chronic prostatitis is caused by a bacterial infection. It may be associated with or follow urinary tract infection ( cystitis ), urethritis , epididymitis , or acute prostatitis . The disorder is diagnosed in 5 out of 1,000 outpatient visits. It is estimated that as many as 35% of men over 50 years old may have chronic prostatitis. Increased risk is associated with men over 30 years old.

Certain factors may predispose a person to develop chronic prostatitis, such as excessive alcohol intake, perineal injury, and certain sexual practises. It is hypothesised that these factors may cause congestion of the prostate gland which produces an excellent breeding ground for various bacteria.

Prevention:
Not all types of prostatitis are preventable. Those that are associated with sexually transmitted diseases may be prevented by practicing safer sex behaviors .

Symptoms:

Note: There may be no symptoms.

Additional symptoms that may be associated with this disease:



Signs and Tests:
A physical examination will reveal an enlarged, mildly tender prostate
The examination may reveal enlarged and/or tender lymph nodes in the groin area, scrotal swelling and tenderness and a urethral discharge.

Triple-void urine specimens may be collected for urinalysis and urine culture

  • #1 initial stream
  • #2 mid-stream
  • #3 post (after) prostatic massage by examiner

A urinalysis reveals increased WBCs and bacterial growth upon culture of urine #3. Prostatic secretions contain increased levels of WBCs and more concentrated bacterial growth upon culture.

Treatment:
Most antibiotics are not able to adequately penetrate the prostate tissue. Often, infectious organisms continue to persist in the prostatic tissue despite treatment. Once antibiotic treatment has ended, often the person may develop a recurrence of symptoms.

MEDICATIONS:
Chronic prostatitis is treated with an extensive course of antibiotics. Trimethoprim-sulfamethoxazole and tetracycline derivatives are commonly used. Other antibiotics that may be used include:

  • carbenicillin
  • erythromycin
  • nitrofurantoin

The course of antibiotic therapy is long, frequently 6 to 8 weeks and recurrence is common.

Stool softeners (such as colace) may be recommended to reduce the discomfort associated with bowel movements.

SURGERY:
Transurethral resection of the prostate may be done if antibiotic therapy is unsuccessful. This surgical treatment is usually not performed on younger men because it carries potential risks for sterility, impotence , and incontinence .

OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary frequency and urgency. Urinary retention, requiring the placement of a suprapubic catheter , may occur as a result of the swollen prostate occluding the urethra.

Warm tub baths or sitz baths may provide some relief of the perineal and lower back pain associated with acute prostatitis .

Preventive measures may reduce symptoms and may prevent recurrence of infection. Cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

DIET:
Increasing the intake of fluids (2000 to 4000 cc per day) may allow frequent urination to flush the bacteria from the bladder and decrease urinary symptoms. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, hot or spicy foods, and caffeine .

MONITORING:
Follow-up should include an examination at completion of antibiotic therapy to ensure that infection is no longer present.

Prognosis:
The outcome for acute prostatitis is expected to be better than for chronic prostatitis.

Complications:
Urinary retention may occur as a result of an enlarged prostate occluding the urethra.

Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms occur.


This is an internal view of the male reproductive system.



This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.