Prostatitis

Prostatitis

Prostatitis or inflammation of the prostate is the most frequent reason for consultation in urology in patients between 25 and 40 years of age, and also appears in older people because it accompanies benign prostate enlargement.

It causes multiple disorders such as malaise, tiredness, fever, chills or shivering. These symptoms are accompanied by pain, often erratic (changing location), vague (difficult to pinpoint) and variable in presentation and intensity.

Pain in the lower abdomen or testicular pain radiating to the area behind the testicles (the perineum) is typical and can cause urinary problems: getting up several times during the night, urgency when going to the toilet, sensation of incomplete emptying, etc. It can even cause problems with sexual intercourse such as pain when ejaculating, blood in the semen or erectile dysfunction.

Depending on its duration, prostatitis can be classified as acute or chronic, the only difference being the length of time the condition lasts. Although prostatitis is classified as chronic, it tends to appear with less intensity, even appearing and disappearing occasionally, with varying symptoms, intermittency and duration.

In general, it causes a state of anxiety and concern among patients, due to the inaccuracy of their symptoms and the weariness caused by the search for a treatment that provides a definitive solution after wandering from one consultation to another.

How are prostatitis classified?

Prostatitis is divided into two main groups:

  • Bacterial and abacterial: 

Infection is present in prostatitis in 12-14% of cases. This is called bacterial prostatitis. It may originate from an infectious source in the mouth, pharynx, neighbouring rectal process, or infect one or more glands of a previously inflamed prostate.

When we do not find a causative bacterium in the studies we speak of abacterial prostatitis.

  • Acute prostatitis and chronic prostatitis:

Acute prostatitis is the first or isolated occurrence of prostatitis. Acute bacterial prostatitis is the most alarming because of its symptoms and is often mistaken for "cystitis" or an acute urinary tract infection. This misdiagnosis leads to many acute bacterial prostatitis being undertreated for an insufficient time, opening the way to chronification.

Chronic prostatitis presents a similar clinical picture to acute prostatitis, generally with less intensity but with a longer duration, or it reappears and disappears. Its characteristic feature is precisely the variability of symptoms, their intermittency and duration.

We classify prostatitis as chronic if the patient must have had several prostatitis over several years. Differential changes also occur in the patient's clinical manifestations:

  • Changes in the prostate towards fibrosis begin to appear.
  • The cells that appear in the prostate fluid are different.
  • Stones that appear in the prostate tend to calcify.

All chronic prostatitis always started with an acute process, and acute bacterial prostatitis can become chronic simply because it recurs.

What are the causes of acute prostatitis?

The prostate is a gland that is located in an area of the body very close to the outside and in contact with urine where there is a large amount of bacteria. This can contribute to the development of infection due to bacteria coming in from the urine or from the urethra.

Similarly, there are anatomical causes such as meatal stenosis, urethral stenosis or benign prostatic hyperplasia; and bad habits of the patient such as drinking little water, sedentary lifestyle, retaining urine or semen.

In our centre we always rule out infection, which is present in less than 15% of cases. The appearance of prostate stones as a consequence of inflammation or previous infections makes the appearance of new infections more likely and makes it more difficult to cure infectious processes, as the bacteria settle on the surface of the stones, protected by mucus, sometimes becoming very resistant to antibiotic treatment and opening the way to chronification.

What factors favour the development of acute prostatitis?

They are generally acquired habits. They are the main cause of their onset and recurrence in chronic diseases:

  • Drink little water.
  • Holding back the urge to urinate or interrupting urination.
  • Failure to ejaculate with proportionate assiduity or interrupted ejaculation.
  • Sedentary lifestyle.

What protocol do we implement at GUA to treat acute prostatitis?

This type of pathology is sometimes very difficult to treat and antibiotics are not enough. Sometimes it overlaps with other disorders such as pelvic floor problems or myofascial syndromes. That is why in the centre's protocol all possible causes are always studied.

In addition to antibiotics, prostatitis should be treated with other drugs (such as pelvic decongestants or muscle relaxants) to relieve symptoms.

We can also use other therapies to treat prostatodynia (prostate pain) by applying low intensity Focal Shock Waves through the perineum.

To check the cure in case of infection, semen culture (semen culture) is performed some time after the end of the antibiotic treatment, which is about two months after the treatment.

What criteria do we at GUA follow for prescribing antibiotics for the treatment of acute prostatitis?

With regard to antibiotics, our centre maintains these criteria:

  1. We never give antibiotics if there is no evidence of infection (fever, severe general malaise, laboratory abnormalities) or positive cultures.
  2. We never give antibiotics "blindly": we always do a culture and antibiogram.
  3. Minimum treatment time of four weeks.

What causes prostatitis to become chronic?

Prostatitis usually becomes chronic due to:

  • Poorly treated acute prostatitis.
  • Anatomical causes such as meatal stenosis, urethra or benign prostatic hyperplasia. 
  • Bad habits of the patient such as drinking too little water, sedentary lifestyle, withholding urine or semen, etc.

In our centre we always rule out infection, which is present in 12-14% of cases. The presence of stones in the prostate makes reinfection more likely, and makes it more difficult to cure infectious processes, as the bacteria settle on the surface of the stones, protected by mucus, sometimes making them very resistant to antibiotic treatment.

With regard to antibiotics, our centre maintains these criteria:

  1. We never give antibiotics if there is no evidence of infection.
  2. We never give antibiotics "blindly": we always do a culture and antibiogram.
  3. Minimum treatment time of four weeks.

What protocol do we follow at GUA to treat chronic prostatitis?

In our long experience we have explained this hundreds, thousands of times to our patients, making it clear to them that whenever they knock on our door our action will have three main lines of action:

  1. Put them on the most appropriate medication for their symptoms.
  2. Always rule out infection.
  3. Assess the impact on the urinary system.

How is chronic prostatitis treated?

This type of pathology is sometimes very difficult to treat and antibiotics are not enough. Sometimes it overlaps with other disorders such as pelvic floor problems or myofascial syndrome. That is why in the centre's protocol all possible causes are always studied.

In addition to antibiotics, prostatitis should be treated with other drugs (such as pelvic decongestants or muscle relaxants) to relieve symptoms.

We can also use other therapies to treat prostatodynia (prostate pain) by applying low intensity Focal Shock Waves through the perineum.

How is the effectiveness of the treatment tested?

In case of infection, a semen culture (semen culture) is performed two to three weeks after the end of the antibiotic treatment to check for healing.

What are the possible consequences of prostatitis?

Prostatitis may leave the patient with a worse urinary flow, as the result is a fibrous or clumsy bladder neck, which opens worse (neck sclerosis). Here we enter another field, which is that of a prostate that is obstructive, not because it has grown, but because it has closed and strangles the bladder neck.

  • Examination: Painful, fluid-producing prostate.
  • Blood tests: signs of inflammation or infection, elevated PSA.
  • Urinalysis: fractionated urine, urine post prostate expression.
  • Semen culture.

For acute prostatitis

  • Prostatic anti-congestants.
  • Antibiotics in bacterial prostatitis.
  • Anti-inflammatory drugs if the prostate is painful.
  • Muscle relaxants.
  • Medication for irritative symptoms (antimuscarinics).
  • Medication to relax the bladder neck (alpha-one adrenergic blockers).

For chronic prostatitis

  • Low-intensity focal shock waves.
  • Antibiotics.
  • Pelvic anti-congestives.
  • Muscle relaxants

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