Prostatitis is a term used to describe any inflammatory condition of the prostate gland. It is surprisingly common, with up to half of all men developing symptoms of it at some stage during their life.
Types of prostatitis
Bacterial prostatitis occurs if a urinary infection secondarily infects the prostate. If it is successfully treated within a few days it is known as acute but if it persists it becomes chronic.
Non-bacterial prostatitis describes inflammation within a prostate gland without any evidence of bacterial infection (usually because it has been successfully treated, but despite this the inflammation persists).
Prostatodynia means 'painful prostate' and is characterised by the symptoms of prostatic inflammation but without evidence of inflammation or bacterial infection. It is also known as chronic pelvic pain syndrome.
Symptoms of Prostatitis
Acute: fever and chills. Frequent, urgent and painful urination. Joint, muscle and back ache. Pain in urethra, testicles and area between the scrotum and the rectum (perineum). Painful ejaculation.
Chronic: painful urination. Recurring urinary infections. Discomfort in genitals and perineum. Back ache and abdominal pain. Painful ejaculation. Blood in semen.
Complications of prostatitis
Prostatic abscess - a serious condition, in which a collection of pus can cause severe pain, fever and a rapid deterioration in health. It is only relieved by drainage of the abscess bursting or if it bursts.
Acute urinary retention - the inability to pass any urine, which needs to be relieved by inserting a catheter (tube) to drain the bladder.
Septicaemia (blood poisoning).
Investigations for Prostatitis
Digital rectal exam (DRE) to determine if the prostate gland is tender or swollen.
Blood tests to measure inflammatory markers, the health of the urinary system and PSA.
Prostate massage, following which the first urine sample, which contains the expressed prostatic secretions, is cultured for infection.
Prostate biopsy to determine whether inflammation truly exists in the prostate.
Flow rate and bladder ultrasound to investigate obstructive bladder symptoms.
Cystoscopy to investigate irritative bladder symptoms.
CT scan of abdomen and pelvis to ensure the health of other organ systems, if all tests are negative for prostatitis.
Nonbacterial prostatitis is diagnosed when tests reveal no bacteria in the urine or prostatic secretions.
There is no test to diagnose prostatodynia; which is diagnosed after eliminating other probable causes.
Treatment of Prostatitis
Antibiotics - it is important to use an antibiotic which penetrates the prostate well (most don't) for a sufficient length of time (usually 6 weeks). The quinolone family of antibiotics is best for this, such as ciprofloxacin and norfloxacin.
Anti-inflammatory drugs - such as Brufen and Neurofen.antidepressant drugs - effective in many patient with neurogenic (nerve-mediated) pain.
Prostate block - long-acting local anaesthetic administered under ultrasound guidance around the prostate to block the nerves subserving pain either as a diagnostic manoeuvre or as treatment.
Surgery: in cases of chronic bacterial prostatitis or prostatodynia, surgery to remove part or all of the prostate is a treatment option. It is only recommended for patients who experience chronic, debilitating pain despite medication due to the risks of side-effects. In selected men it is usually very effective but is not guaranteed to resolve the problem.
Christopher Eden is a leading Consultant Urological Surgeon working in London, Surrey and Hampshire who has had an extremely broad urological training in world-renown centres and who specialises in prostate disease. He has published more than 50 peer-reviewed scientific papers, 10 book chapters and a book. Experience matters: http://www.theprostateclinic.com/prostatitis.php