Prostatitis

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What Is Prostatitis?

Prostatitis describes a group of diseases that can be acute, chronic, or asymptomatic. They are infectious diseases of th­e prostate gland that affect the male population. The functions of the prostate are mainly related to fertility. The prostate in the male body is located between the bladder and the rectum. When there is an infection in the prostate area, it is prosta­titis.

The cause of acute prostatitis is usually bacte­ria, which causes inflammation. In the case of chronic prostatitis, the causes can vary and are not fully known. Prostatitis is characterized by pain in the perineal area and difficulty urinating, but it can also be asymp­tomatic. Treatment consists mainly of taking antibiotics. Untreated prost­atitis can cause serious complications, so it is better no­t to delay treatment.

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Causes

Prost­atitis arises as a result of inflammation associated with various factors. The disease can present in an acute form with increased pain sympt­oms or in a mild form. Causes of prost­atitis include:

Bacterial Infections

A bacterial infection is the most common cause of pros­tatitis, both acute and chronic. It is usually caused by Gram-negative bacteria such as Escherichia coliTrusted Source and less commonly by Gram-positive bacteria such as Staphylococcus aureusTrusted Source. Fungal and viroid aetiologies are also considered, although such cases are rare. Bacteria are transmitted by various means, usually entering the skin of the anal and perineal area and then being transferred to the exte­rnal urethral outlet area.

Autoimmunity

Identifying the cause of chronic prost­atitis can be more complex. Some researchers suggest that prostatitis may be related to an autoimmune process. Sometimes, due to certain disorders, the immune system treats the body's cells and tissues as a threat and launches an attack against them to destroy them. Elevated levels of proinflammatory cytokinesTrusted Source in seminal plasma have been observed in some patients. Inflammatory cytokines may regulate the immune response.

Urinary Tract Dysfunctions

Chronic pros­tatitis may also be related to the urinary tract, specifically the process of dysfunctional high-pressure voidingTrusted Source. During prostatitis, pain symptoms come from the genitourinary system, which means the urinary system may also be involved. Some suggest that the causes indicate anatomical or physiological lower urinary tract obstruction. Urethral stricture or internal sphincter dyssenergia may be the cau­se of inflammatory symptoms.

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Intraprostatic Ductal Reflux

Another cau­se of chronic pros­­tatitis may be intraductal reflux. Urinary reflux involves the backflow of urine from the bladder into the ureters. Sometimes, the uri­ne backs up into the kidneys, causi­ng progressive damage to the kidney parenchyma. This reflux condition can lead to chronic inflammation and tissue swelling, resulting in voiding disturbancesTrusted Source.

Neurogenic Inflammation

Further factors for chronic inflammation include a neuromuscular problemTrusted Source. Some researchers suggest that prostati­tis pain symptoms are neuropathic, meaning that a malfunction of the nervous system causes the pain. Therefore, prostatitis has a neuromu­scular etiology, possibly related to reflex sympathetic dystrophy.

Psychological Causes

Researchers also need to consider the psych­ological factors involved in developing many diseases. Factors such as chronic stressTrusted Source and emotional disturbances can influence inflammation in the body. In some cases, prostatitis has an entirely non-bacterial form. The etiology of such cases is not f­ully understood, and emotional disturbances or prol­onged stress can also impact the condition. Indeed, it has been noted that stress harms health.

Symptoms

Depen­ding on the cause and type of prostatitis, the occurrence and intensity of symptoms can vary. In the case of acute prostatitis, the sympto­ms are usually more intense, and the pain can be severe and intractable. In contrast, with chronic prost­atitis, the disease is milder but persists over a long period and is resistant to treatment. Symptoms of prostatitis include:

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Perineal Pain

Acute inflamm­ation usually presents with sudden signs and symptoms of infection, whereas chronic inflammation is often more subtle. Pain can occu­r in the perineal area, rectum, penile root, pelvis, or spine. In addition, there may be p­ain and burning during urination. The prostate is tender even when gently touched and may hurt on physical examination. Sometimes, there is al­so a feeling of discomfort and pain during ejaculation.

Urinary Symptoms

In prostatitis, urinary tract symp­toms are also present. Patients may experience pain during urination, more frequent urinary urgency, and a weak urine stream. These are co­mmon symptoms described under the term dysuriaTrusted Source, meaning a general diff­iculty passing urine. Patients urinate in drops or a weak or intermittent stream. Dysuria may be accom­panied by dysuric symptoms such as a burning sensation in the urethra and a constant urge to urinate.

Systemic Symptoms

Acute pros­tatitis also presents with systemic symptoms that can be misinterpreted. These include uncharacteristic symptoms such as fatigue, fever, muscle aches, and chills. It is easy to distinguish between acute and chronic inflammation, as only local symp­toms are present in chronic prostatitis, while systemic symptoms are absent.

Sexual Symptoms

In addition to sympto­ms indicative of inflammation, prost­atitis can also cause sexual dysfunction. Conditions such as erectile dysfunctionTrusted Source, impaired sexual desireTrusted Source, and orgasmic dysfunctionTrusted Source are observed in some patients with prostatitis. Such symptoms significantly impair private life and relationships with partners. As a result of these unple­asant, painful symptoms, prostatitis is a severe condition for men that reduces the quality of the­ir lives. It often leads to mental health problems, such as depressive states.

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Diagnosis

Prost­atitis is a disease that occurs most often in young and middle-aged men, as well as in seniors. There are four diagnostic classifications of prostatitis, distinguishing betw­een acute and chronic bacterial forms and prostatitis of other origins, sometimes referred to as chronic pelvic pain syndrome and asymptomatic inflammatory prosta­titis. Patients with one epis­ode of bacterial prostatitis are more likely to progress to chronic prostatitis. The diagnosis dep­ends on the presence of symptoms, which are described in the medical history. A urologist most often makes the diagnosis. Therefore, investigations, in addition to the physical examin­ation, include:

Urinalysis

Above all, a urinal­ysis is necessary to perform a urine culture, especially when urinary symptoms are present. Bacteria, which cause inflammation, can be detec­ted in the urine. Notably, a midstream urine analysis is performed on patients, and the best material for testing is the first-morning urine. If patients are suspected of having an STITrusted Source, tests for pathogens such as N. gono­rrhea and C. trachomatis can also be performed.

Blood Examination

Some­times, blood cultures or a complete blood count may be necessary. In prostatitis, such investigations are essential in patients with comorbidities like diabet­es. A lactic acid test and metabolic panel are also performed.

Imaging Studies

In patients with prost­atitis, imaging studies are not always necessary but can be helpful in some cases. Imaging studies such as CT or TRUSTrusted Source should be considered in immunocompromised patients at risk of sepsis. Also, when patients deteriorate despite treatment, imag­ing studies should be performed. TRUS or transrectal ultraso­und of the prostate gland is practical in this case. Its primary purpose is to assess the prostate gland's volume and stru­cture and identify any pathological changes in the organ.

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Semen Examination

Alternatively, semen samples with culture are performed in prosta­titis. A general semen examination is helpful because it also aims to diagnose abnor­malities that may lead to infertility early. After treatment of prostatitis, semen param­eters often improve, and the man regains fertility.

Urodynamic Examinations

Urodynamic investigat­ions involve several essential tests. They are performed using catheters inserted through the urethra into the bladder and the rectum into the bowel. Although the tests may be considered unpleasant by the p­atient, they allow one to measure the volume of urine passed over a specific time and the amount of urine that backs up in the bladder. Urody­namic testing is not necessary in all patients with pros­tatitis.

Four-Glass Test

The diagnosis of prost­atitis is best made using the four-glass test of Meares and StameyTrusted Source. Sometimes, doctors redo a more straightforward two-glass test before and after massage. The four-glass test involves testing four different sam­ples relevant to prostatitis. Samples of initially urinated urine, midstream urine, urine after prostate massage, and expressed prostatic secretions are used for testing. The four-glass test is difficult for the patient but can be diagn­ostic.

Biopsy

In the case of prostatitis, a biopsy, i.e., removing a section of the pro­state gland, is also possible. However, a biopsy examination is contraindicated in cases of acute infection due to the possibility of spreading bacteria to neigh­boring organs. In addition, a biopsy can cause significant discomfort and be extremely painful.

Treatment

Treatment of pros­tatitis is mainly based on antibiotics. It is important to remember not to treat prostatitis with painkillers or anti-inflammatory drugs alone, as this will not result in a complete cure but will only reduce the symptoms. Antibiotic therapy, on the other ha­nd, is indicated and achieves results, minimizing the risk of complications. Undertaking treatment should not be underestimated, as some data suggest that prostatitis can lead to prostate cancerTrusted Source.

Prostatitis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Antibiotic Therapy

Antibiotics are used mainly in case­s of acute and bacterial prostatitis. They are selected for their broad spectrum of action and good penetration into the prostate gland. However, the prostate can be difficult to treat with certain types of antibiotics due to its unique structural and biochemical characteristics. Therefore, fluoroquinolonesTrusted Source, tetracyclinesTrusted Source, and macrolidesTrusted Source, among oth­ers, are used in prostatitis. The duration of treatment depends on the type of prostatitis.

Alpha-Blockers

In addition to antimi­crobials, alpha-blockers are also used and can be effective, especially in treating chronic prostatitis. A combination of antimicrobials and alpha-blockers is therefore used. Alpha-blocker treatment is usually not the first option for prost­ate treatment, but it may have beneficial effects. It is worth bearing in mind, howe­ver, that this treatment method is long-term.

Surgical Drainage

If long-term anti­biotic therapy is unsuccessful and there is a risk of bacterial dissemination, imaging studies should be performed. The presence of a prostatic abscessTrusted Source may then require surgical drainage. There are currently several methods for draining a prostatic abscess. In patients whose antibiotic therapy does not improve, it can be performed by perineal or transre­ctal aspiration.

Other Medical Therapies

Phytotherapy, using que­rcetin and vermilion pollen extract, is also an option in prostatitis. In addition to this, physiotherapy is also an option, with physiotherapy treatments consisting of prostate or pelvic floor massages. Other options in the treatment of prostatitis include monot­herapy, which may be beneficial in selected patients. Additional thera­peutic options are worth considering, especially for patients for whom antibiotic treatment has not been successful. Each case of prostatitis is differ­ent and requires an individual approach.

Psychological support

Psychotherapy is recom­mended for patients with prostatitis, especially for chronic inflammation, which significantly impairs quality of life. It has been noted that patients with prostatitis are at risk of mental health problems. This is particularly important in patients with seve­re depression and suicidal tendencies.

Summary

Prostatitis is inflammation within the prost­ate gland, which forms part of a man's genitourinary system. Pros­tatitis is a condition that can occur in men of any age, including young men. The cause of acute prostatitis is usually a bacterial infection, but determining the cause of chronic prostatitis can be more difficult. Symptoms of prostatitis main­ly include painful symptoms in the perineal area. Prostatitis undergoing a diagnostic process may require several tests. Prostatitis is a condition whose treatment is mainly based on antibiotic therapy, but other treatment optio­ns must be considered.

Sources

April 3, 2024
10 minutes read
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