Prostatitis
What is it?
Prostatitis is a very common urological condition. In the UK it accounts for almost one quarter of the consultations with Urologists. Prostatitis literally means 'inflammation of the prostate'. It can present as an acute or chronic syndrome with the cause being an infectious or non-infectious process.
What are the symptoms?
The main symptom is pain or discomfort in the area around and between the scrotum and the anus. However, pain may be felt in the lower back, penis, testicles, rectum and inner thighs. There may be lower urinary tract symptoms such a burning sensation in passing urine and a need for frequent urination. Discomfort can occur during or after ejaculation. If it is an acute bacterial infection causing the prostatitis then a fever may be present.
What are the causes?
It is useful to divide prostatitis into three separate syndromes. Namely, acute bacterial prostatitis, chronic bacterial prostatitis and chronic abacterial prostatitis.
Acute bacterial prostatitis: This is often due to bacteria that commonly cause infections of the urinary tract.
Chronic bacterial prostatitis: Patients initially suffer an acute attack that settles with the appropriate antibiotic therapy. However, because the bacteria persist as a nidus in the prostate gland, patients with chronic bacterial prostatitis are characterised by recurrent episodes of infection. They are often asymptomatic between episodes.
Chronic abacterial prostatitis: Patients suffering from this type of prostatitis do not have recurrent urinary tract infections nor have demonstrable bacteria localised to the prostate. The cause of this syndrome is controversial. A number of reasons have been suggested. These include anatomical abnormalities, reflux in the prostatic ducts, high pressure voiding, trauma and even autoimmune processes.
How is it diagnosed?
Assessment of a patient with suspected prostatitis includes taking a history of the relevant symptoms, an examination of the abdomen, external genitalia and the perineum, as well as a digital rectal examination. In acute prostatitis the prostate will be tender and have a boggy consistency to it. Your doctor may also carry out tests to exclude BPH and prostate cancer. With severe inflammation your PSA level may be increased, and therefore may not indicate prostate cancer.
To help with tailoring the therapy you will be asked to produce a mid stream urine sample. You will then have your prostate massaged so that secretions are released. This procedure is similar to a digital rectal examination. The secretions will be collected from the end of your penis. You will then be asked for a second urine sample. This method enables the bacteria to be identified and the correct antibiotic to be prescribed.
There is no specific technique to diagnose chronic abacterial prostatitis. Often the diagnosis comes from the history and exclusion of the tests above. Occasionally other tests such as uroflowmetry, urodynamics or cystoscopy are employed in the evaluation.
What is the treatment?
If there is a bacterial cause for the prostatitis then a course of antibiotics will be prescribed. This is usually for a prolonged course of 4 to 6 weeks. It is imperative that you complete the course. You may also be prescribed an anti-inflammatory drug.
If bacteria are not present an anti-inflammatory drug may help as well as a prostatic massage.
Occasionally an abscess forms. This is a 'walled off' area of pus that antibiotics have difficulty in penetrating. Therefore a small operation may be necessary to drain this collection.
Further information
Your local GP surgery is the best place for you to find information on Prostatitis, especially if you have specific concerns about your symptoms and treatment. The following websites can also be useful sources of information and support.
Prostate Research Campaign UK www.prostate-research.org.uk
UK Prostate Link www.prostate-link.org.uk
