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ProstatitisProstatitis is any form of inflammationof the prostategland. Because women do not have a prostate gland, it is a condition only found in men. Prostatitis may account for up to 25 percent of all office visits by young and middle-agemen for complaints involving the genital and urinary systems.
Signs and symptomsInflammation of the prostate leads to pain, often during voiding but also in back and rectum. Frequent urination and increased urgency may suggest a cystitis(bladder infection). Ejaculationmay be painful, as the prostate contracts during emission of semen. DiagnosisIf prostatitis is suspected, urinalysismay show white blood cells, red blood cells, nitritepositivity and microorganisms. This is mainly so in acute prostatitis and asymptomatic inflammatory prostatitis (see below). In the other types, urinalysis may be unhelpful. Prostate specific antigenlevels may be elevated, although there is no malignancy. In acute prostatitis, a full blood countreveals increased white blood cells. Sepsisfrom prostatitis is very rare, but may occur in immunocompromisedpatients; high feverand malaise generally prompt blood cultures, which are often positive in sepsis. ClassificationThere are four forms of prostatitis:
Acute prostatitisAcute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. It is treated with an appropriate antibiotic, such as ciprofloxacin. Chronic bacterial prostatitisChronic bacterial prostatitis (category II in the NIH classification system) is defined as recurrent urinary tract infections in men that originates from a chronic infection in the prostate. In between symptomatic infections, there are bacteria in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. Therapy requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well. These include quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may be helped by the use of alpha blockers (alfusosin, tamsulosin), prostate massage or long term low dose antibiotic therapy. Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder) or prostatic stones. Chronic prostatitis/Chronic Pelvic Pain Syndrome/Pelvic Myoneuropathy (ICD-9-789.09)According to many researchers, this is a poorly understood form of the disease. It is found in men of any age, with the peak onset age at the 30s; symptoms go away and then return without warning. It can range from mild discomfort to totally debilitating. Chronic prostatitis/chronic pelvic pain syndrome/pelvic myoneuropathy may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism. In the noninflammatory form, no evidence of inflammation, including infection-fighting cells, is present. Theories behind the disease include autoimmuneand neurogenic inflammation. In the latter, dysregulation of the local nervous system due to past traumatic experiences lead to inflammation that is mediated by substances released by nerve cells (such as substance P). The prostate itself has nothing to do with this condition, but rather its surrounding pelvic floor and lower abdominal muscles and nerves. Due to the dysfunction of the pelvic floor muscle, sufferers frequently cannot sit continuously for even a moderate amount of time. Asymptomatic inflammatory prostatitisThere is no pain or discomfort but there are white blood cells in the semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer. TherapyAntibioticsare the first line of treatment in infectious prostatitis. Prolonged high-dosed courses are often attempted to eradicate infection in chronic prostatitis. Analgesicsmay be required to control the pain. For chronic nonbacterial prostatitis (pelvic myoneuropathy), the latest type of treatment is called "the Stanford Protocol", developed by Rodney Anderson and David Wise of Stanford University around the year 2000. This is a combination of medication (using tricyclic antidepressant and benzodiazepam), psychological therapy (paradoxical relaxation, a type of progressive relaxation technique developed by Edmund Jacobson during the early 20th century), and physical therapy (Myofascial Trigger Point Therapy on Pelvic Floor and Abdominal muscles, and also yoga type exercises with the aim of relaxing pelvic floor and abdominal muscles). Though not part of the protocol, the use of a biofeedback machine is also recommended for the patient to relearn how to control pelvic floor muscles. The current line of thinking is that Antibiotics resolve most if any, infections in a very short period of time. Further many suffers have no initial trigger other than anxiety. This leaves the balance of the pelvic area in a sensitized condition resulting in a loop of muscle tension and hightened neurological feedback. Hence the newly formed common term, "Chronic Pelvic Pain Syndrome or CPPS." Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as Trigger Points), physical therapy to the area, and progressive relaxation therapy to reduce causitive stress. References
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