Prostatitis

What Is Prostatitis?

The prostate or prostate gland surrounds the beginning of the urethra in men. The gland, which is about the size of a walnut, produces a milky secretion that is part of the seminal fluid. In about 15 percent of men, it becomes infected at least once in life, often between 40 and 50. The diagnosis is prostatitis.

Patients often suffer from pain in the pelvic area and discomfort when urinating. In 30 percent of the cases, the disease is protracted and lasts longer than a year. The level of suffering of the affected men is high, and life's quality is significantly reduced.

The National Institute of Health (NIH) has graded prostatitis syndrome into four categories.

• Category I - acute bacterial prostatitis

Acute bacterial prostatitis is a bacterial infection of the prostate gland associated with severe pain, fever, and difficult micturition (urination).

• Category II - chronic bacterial prostatitis

Chronic bacterial prostatitis is a long-lasting bacterial infection of the prostate with or without symptoms. Common symptoms are a feeling of pressure in the lower abdomen and perineal area and brown coloring of the sperm.

• Category III - chronic prostatitis/ chronic pelvic pain syndrome

Chronic prostatitis or chronic pelvic pain syndrome used to be called "abacterial prostatitis," as no bacterial involvement can be detected. It is graded into an inflammatory form (IIIa) and a non-inflammatory form (IIIb). Typically, patients suffer from chronic pelvic pain.

• Category IV - asymptomatic prostatitis

Inflammation of the prostate is detectable, but the patient has no symptoms.

Causes: Where Does the Patient Get Inflammation of the Prostate Gland?

In acute bacterial prostatitis, the pathogens usually enter the prostate gland via the urethra in ascending order. Commonly involved germs are Escherichia coli and other enterobacteria and enterococci.

If therapy is delayed or ineffective, acute prostatitis can become chronic. Most often, however, chronic prostatitis is caused by urinary tract infections. Prostatolith can also be a source of infection.

Patients with immunodeficiency or certain pre-existing conditions, such as diabetes, have a greater risk of developing bacterial prostatitis.

Various causes can trigger chronic prostatitis or chronic pelvic pain syndrome.

Anatomical changes, such as cysts or adhesions in the prostate area, urethra, bladder-neck, and rectum, can trigger inflammation and the typical pain. In most cases, the reason for the chronic pelvic pain syndrome remains unclear.

In the inflammatory form, inflammatory cells (leukocytes) are detected in the prostate secretion, but no pathogens. There is evidence that difficult-to-prove pathogens such as chlamydia, ureaplasma, and mycoplasma can cause inflammation.

Experts discuss other possible causes of chronic prostatitis:

• Detrusor sphincter dysfunction

This is a bladder voiding dysfunction caused by insufficient relaxation of the bladder neck muscles, which leads to a backflow of urine into the prostate tubules, causing an inflammation.

• Immune dysfunction

In some cases, indications of a malfunction of the immune system and autoimmune processes were found.

• Neuropathic pain

Pain caused by nerve damage is called neuropathic pain. Many nerves run near the prostate. Irritation of these surrounding nerves could lead to typical chronic pelvic pain.

• Psychosomatic dysfunction

Psychological problems can affect the body. Known symptoms are headache, backache, and irritable bowel syndrome.

It is suspected that psychological problems can also trigger chronic pelvic pain syndrome.

Symptoms: What Does an Inflammation of the Prostate Feel Like?

Typical symptoms characterize acute bacterial prostatitis:

• Fever with chills
• A general feeling of illness
• Severe pain in the back and perianal area
• Frequent, difficult, and painful urination
• In severe cases, urinary retention, i.e., the patient cannot pass urine.

Chronic bacterial prostatitis and chronic pelvic pain syndrome cannot be distinguished based on the symptoms.

These are rather unspecific. The following symptoms can occur:

• Pain, especially in the anorectal and genital area, but also in the entire pelvis
• Complaints when urinating
• sexual dysfunction (erection difficulties, loss of sexual drive)
• Recurrent urinary tract infections with the associated complaints
• Brown coloration of the ejaculate due to blood in the sperm
• Phases with no symptoms

Asymptomatic prostatitis is an incidental finding because patients have no symptoms. It is diagnosed, for example, during examinations for infertility or during the clarification of prostate carcinoma.

Diagnosis: How Is an inflammation of the Prostate Recognized?

Acute bacterial prostatitis is noticed by its typical symptoms. During the rectal examination, the doctor will determine the enlargement of the prostate. To clarify an abscess, the doctor may perform an ultrasound examination. The urine contains large quantities of leukocytes (inflammatory cells). The diagnosis is confirmed by the detection of the pathogen in the medium jet urine. The PSA values (values of the prostate-specific antigen) are frequently elevated in the serum.

If chronic bacterial prostatitis is suspected, the doctor will first exclude a urinary tract infection. For this purpose, he compares the germ counts (number of pathogens) of urine, medium-stream urine, prostate secretion, and exprimate urine. Exprimate urine the urine collected after a prostate massage. In prostate secretion or exprimate urine, the germ count must be ten times higher than in urine. Besides, an increased leukocyte count in the prostate secretion must be detected to make the diagnosis.

In chronic pelvic pain syndrome, bacteria cannot be detected in the prostate secretion, but sometimes an increased number of inflammatory cells (leukocytes). If the number of leukocytes is increased, this is called inflammatory prostatitis. If it is not, the prostatitis is classified as non-inflammatory.

The doctor examines the patient rectally and can detect changes in the pelvis and the prostate area and, if necessary, initiate further examinations.

Often the doctor finds no cause for the symptoms. Then he makes the diagnosis based on the typical symptoms of pelvic pain syndrome. Pain in the anogenital region and pelvis that persists or recurs over months is an essential criterion for diagnosis.

The diagnosis of asymptomatic prostatitis is made by detecting inflammatory cells and an increased number of leukocytes in the prostate secretion.

Prostatitis Treatment

After diagnosing acute bacterial prostatitis, the patient is initially treated with antibiotics on an inpatient basis. Modern fluoroquinolones are the treatment of choice. These are initially given intravenously and then orally for four weeks. After a germ determination with a resistance test, the antibiotic is changed if necessary. If the patient cannot empty the bladder sufficiently, alpha-receptor blockers can be used. Alpha-receptor blockers relax the muscles of the prostate and bladder and facilitate the emptying of the bladder.

If the patient is unable to urinate, the doctor inserts a catheter. A disposable catheter can be placed in the urethra, or urine can be drained through a catheter inserted through the abdominal wall above the pubic bone into the bladder.

Chronic bacterial prostatitis is also treated with fluoroquinolones for four weeks. If the bacteria are resistant, therapy with Clotrimazole for three months is recommended. If the disease recurs, long-term antibiotic treatment over six months can also be attempted. Surgical removal of the prostate should only be considered if all therapy attempts fail.

For chronic pelvic pain syndrome treatment, therapy with alpha-receptor blockers over six months is recommended to facilitate bladder emptying. If a functional disorder of the pelvic floor muscles is suspected, muscle relaxants can help relax the muscles. Besides, antibiotic therapy should be carried out since undetectable pathogens are also discussed as a cause of chronic pelvic pain syndrome. As painkillers, the doctor usually prescribes non-steroidal anti-inflammatory drugs (NSAID) or stronger painkillers if necessary.

If there are anatomical changes (e.g., cysts or adhesions), these are treated surgically if possible.

According to current doctrine, asymptomatic prostatitis does not need to be treated. But, there are reasons for therapy:

An infection of the genital tract can lead to infertility. In 6 to 10 percent of cases, an infection of the genital tract is held responsible for male infertility.

In addition, the prostate's chronic inflammation can develop into cancer, the so-called inflammation-associated prostate carcinoma. An increase in PSA levels, which is typical of prostate cancer, is also found in patients with prostatitis. The PSA level can be reduced by treatment with anti-inflammatory drugs and antibiotics.

Risks and Prognosis

The prognosis of acute bacterial prostate inflammation is quite good. The probability of falling ill again is only 13 percent.

Only very rarely do serious complications such as a prostate abscess or blood poisoning occur. Prostatitis can forward the development of prostate cancer. Therefore, timely therapy is important.

The treatment of chronic pelvic pain syndrome is much more complicated and protracted, and a cure is not always possible, as often, no cause for the disease is found. Therefore, the goal is to reduce the symptoms as much as possible by an adapted therapy to regain quality of life.

Which Doctors and Clinics Are Specialized in Prostate Inflammation?

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience.

We help you to find an expert for your disease. All listed doctors and clinics have been reviewed by us for their outstanding specialization in prostate inflammation and are awaiting your inquiry or treatment request.

Sources:

• „Prostatitis und männliches Beckenschmerzsyndrom – Diagnostik und Therapie“, Dtsch. Ärzteblatt, 2009
• „Urogenitale Infektionen als Risiko für männliche Infertilität“, Dtsch. Ärzteblatt, 2017
• Urologie, Hautmann und Huland, Springer Verlag 2006
• RKI, Heft 36 Prostataerkrankungen
• „Prostatitis – Hartnäckig und schwer zu behandeln“, Pharmazeutische Zeitung, Ausgabe 12/ 2007