Prostatitis - Causes, Symptoms and Treatments

Definition:

Prostatitis, inflammation of the prostate gland, may be acute or chronic. Acute prostatitis most often results from gram­negative bacteria and is easy to recognize and treat. However, chronic prostatitis, the most common cause of recurrent urinary tract infections (UTI's) in men, is less easy to recognize. As many as 35% of men over age 50 have chronic prostatitis.

Causes of Prostatitis:

About 80% of bacterial prostatitis cases result from infection by Escherichia coli; the rest, from infection by Klebsiella, Enterobacter, Proteus, Pseudomonas, Streptococcus. These organisms probably spread to the prostate by the bloodstream or from ascending urethral infection, invasion of rectal bacteria via lymphatics, reflux of infected bladder urine into prostate ducts or, less commonly, infrequent or excessive sexual intercourse or such procedures as cystoscopy or catheterization. Chronic prostatitis usually results from bacterial invasion from the urethra.

Signs and symptoms of Prostatitis:

Acute prostatitis begins with fever, chills, low back pain, myalgia, malaise, nausea, vomiting, perineal fullness, and arthralgia. Urination is frequent and urgent. Dysuria, nocturia, urinary obstruction, and decreased sex drive may also occur. The urine may appear cloudy. When palpated rectally, the prostate is tender, indurated, swollen, firm, and warm.

Chronic bacterial prostatitis sometimes produces no symptoms but usually elicits the same urinary symptoms as the acute form but to a lesser degree. UTI is a common complication. Other possible signs include painful ejaculation, hemosperrnia, persistent urethral discharge, and sexual dysfunction.

Diagnosis of Prostatitis:

Characteristic rectal examination findings suggest prostatitis. In many cases, a urine culture can identify the causative infectious organism.

However, firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens: one collected when the patient starts voiding (voided bladder one- VB I); another midstream (VB2); another after the patient stops voiding and the doctor massages the prostate to produce secretions (expressed prostate secretions-EPS); and a final voided specimen (VB3). A significant increase in colony count in the prostatic specimens confirms prostatitis.

Other conditions to consider are benign prostatic hypertrophy, prostate cancer, and epididymitis.

Treatment of Prostatitis:

Systemic antibiotic therapy is the treatment of choice for acute prostatitis. Septra, Bactrim, or a fluoroquinolone is given orally and, if clinical response is satisfactory, continued for 30 days. If sepsis is likely, I.V. gentamicin plus ampicillin may be given until sensitivity test results are known. If test results and clinical response are favorable, parenteral therapy continues for 48 hours to 1 week; then an oral agent is substituted for 30 more days. In chronic prostatitis due to E. coli, fluoroquinolones are given for 3 months.

Supportive therapy includes bed rest, adequate hydration, and administration of analgesics, antipyretics, sitz baths, and stool softeners as necessary. In symptomatic chronic prostatitis, regular massage of the prostate is most effective. Regular ejaculation may help promote drainage of prostatic secretions. Anticholinergics and analgesics may help relieve nonbacterial prostatitis symptoms. Alpha-adrenergic blockers and muscle relaxants may relieve prostatodynia.

If drug therapy is unsuccessful, treatment may include transurethral resection of the prostate, which requires removal of all infected tissue. However, this procedure is usually not performed on young adults because it may cause retrograde ejaculation and sterility. Total prostatectomy is curative but may cause impotence and incontinence.

Special considerations of Prostatitis:

• Ensure bed rest and adequate hydration. Provide stool softeners and administer sitz baths, as ordered.
• As necessary, prepare to assist with suprapubic needle aspiration of the bladder or a suprapubic cystostomy.
• Emphasize the need for strict adherence to the prescribed drug regimen. Instruct the patient to drink at least 8 glasses of water a day. Have him report adverse drug reactions (rash, nausea, vomiting, fever, chills, and GI irritation).