Content

Introduction

Introduction

Prostatitis is inflammation of the prostate (or prostate gland), a gland that is part of the male genital system, located just below the bladder. It is similar in shape and size to a chestnut and tends to enlarge as it ages. The main function of the prostate is to produce and store seminal fluid which is released during ejaculation.

Prostatitis should not be confused with prostate cancer, since it does not depend on tumor processes, nor with benign prostatic hypertrophy which is an abnormal enlargement of the gland. Prostatitis can affect any male person. It is estimated that 50% of patients men suffer from prostatitis at least once in their lifetime, in all age groups, but more frequently in those between 30 and 50 years. Prostatitis can be:

  • acute, caused by a "bacterial infection
  • chronic, caused by a "bacterial infection
  • chronic of non-bacterial origin (or syndrome chronic pelvic pain)
  • asymptomatic
Symptoms

Symptoms

The disorders (symptoms) caused by prostatitis vary according to the type of inflammation but typically are represented by a certain degree of urinary irritation, pain in the lower abdomen, sexual problems, possible decrease in fertility.

There acute prostatitis of bacterial origin it generally manifests itself abruptly and suddenly with the typical signs of genitourinary infection, such as:

  • chills
  • fever
  • pain in the genital area and lower back
  • difficulty, irregularity and pain in passing urine (dysuria)
  • frequency - urgency to urinate, often at night (nocturia)
  • pain or burning when urinating
  • muscle and joint pain, flu-like symptoms
  • presence of bacteria in the urine
  • presence of blood in the urine (hematuria)

There chronic prostatitis of bacterial origin it is characterized by symptoms that appear gradually. In general, the symptoms are less intense and intermittent and periods in which they are not felt alternate with periods in which they are particularly evident.

There chronic prostatitis of non-bacterial origin (or chronic pelvic pain syndrome) presents with symptoms similar to those reported for prostatitis of bacterial origin. However, their appearance is not attributable to anything specifically detectable and at times they can fade over time until they disappear and then reappear without warning. The specific feature of this form of prostatitis is the absence of bacteria in the urine, sperm and urethral swab, as well as fever.

There asymptomatic prostatitis it does not cause pain or discomfort although there are signs of inflammation such as, for example, the presence of white blood cells in semen or prostate fluid.

Causes

Causes

Most of the acute prostatitis of bacterial origin it is caused by fecal bacteria, therefore, coming from the intestine, in particular by Escherichia Coli which is responsible for 50-90% of cases, but also by bacteria of the genus Proteus, Klebsiella, Serratia and Pseudomonas. Other bacteria belonging to the Enterococcus and Staphylococcus species, as well as sexually transmitted microorganisms such as, for example, Neisseria gonorrhoeae, Chlamydia trachomatis and "Ureaplasma urealyticum, are more rarely the cause of prostatitis. In people who have a weakening of the defense system of the" organism (immunosuppressed or immunodeficient) prostatitis can also be caused by other species of bacteria such as Salmonella, Staphylococcus and Mycobacterium. If favored by poor hygiene, weak immune defenses and behavioral factors (such as stress, smoking, alcohol, dietary imbalances and a sedentary lifestyle), these bacteria can go up the urethra and reach the prostate.

There chronic prostatitis of bacterial origin it is generally the consequence of a relapse, that is of an infection of the prostate which, despite the therapy, recurs over time. It is caused by bacteria that are localized in particular areas of the prostate where they are difficult to reach by antibiotics. A factor favoring the chronicization of bacterial prostatitis is the presence of recurrent urinary tract infections.

There chronic prostatitis of non-bacterial origin it is the most common form of prostatitis. It can appear at any age but generally affects men over the age of 25. In this type of prostatitis there are no signs of infection and despite numerous studies, the factors that determine its onset are not yet fully known. There have been several hypotheses about the origin of this disease which include injuries to nerves in the lower urinary tract, caused by surgery or a traumatic event (such as a cycling or horse riding injury), or excessive stress or overload. psycho-physical, heavy work activities and the practice of high impact sports.

There asymptomatic prostatitis is a typical inflammatory disease of the prostate characterized by the presence of white blood cells in the spermatic and prostate fluid, a hallmark of an ongoing inflammatory process. The reasons why this condition is asymptomatic, that is, it does not cause any symptoms, are not yet understood.

Diagnosis

Diagnosis

Detection (diagnosis) of prostatitis is mainly based on patient-reported symptoms (symptoms) and a general physical examination. Once the suspicion of prostatitis is confirmed, laboratory tests of urine and prostatic or seminal fluid must be performed to identify the prostatitis. "possible presence of bacteria. These tests are usually sufficient but, especially in cases of prostatitis of non-bacterial origin, they can be integrated with a urodynamic examination (uroflowmetry), which studies and evaluates the functionality of the bladder and urethra during their storage tasks ( bladder) and release (urethra) of urine, and with transrectal prostatic ultrasound that allows to verify the size and morphology of the prostate. For prostatitis of non-bacterial origin (chronic pelvic pain syndrome and asymptomatic prostatitis) are distinctive signs of disease the presence of white blood cells, even in large numbers, in the sperm and urine.

Therapy

Therapy

The therapy of prostatitis depends on the causes that determine it but their elimination is not always simple and can take a long time. In the case of acute prostatitis of bacterial origin the commonly used therapy is antibiotic therapy. The doctor chooses the type of antibiotic, the dose and the method of administration (posology) most indicated based on the severity of the disease, the patient's state of health and his response to therapy. Since the prostate is scarcely sensitive to the action of antibiotics, the cure of the disease often requires prolonged pharmacological treatment, even for many weeks, using antibiotics / antibacterials capable of penetrating deeply into the prostate tissue.

Antibiotic treatment can be accompanied by the use of other pain relieving drugs (painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs called NSAIDs such as ibuprofen) or to mitigate urinary disorders by relaxing the smooth muscles of the bladder and prostate ( alpha blockers and supplements).

The treatment of chronic prostatitis of bacterial origin it is based, as for the acute forms, on antibiotic therapy but is more complex both for the low sensitivity to the treatment and for the tendency of the infection to recur (relapse). To minimize these risks, it is important to strictly follow the indications on the duration of antibiotic therapy and on the modality of taking the drugs.

Although there is no specific cure for the prostatitis of non-bacterial origin, people who suffer from it can relieve symptoms by using alpha-blocker, pain reliever, and anti-inflammatory drugs. The use of antibiotics for the treatment of prostatitis of non-bacterial origin (chronic inflammatory pelvic pain syndrome) is, on the other hand, a matter of discussion since antibiotic therapy would in any case seem to have given positive results, even in the absence of detectable bacterial infections.

There asymptomatic prostatitis generally does not require any treatment.

Recovery from acute bacterial prostatitis depends on the speed of its discovery and initiation of the appropriate therapy, which almost always resolves the inflammatory state. On the contrary, late diagnosis and neglect of therapies can result in chronic inflammation and various other complications.

In addition to drug therapies, the symptoms of prostatitis can be alleviated by simple remedies such as:

  • hot baths or compresses
  • reduction of foods and drinks that can irritate the bladder (alcohol, caffeine, spices and acidic foods)
  • caffeine-free drinks, especially water, capable of promoting urination and the elimination of bacteria
  • avoid sitting for a long time or playing sports which can irritate the prostate, such as cycling, horse riding and the like
Prevention

Prevention

Maintaining a correct lifestyle is a valuable aid in the prevention of prostatitis. In particular:

  • follow a diet low in fat, salt and spices, prefer the consumption of fruit and vegetables
  • drink plenty of water during the day
  • avoid or reduce the intake of foods that irritate the bladder, such as alcohol, caffeine, spices and acidic foods
  • regularly engage in moderate physical activity
  • keep body weight under control
  • take care of intimate hygiene
  • quickly cure urinary infections
  • carry out at least one urological examination in each of the following three life stages: puberty, adulthood and old age
Complications

Complications

In the absence of adequate treatment or in case of delay in the administration of therapy, acute prostatitis of bacterial origin can become chronic or even be transmitted to nearby organs or tissues (for example testes and epididymis). More rarely, the infection can also spread to the blood (bacteremia) and, in severe cases, to the whole body (sepsis or septicemia). Other possible complications of prostatitis are the inability to urinate and the formation of a pus-filled cavity in the prostate (prostate abscess).

Like many chronic conditions that cause persistent pain that is difficult to treat and tends to recur, chronic non-bacterial prostatitis is often responsible for episodes of depression and anxiety.

In-depth link

In-depth link

Mayo Clinic. Prostatitis (English)

NHS. Prostatitis (English)

National Institutes of Health (NIH). National Institute of Diabetes and Digestive and Kidney Diseses (NIDDK). Prostatitis: Inflammation of the Prostate (English)

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