Prostatitis : Diagnosis and Treatment
Summary :
◉ Diagnosis of prostatitis
Your doctor will perform a physical exam, review your symptoms, medical history, and order tests to determine the cause. Allows these tests:
◉ During a physical examination, the doctor examines the body and checks whether:
- Discharge from the urethra
- Enlarged or painful lymph nodes in the groin
- A swollen or tender scrotum
- Rectal Examination: The doctor inserts a gloved, lubricated finger into the rectum to check the prostate for pain and swelling. This examination may include prostate massage to collect a sample of seminal fluid.
◉ Medical tests may include :
- Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
- Semen Culture: A semen sample is tested in the laboratory for bacteria and white blood cells.
- PCR for STIs : This test is very accurate and should be done if an STI, such as chlamydia, is suspected to be the cause of prostatitis.
- Blood Test: A blood test measures PSA , a protein made by the prostate. High levels can indicate prostatitis, BPH or prostate cancer.
- Prostatic Massage: The health care provider massages your prostate to drain fluid in the urethra. This fluid is then examined under a microscope to check for inflammation or infection. This test is usually done during a rectal exam.
- Cystoscopy: A thin, flexible tube and viewing device is inserted into the penis and through the urethra. A cystoscopy can look for other urinary tract problems (structural changes or blockages) but does not diagnose prostatitis.
- Transrectal ultrasound: A thin ultrasound probe inserted into the rectum uses sound waves to produce images of the prostate. This test may show prostate abnormalities, abscesses or stones.
1- Diagnosis of acute bacterial prostatitis (ABP)
- Diagnosis is based primarily on history and physical examination, but may be aided by urinalysis.
- Urine cultures should be obtained from all patients suspected of having acute bacterial prostatitis to determine the causative bacterium and its antibiotic susceptibility profile. It is often caused by Escherichia coli, followed by Pseudomonas aeruginosa, Klebsiella, Enterococcus, Enterobacter, Proteus and Serratia. In sexually active men, Neisseria gonorrhoeae and Chlamydia trachomatis should be considered.
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Blood culture is indicated in patients with a body temperature above 38.4°C, a possible blood-borne source of infection (endocarditis), evidence of generalized infection (sepsis) or who are immunocompromised.
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Prostate massage is contraindicated, it increases the risk of bacteremia and, subsequently, sepsis.
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Imaging is only indicated when a prostatic abscess is suspected in a patient with ABP who is not improving with treatment.
2- The diagnosis of chronic bacterial prostatitis (CBP)
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Recognizing chronic bacterial prostatitis can be difficult, as the history and examination are highly variable. It is often diagnosed presumptively and treated empirically with antimicrobials when men have chronic urogenital symptoms (more than 3 months).
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Definitive diagnosis of PBC requires the presence of urinary tract infections and isolation of an etiologically recognized organism from prostatic fluid or urine
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For the location of urinary tract infections, the four-glass test (Meares-Stamey 4 glass test) is still considered the diagnostic standard, but it is cumbersome and little used in the field. Instead, pre- and post-prostate massage urine specimens for analysis and culture may be useful.
3- The diagnosis of chronic prostatitis
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Chronic prostatitis/chronic pelvic pain syndrome is a diagnosis of exclusion and laboratory or imaging studies are indicated to exclude
other potential causes of symptoms.
◉ Differential diagnosis
- Urethritis
- Urinary tract infection.
- Prostate or bladder stones
- Prostate abscess
- Benign prostatic hyperplasia
- Stricture of the urethra
- Prostate cancer
- Bladder cancer
◉ Treatment of prostatitis
Treatment for prostatitis depends on the specific type diagnosed and your symptoms.
◉ Treatment of acute bacterial prostatitis
Acute prostatitis (where symptoms are sudden and severe) is usually treated with painkillers and a 2-4 week course of antibiotics.
The antibiotics prescribed must have good penetration into the prostate tissue (alkaline) and be adapted to the type of bacteria responsible for the infection (ex: fluoroquinolones, tetracyclines, macrolides and trimethoprim).
The doctor may also recommend:
- Avoid the consumption of substances that irritate the bladder: alcohol, caffeine, acidic and spicy foods.
- Drink more fluids to urinate more often. This helps get rid of bacteria faster.
- Supportive measures such as sitz baths
Criteria for hospitalization for acute bacterial prostatitis:
- Signs of bacteremia or sepsis.
- Urinary retention
- Failure of outpatient care
- Severe dehydration and inability to take oral fluids
- Risk factors for resistance
◉ Treatment of chronic bacterial prostatitis
The doctor treats chronic bacterial prostatitis, guided by the culture results, with antibiotics. However, the treatment requires a longer duration (up to 6 months).
He may also use alpha-blockers, these medications help relax the bladder muscles near the prostate and ease symptoms such as painful urination.
◉ Treatment of chronic prostatitis
Nonbacterial prostatitis is difficult to cure, so the goal is to control symptoms. Several types of drugs can be used:
- Long-term antibiotics to ensure prostatitis is not caused by bacteria.
- Alpha-adrenergic blockers help relax the muscles of the prostate.
- Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs), which may relieve symptoms.
- Muscle relaxants like diazepam or cyclobenzaprine can help reduce pelvic floor spasms.
- Hot baths to relieve some of the pain.
- Prostate massage, acupuncture and relaxation exercises.
- Dietary changes to avoid bladder and urinary tract irritants.
- Pelvic floor physiotherapy.
- Surgery may be done in rare cases if medication does not help.
◉ Alternative therapies
- Biofeedback: A biofeedback specialist uses signals to teach you how to control certain body functions and responses, including relaxing your muscles.
- Acupuncture: This pain management treatment involves inserting very fine needles through your skin at different depths in certain areas of your body.
- Herbal Remedies: Some studies suggest that rye (cernilton) pollen extract may help manage pain associated with chronic prostatitis/chronic pelvic pain syndrome. There is insufficient evidence for other herbal remedies for the treatment of pain associated with prostatitis.
◉ Complications
There are several potential complications of prostatitis, which may include the following:
- Sepsis
- Epididymitis
- Abscess
- Chronic prostatitis
- Chronic pelvic pain
- Anxiety or depression
- Sexual dysfunction
- Infertility
- Infection that spreads to the upper pelvic bone or lower spine
- inflammation of the reproductive organs near the prostate
⮜ Prostatitis: Types, Causes and Symptoms
