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Prostate

Although the term prostatitis means inflammation of the prostate, it should be perceived as a syndrome.

25% of patients who have referred with urogenital complaints (burning and stinging sense while urination, awakening for urination at night, difficult urination, waist pain, pain on inguinal region and fatigue etc.) are diagnosed with prostatitis and 50% of men are examined because of prostatitis in any period of their life.

 

However, the microorganism that cause the disease may be detected in 10 to 15% of cases only. The most common agents are; Escherichia coli and Pseudomonas Aureginosa.

 

There are several types of prostatitis;

1- Acute bacterial prostatitis

2- Chronic bacterial prostatitis

3- Non-bacterial prostatitis

3-a) Inflammatous Non-bacterial prostatitis

3-a) Non-inflammatous Non-bacterial prostatitis

4- Asymptomatic prostate inflammation

 

ACUTE PROSTATITIS

Acute prostatitis is the inflammation of the prostate gland.

It is more common in men younger than 50 years.

It may occur because of a bacteria as well as germs may not be responsible from this infection.

The patients have cystitism complaints such as intermediate or severe fever started immediately, tremor, waist pain, perineal pain, frequent urination, immediate urination desire, burning sense while urinating and fatigue. Urethral discharge may be detected. Most of the patients have a difficulty to urinate. Muscle and joint pains are also frequent.

Diagnosis: The pre-diagnosis is determined by observing the pyuria (plenty leukocytes), hematuria (blood cells) and bacteriauria (germ) in simple urine tests. Final diagnosis is determined with;

EXAMINATION OF THE PROSTATE FLUID VB3 (3 cups test) TEST

The patient urinates about 10 ml into the 1st container (VB1), orta akım urine is collected into the second container (VB2) and then the urologist examined the prostate of the patient by fingers (digital rectal examination) and prostate massage is done and the secretion (EPS) obtained is collected into the 3rd slide and the urine after the massage is put into the 4th container.

Containers are examined for leukocytes and bacteria. Whichever is present;

VB1: Inflammation of frontal urinary tract (anterior urethritis)

VB 1-2-3 : Sistitis or upper urinary system infections

EPS and/or VB3: Prostate originated infection.

In tuşe rectal (TR), prostate is edematous, hot and painful.

In ultrasonography, prostate gland seems edematous and infected.

The patients should be hospitalized. Serous fluid and antibiotherapy are started. Also, urinary relaxation agents, anti analgesics and anti-inflammatory treatment are applied. The patients are recommended to prevent constipation, intake fluid more and rest.

Oral antibiotherapy should continue for 30 days even the body temperature has decreased and complaints recovered.

If acute prostatitis cases are not treated well, prostate abscess may develop. Although history of acute prostatitis is not frequent much in patients with chronic prostaitis, it may become chronic.

 

PROSTATE ABSCESS

It is frequently a complication of bacterial prostatitis. It is more common on diabetes mellitus basis.

High fever, cysticite, hematuria, urethral discharge and perineal pain are most common complaints.

In TR: There are fluctuation areas on the prostate.

Diagnosis: May be determined easily with transrectal ultrasonography (TRUS) and computed tomography (CT).

Treatment: Long term antibiotherapy + abscess drainage

CHRONIC PROSTATITIS

Patients with chronic prostatitis have some symptoms such as pain, frequent urination, urgent desire to pass urine, burning sensation while urinating. Fever is absent in general. Plenty leukocytes are detected in the prostatic fluid after touché rectal (prostate examination by finger). It is diagnosed by reproduction in the culture of the discharge obtained by the prostatic massage or urine obtained after the massage while culture performed with the midflow urine sample was negative and by imaging the prostate with ultrasonography. Treatment of the chronic prostatitis is very problematic. Drugs effective on urinary infections may not be effective on chronic prostatitis. A treatment with trimetkoprim- sulfamethoxazole combination for 4 to 16 weeks provide a cure with a ratio of 30 to 40%. Suppressive antibiotic therapies may be necessary for 6 to 8 months for the patients which have continuous positive cultures. However, relapse may occur after discontinuation of the antibiotics. Infection may spread to kidneys and genital organs such as testicles and epididymis. It may even cause male infertility.

NON-BACTERIAL PROSTATITIS

It is the most common prostatitis syndrome. It is an inflammation of the prostate with an unknown cause. There are some symptoms such as pain, frequent urination, urgent desire to pass urine, burning sensation while urinating just like chronic prostaitis. Cultures of these patients are negative and they do not have any urinary system infection. The most common cause in this type of patients is Chlamidya Trachomatis. It is commonly seen with psychological disorders such as anxiety- depression and doxycyclin or erythromycin for 2 to 4 weeks may be useful. Anti-inflammatory and anti-cholinergic agents may be useful for recovery of the complaints.

 

PROSTATODYNIA (ASYMPTOMATIC PROSTATE INFLAMMATION)

Very rare urination complaints and pelvic pain are characteristic for ASYMPTOMATIC PROSTATE INFLAMMATION. Patients are generally between 20 and 45 years old. Inflammation cells are absent in the prostatic secretion and infection is not detected. The cause may be a functional disorder that prevents relaxation of the bladder neck and sphincter during urinating. Psychological problems accompany in frequent.

Antibiotics are not effective. Alpha-adrenergic blockers facilitate the urinating. Diazepam and myorelaxant agents may be useful.