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Prof. Dr. Mustafa SOFİKERİM | Urology

Prostatitis

This is an important disease because of the physical discomfort, as well as the diminishing quality of life and negative effects on the psychological state of the patient.
Prostate inflammation (prostatitis) is a condition which emerges because of inflammation of prostate tissue and surrounding tissues. There are several types of prostatitis. Different symptoms may occur in each type. Prostatitis is one of the chronic diseases in urology and its treatment takes a long time. The most important symptom of prostatitis is pain. In some patients, the pain may be mild blunt pain and does not cause much distress, however sometimes it could be severe in some patients. The majority of patients are located somewhere between these two extremes.

Prostate inflammation may be acute or chronic. This condition encountered in all ages can be seen at a much younger age. The cause of inflammation is usually unknown. In some cases, this disease may be the result of an inflammation in the urinary tract, in some cases by an inflammation of the bloodstream from the intestines.

This is an important disease because of the physical discomfort, as well as the diminishing quality of life and negative effects on the psychological state of the patient.



Acute bacterial prostatitis

It is the least visible type of prostatitis. It is easily diagnosed. It is easier to treat than other types of prostatitis. The cause is a sudden developing bacterial infection. It is easy to diagnose because it has significant findings. There is a typical urinary tract infection table. The patient may have high fever, chills and tremors. The patient is admitted to the emergency room or urologist. It can be seen in all age groups..


Symptoms of acute bacterial prostatitis:

  • Painful urination
  • Difficulty in emptying the bladder completely
  • Pain in the lower part of the waist
  • Pain in the abdomen and pelvic region
  • High fever, chills and tremors.


Chronic bacterial prostatitis

Chronic bacterial prostatitis is similar to acute bacterial prostatitis, but symptoms develop more slowly and the patient has less adverse effects. Frequent recurrent urinary tract infections in men should also suggest chronic bacterial prostatitis. It can be seen in every age group, but is more common in middle and young male group.


Chronic pelvic pain syndrome - Abacterial prostatitis (Prostatodini)

This group is the most common form of prostatitis. The real reason is rarely identified. It may originate from an existing infection. It may be caused by pain caused by an inflammation or muscle spasms in the pelvic region. Inflammation in the prostate may not give any symptoms.


General symptoms observed in the patient;

  • Pain in genital areas, groin, pelvic region
  • Frequent urination
  • Pain during urination
  • Pain during ejaculation
  • Ejaculate with different colors or scented
  • Symptoms such as urine coming in dark color and scented.


Asymptomatic inflammatory prostatitis

There is no sign of this type of prostatitis, but there is inflammation in the prostate. The diagnosis is usually made when the patient is being examined for non-prostatic reasons. Although observing imflammation in prostate biopsy is a symptom, the sign of inflammation in the semen or urine refers to asymptomatic prostatitis.


What are the causes of prostate inflammation?

The true and exact agent of prostate inflammation has not been definitively determined by the medical world. There are many theories on this subject. Some types of prostatitis are associated with sexually transmitted inflammation. Acute or chronic bacterial prostatitis resulting from these infections may then lead to persistent (chronic) infection in the prostate. This type of infection passes to prostate through the penis end over the urethra.

The prostate is an organ in the secretory gland, which is a suitable base for infection. There are very thin channels that produce prostate fluid. These channels provide the appropriate environment for the attachment of microorganisms that cause infection.

Bacterial prostatitis is not an infectious disease. The patient does not infect the sexual partner with bacterial prostatitis.

In some cases or after some medical interventions, the risk of developing bacterial prostatitis increases. A patient with a catheter or a urologic operation increases the risk of prostatitis.

Chronic prostatitis and chronic pelvic pain syndromes are caused by atypical microorganisms. Common ones are; Chlamydia may be sexually transmitted microorganisms such as mycoplasma. Pain in the organs around the prostate is common. The nerves around the prostate and the pain throughout the muscles spread to the surrounding tissues in the form of pain reflected pain.


What are the symptoms of prostate inflammation?

Symptoms of prostate inflammation vary depending on where the infection affects. Some patients have no symptoms, and some patients may have symptoms similar to those of urinary tract infections. As there are other diseases that lead to the same symptoms, diagnosis is often delayed. Since the type of prostatitis is affected by the type of treatment, it should be examined by the urology doctor during the diagnosis.
In acute bacterial prostatitis, symptoms usually occur suddenly and are very severe. The patient usually applies to the emergency department.


Symptoms of prostate inflammation:

  • High fever, chills and tremor
  • Severe burning sensation during urine.
  • Difficulty in emptying the bladder completely.

Symptoms in chronic bacterial prostatitis are similar to acute bacterial prostatitis but no high fever:
  • Burning sensation during urine
  • Frequent urination
  • Frequent urine at night
  • Pain in the perineum is common in the testes, in the bladder and in the lumbar region around the breech.

Symptoms such as pain during ejaculation, change in form of ejaculate, and clotted ejaculate can be seen. Chronic bacterial prostatitis may occasionally show increasing and decreasing symptoms.

In chronic prostatitis or chronic pelvic pain syndrome, difficulty in urination, pain and discomfort, pain in the perineum, pain in the testicles and suprapubic area are common symptoms. Ejaculation may cause changes in pain and ejaculate formation. Almost the same symptoms occur with the symptoms of chronic bacterial prostate.


How is Prostatitis diagnosed?

The correct diagnosis is very important, as different treatments for different types of prostate will be applied. Similar diseases such as urethritis, cystitis, prostate enlargement or prostate cancer should be distinguished first. Because the treatment of these conditions is different, the diagnosis should be made correctly.

Many methods should be used to establish the diagnosis accurately. The most important step in the diagnosis of prostatitis is digital rectal examination (rectal examination) or rectal touch. It is a simple examination method. The doctor examines the prostate with the index finger by applying lubricant from the patient's anus. In this examination, the size of the prostate, whether there is inflammation, whether or not contain tumors. The swollen or hard areas in the prostate contain different meanings.

While there is no discomfort during a prostate examination in a normal person, serious discomfort occurs in patients with prostatitis. During the patient's examination, sometimes discomfort and pain occurs and sometimes drainage happens from the urethra. The pain occurring during this examination is short-lived and, in many cases, results in significant relief. Prostate biopsy or transrectal ultrasound may be necessary when a suspicious tissue is detected on the prostate during physical examination. The patient is asked for a PSA test to investigate prostate cancer. Sometimes when PSA test is applied in the acute flaming periods of prostatitis and specifically in bacterial prostatitis, cancer may occur in the test while actually there is no cancer in the body.

During the examination, the prostate fluid can flow through the urethra. A sample is taken from this flowing liquid for microscopic examination. In addition, microbic analysis is conducted by taking the liquid samples such as urine or semen culture produced in this part. In addition, cystoscopic examination of the prostate may be required if ultrasonographic examination showing urinary tract is required. Uroflowmetry test showing urine flow velocity can be used to check if any dysfunction related to infection and edema in prostate has developed.



How is prostatitis treated?

In the treatment of prostatitis, the treatment plan is established after determining the type of prostatitis. Acute bacterial prostatitis is also treated with antibiotics for at least 2 weeks. In some cases, it may be necessary to deposit the patient and administer intravenous antibiotics and serum therapy. Urinary drainage should be provided in case of difficulty in emptying urine and catheter should be applied if necessary. Treatment success in acute bacterial prostatitis is close to 100 percent. Sometimes treatment can be continued for up to 4 weeks when resistant microorganisms are encountered. An important detail during the use of antibiotics is that the duration of use is not less than the time specified by your physician. In case of early discontinuation of the antibiotic due to the symptoms, the disease is rapidly settled and becomes a chronic disease. If the diagnosis is chronic bacterial prostatitis, the patient will need longer duration of antibiotic treatment. This can be in periods ranging from 4 to 12 weeks.

70% of chronic bacterial prostatitis patients recover with this treatment. Sometimes a recurrence of prostatitis infection may occur after a period of 6 months, and the same treatment or a similar alternative is repeated. In patients who do not heal with antibiotic therapy, it may be advisable to use a low-dose antibiotic for a longer period of time. Prostate massage has an important role in the diagnosis of the disease as well as its treatment. Sometimes prostatitis can be treated with prostate massage without antibiotics. In patients who do not respond to treatment, cystoscopic examination may be the preferred method to remove tissue that causes infection in the prostate.

Some foods and beverages have a negative impact on the prostate. These;

Spicy food,
Drinks containing caffeine and acidic gas
Exercises that apply pressure to the perineum area can increase prostatitis problems, especially in cycling.

Prostatitis is not a disease that is never lost when it is placed in the body.

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