Prostatitis
is the
general name for an inflammation of the prostate gland. According
to the National
Institute for Diabetes and Digestive and Kidney Diseases,
prostatitis may account for up to 25 percent of all office
visits by young and middle-aged men with genitourinary complaints.
Prostatitis
may be acute or chronic. Some types of prostatitis are caused
by a bacterial infection and others are not. How the prostate
becomes infected is not clearly understood. It is possible
that infected urine may flow backward from the urethra into
the prostatic ducts of the prostate gland. Rectal bacteria
may also find its way into the prostate.
Prostatitis
is not contagious and is not considered to be a sexually transmitted
disease.
Types of prostatitis
- Acute bacterial prostatitis
The least common type of prostatitis, but the easiest
to diagnose and treat effectively. It is caused by a bacterial
infection and characterized by a sudden and severe onset
of symptoms, including chills and fever; blood in the urine;
lower back pain; pain in the perineum (area between
the scrotum and rectum); or extreme pain, urgency, or difficulty
with urination. Men with these symptoms need to seek medical
attention immediately, as hospitalization may be required.
Acute bacterial prostatitis is treated with antibiotics
and usually responds quickly to treatment.
- Chronic
bacterial prostatitis
Also caused by bacteria and is one of the most common causes
of recurring urinary tract infections in men. Symptoms may
include urinary difficulty, frequency or urgency; pain or
burning with urination; and pain in the lower back, perineum,
penis, scrotum and/or pubic region. These symptoms are usually
not evident until sufficient amounts of bacteria have built
up. Chronic bacterial prostatitis is treated with antibiotics,
but it often recurs.
- Chronic
nonbacterial prostatitis
The most common type of prostatitis, but the least understood.
It is not caused by bacteria; therefore, it cannot be treated
with antibiotics. The cause of chronic nonbacterial prostatitis
is unknown. Its symptoms are similar to those of chronic
bacterial prostatitis: urinary difficulty, frequency or
urgency; pain or burning with urination; and pain in the
lower back, perineum, penis, scrotum and/or pubic region.
Chronic nonbacterial prostatitis may be inflammatory or
noninflammatory and symptoms may go away and return without
warning.
- Prostatodynia
Also known as prostate pain, prostatodynia produces symptoms
similar to nonbacterial prostatitis but tests show no sign
of inflammation, as they do in all types of prostatitis.
Prostatodynia may be caused by muscle spasms in the bladder
neck or pelvis.
Risk factors for prostatitis
Certain conditions or medical procedures increase the risk of
contracting prostatitis. You are at higher risk for getting
prostatitis if you:
- recently
have had a medical instrument, such as a urinary catheter
(a soft, lubricated tube used to drain urine from the bladder),
inserted during a medical procedure
- engage
in rectal intercourse
- have
an abnormal urinary tract
- have
had a recent bladder infection
- have
an enlarged prostate (BPH).
Testing for prostatitis
Testing for prostatitis involves looking for signs of inflammation
or infection in the fluid secreted by the prostate gland and
in the urine. The following tests are used.
- Microscopic
analysis of expressed prostatic secretions (EPS)
The fluid produced by the prostate gland is examined for
infection. This fluid is obtained by prostate massage, which
is also done during a digital rectal examination. The doctor
vigorously massages or presses on the prostate gland to
express, or force, fluid out of the prostate, into the urethra
and out of the body through the penis. These expressed prostatic
secretions (EPS) are collected on a glass slide and examined
under a microscope for signs of infection, such as abnormally
high levels of infection-fighting white blood cells.
Prostate massage is not performed in the case of acute bacterial
prostatitis, which is not only painful but could cause the
release of bacteria into the bloodstream. Because a urinary
tract infection often accompanies acute bacterial prostatitis,
the bacteria would show up in a simple urine test.
- Urinalysis/urine
culture
Prostatitis is most commonly diagnosed through a three-part
urine test which collects urine from the urethra and the
bladder, as well as urine containing fluids from the prostate.
The procedure is as follows:
- The
patient's first ounce of urine comes from the urethra
and is collected in one container.
- The
midstream sample of urine comes from the bladder and
is collected in another container.
- The
patient urinates in a toilet until his bladder is almost,
but not completely, empty.
- Before
the patient completely empties his bladder, he is given
prostate massage (see above), during which expressed
prostatic secretions are collected on a glass slide.
- The
patient completely empties his bladder in the third
container, which contains prostatic fluid as well as
urine.
Test results for prostatitis
Comparing the urine samples to the expressed prostatic
secretions helps determine whether the infection, if any,
is coming from the urethra, bladder, or prostate gland.
- In
chronic bacterial prostatitis, white blood cells will be
found in the urine or prostatic fluid.
- In
nonbacterial prostatitis, the prostatic fluid will have
high levels of white blood cells and show other signs of
inflammation, but no bacteria.
- In
prostatodynia, urine and prostatic fluid will look normal.
The
Prostate Cancer pages of this Web site are part of the Comprehensive
Prostate Cancer Awareness Program (CPCAP), a major regional
effort to reduce the rates of death and illness caused by
prostate cancer in southwestern Pennsylvania. Funding for
CPCAP is provided by a grant from the Commonwealth of Pennsylvania.
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