Department of Urology

Prostatitis

Overview

Prostatitis literally means inflammation of the prostate. Prostatitis is a frequently painful condition seen in 10-12% of men. It affects mostly young and middle-aged men. Doctors may have difficulty diagnosing prostatitis because the symptoms are not the same for every patient, and many of the symptoms—such as painful or burning urination and incomplete emptying of the bladder—could be signs of another disease. Other symptoms include frequent urination, feeling of a need to urinate urgently, low back pain, burning in the penis with or without urination, pain in the rectum and scrotal area, lower abdominal pain, pain with ejaculation and fever or chills.
The prostate is a gland the size of a walnut that sits at the bottom of the bladder in men, the urethra, the tube that empties the urine out of the bladder runs right through the prostate. The prostate produces the fluid in semen.

Symptoms

The term prostatitis is used to describe four different disorders:

  • Acute bacterial prostatitis is the least common of the four types and can make men very ill. Fortunately, it is the easiest to diagnose and treat effectively. Men with this disease often have chills; fever; pain in the lower back and genital area; urinary frequency and urgency, burning or painful urination and body aches. Bacteria and white blood cells are present in the urine and prostate fluid. The treatment includes antmicrobials.
  • Chronic bacterial prostatitis, also relatively uncommon, occurs when bacteria manage to hide and grow in the prostate. Men have urinary tract infections that seem to go away but then come back with the same bacteria. Treatment usually requires the use of antimicrobials for a prolonged period of time. However, antimicrobials do not always cure this condition.
  • Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of prostatitis. It may be found in men of any age. Its symptoms go away and then return without warning, and it may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and prostatic fluid contain white blood cells usually produced to fight infection, but no bacteria can be found. In the noninflammatory no bacteria or white blood cells can be found.
  • Asymptomatic inflammatory prostatitis is the diagnosis given when the patient does not complain of pain or discomfort but has white blood cells in his prostate fluid and semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.

Diagnosis

The doctor will perform a digital rectal exam (DRE) by inserting a gloved and lubricated finger into the patient’s rectum, just behind the prostate so that the prostate can be examined for any abnormalities.

Bacterial prostatitis is diagnosed by a culture. In a urine culture, the bacteria are allowed to grow so they can be identified and tested for their resistance to different types of antimicrobials.

To confirm the prostate infection, the doctor may obtain three urine samples—two before and one after prostate massage. To perform a prostate massage, the doctor will insert a gloved and lubricated finger into the rectum, as in a DRE, and stroke the prostate to release fluids from the gland. The prostate fluid is also cultured along with the post-massage urine sample which will contain prostate fluid. If bacteria is found in the prostate and third urine specimens that is considered a Uro-pathogen (bacteria that cause urinary infections), this suggests the prostate contains an infection. The doctor may obtain urethral cultures by inserting a tiny cotton tip swab into the end of the penis. This is performed to check for organisms in the urethral that may be causing the symptoms of prostatitis.

If no Uro-pathogens are present it suggest a diagnosis of chronic prostatitis/chronic pelvic pain syndrome. Additionally a urine flow test may be obtained and the bladder checked for urine after urination, which could indicate an obstruction in the urinary tract.

If all other possible causes of a patient’s symptoms are ruled out, the doctor may then diagnose chronic prostatitis/chronic pelvic pain syndrome. To aid in understanding the symptoms the doctor may ask a series of questions from a standard questionnaire, the NIH-Chronic Prostatitis Symptom Index.

Treatment

The bacterial forms of prostatitis are treated with antimicrobials. Acute prostatitis may require a short hospital stay so that fluids and antimicrobials can be given through an intravenous, or IV, tube. After the initial therapy, the patient will need to take antimicrobials for 2 to 4 weeks.

Chronic bacterial prostatitis requires a longer course of therapy. The doctor may prescribe a low dose of antimicrobials for 6 months to prevent recurrent infection. If a patient has trouble emptying his bladder, the doctor may recommend medicine or surgery to correct blockage.

Antimicrobials will not help nonbacterial prostatitis. Each patient will have to work with his doctor to find an effective treatment. Changing diet or taking warm baths may help. The doctor may perscribe a medicine called an alpha blocker to relax the muscle tissue in the prostate. No single solution works for everyone with this condition.

No treatment is needed for asymptomatic inflammatory prostatitis.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at finding treatments for urinary disorders, including prostatitis. Dr. John Krieger has been one of the primary researchers in many of these studies.

This information has been abstracted from the NIH web site for patient education.