PROSTATITIS

Prostatitis is a common urologic condition that many clinicians find difficult to treat effectively. It has been estimated that up to half of all men suffer from symptoms of prostatitis at some time in their lives. The prostate is a walnut sized gland that is located beneath the urinary bladder (see picture below). The prostate surrounds the urethra (urine, channel) like a donut. When the prostate becomes inflammed it can impinge on urine flow and cause symptoms. The function of the prostate is to produce fluid and enzymes that contribute to the semen and are needed for male fertility. Prostatitis was categorized into four forms:

Culture diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in the laboratory. On the other hand, microbiologic diagnosis of chronic prostatitis and prostatodynia represents a particular challenge. Chronic prostatitis has a poor record of treatment success. Recent literature suggests that the condition referred to as chronic non-bacterial prostatitis (prostatodynia) may actually have an infectious etiology (cause). Some patients relate the onset of their symptoms to sexual activity- sometimes associated with acute urethritis, while others have indicated no relationship to sexual activity.

Figure 6.1

The use of antimicrobial therapy may or may not elicit a transient relief of symptoms. A number of organisms have been reported to possibly cause this syndrome. Trichomonas vaginalis, Chlamydia trachomatis, mycoplasma,

staphylococci, coryneforms and viruses. These data are controversial since other researchers have failed to demonstrate the presence of these microorganisms in culture or have found them in rare circumstances. The microbiological work up is further complicated by the presence of inhibitory substances known to exist in prostatic secretions and the history of multiple previous courses of antibiotics.

Bacterial infection of the prostrate gland, may occur as a result of urethal infection or by reflux of infected urine into prostatic ducks emptying into the urethra. Other possible routes of infection included invasion of rectal bacteria. There is an association between bacteria prostatitis and urinary tract infection. When the patient has acute bacteria prostatitis, there is an abrupt onset of fever and genitourinary and constitutional signs and symptoms. Chronic bacterial prostatiis is a more subtle illness which is characterized by relapsing, recurrent urinary tract infections and persistence of bacteria in the prostatitis glands despite multiple courses of antibiotics. A third syndrome, chronic idiopathic prostatitis, (sometimes called a bacterial prostatitis, or non bacterial prostatitis and prostatodynia), may or may not be associated with excessive numbers of inflammatory cells in the prostatic secretions and with lack of bacteria in culture. The prostaic secretions from many patients appear normal. The recent literature suggests there is no clear reason to distinguish prostatodynia from non-bacterial prostatitis. Since subjects with prostatodynia may at times have excessive numbers of inflammatory cells in there express prostatic secretions. During the past few years, molecular data and cultures perform with special media strongly suggested that chronic idiopathic prostatitis may actually be a cryptic bacterial infection of the prostate gland that is usually missed or undetected by routine conventional cultures in clinical micro-biology laboratories. The definition of non bacterial prostatitis and prostatodynia are still controversial.