Chronic Prostatitis: State-of-the-art diagnosis and treatment.

What is prostatitis?

Prostatitis is a condition that affects the prostate gland, the walnut-shaped organ that lies just below a man's bladder and surrounds the urethra (the tube through which urine passes). The prostate gland produces most of the fluid in semen.

Prostatitis is sometimes an infection of the prostate, but it can also be an inflammation (swelling) with no sign of infection.

Prostatitis can affect men of all ages. Nearly half of all men have prostatitis-like symptoms at some point during their lifetime.

What are the types of prostatitis?

Types of prostatitis include the following:

  • Acute bacterial prostatitis: a sudden bacterial infection with inflammation of the prostate. This is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition:
    • Have an acute urinary tract infection, and have to urinate more often (including at night);
    • Have pain in the pelvis and genital area;
    • Often have fever, chills, nausea, vomiting, and burning when urinating.

Acute bacterial prostatitis must be treated right away, as the condition can lead to sepsis (bacteria in the blood). If it is not treated, the condition can cause confusion and low blood pressure, and may be fatal. Acute bacterial prostatitis is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids.

  • Chronic bacterial prostatitis: This condition is characterized by repeated urinary tract infections that come from bacteria that chronically infect the prostate gland. There may be burning with urination, urinary frequency, and pain. The diagnosis of this condition is often challenging because it’s often difficult to find the bacteria in the urine, and a sample of prostate fluid needs to be collected and cultured. Treatment includes prolonged antibiotics. Sometimes men are given low-dose antibiotics over a long period of time.
  • Chronic nonbacterial prostatitis/chronic pelvic pain syndrome: This is the most common form of prostatitis (90% of cases). Symptoms include pain (genital, abdominal, pelvic), urinary symptoms, and often erectile dysfunction. Patients have no bacteria in their urine, but may have other signs of inflammation.
  • Asymptomatic prostatitis: In this form, patients have no symptoms but are found to have inflammation in the prostate, either through a prostate biopsy or semen analysis. There is no evidence that this form of prostatitis requires therapy.

What causes prostatitis?

This completely depends on what type of prostatitis it is. Bacterial infection usually enters from the urinary tract. Chronic pelvic pain syndrome may come from an initial infection or injury or from clenching and spasm of the pelvic floor muscles.

What are the symptoms of prostatitis?

You may have no symptoms or symptoms so sudden and severe that you seek emergency medical care.

Symptoms of prostatitis include:

  • Having to urinate often
  • Difficulty urinating
  • Pain or burning during urination
  • Chills and fever
  • Pain that comes and goes in the lower abdomen, around the anus, in the groin, or in the back
  • Pain during ejaculation
  • Pain during sexual intercourse

In addition, the prostate may swell, causing a less powerful urine stream.