Inflammation of the prostate / prostatitis

Causes of Inflammation of the prostate / prostatitis

A distinction between the form of prostatitis is important.
Prostatitis is an acute or chronic non-specific inflammation of the prostate. We distinguish between different forms of prostatitis:

    Acute bacterial prostatitis
    chronic bacterial prostatitis
    nonbacterial prostatitis (no demonstrable pathogens)
    Prostatodynia (also called chronic pelvic pain syndrome).


Chronic diseases affect every other man
The acute bacterial Prostatisis is rare. Therefore, it is believed that more than half of all men in their lives suffer occasionally from a prostatodynia, without agents or inflammatory cells in the affected organ to be found.


The inflammation can be triggered by an ascending infection.
Pathogens can find their way in various ways into the prostate.

    ascending through the urethra. Stenosis within the penis urethra (urethral stricture), outgrowths of the urethra (Urethradivertikel) or phimosis (narrowing of the foreskin), this type of infection is facilitated, because the water can be due to the increased pressure of the urine is pressed into the prostatic transitions.
    hematogenous, when a Einschwemmung of pathogens via the blood from other infected organs takes place.


Symptoms
Or feel very sick and suffer from typical symptoms.
The acute prostatitis is a typical Beschwerdebild.Die victims suffer from:

    Fever
    Chills
    severe malaise
    Pain in the perineal region
    frequent toileting, with little urine comes (pollakiuria)
    uncomfortable urination (dysuria)
    Pain during urination (strangury)
    Pain on defecation

Pus in the urine are often in a weakened urine stream generally also typical, as well as occasional back pain.


Unclear symptoms are often misdiagnosed.
The symptoms of chronic (bacterial and abacterial) prostatitis or prostatodynia other hand, are uncharacteristic. Here, too, disorders of urination in varying degrees. The patients suffer from pain in the perineal region, both the weak and may be more pronounced. Occasionally there is a loss of tactile sensation in the genital area to the pubic bone and the sacrum. Moreover, among the complaints of sexual function disorders in different proportions. Thus, the victims feel pain during intercourse, suffer from premature or delayed ejaculation. It may even lead to loss of erectile function (impotentia coeundi) or come to the loss of libido.


Sometimes, there are no organic causes.
The prostatodynia or the so-called vegetative Urogenitalsyndrom is a chronic non-bacterial prostatitis, exist in the prostate of the outgoing complaints without demonstrable organic cause of pain in the perineal area and radiating to testicles or groin area, burning and itching in the urethra.

 Diagnosis
Bacteria typical symptoms and findings facilitate the diagnosis of acute illness.
The detection of the rarer acute prostatitis is simple and is based on the characteristic symptoms. The palpation by the physician is an enlarged, tender prostate. By an ultrasound examination will be clarified whether a prostatic abscess is present. An abscess is a suppurative Gewebeeinschmelzung, which is common in acute prostatitis. On examination of the urine, there are inflammatory cells (leukocyturia), bacterial and desquamated cells. The three-glass test is positive.


In chronic disease of the digital rectal examination is often unremarkable.
In the chronic form may be indicative of rectal palpation only factor in resurgence of a new infection. Otherwise, the digital rectal examination may be normal. The ultrasound image can show calcium deposits when the inflammation was caused by prostatic stones.


For the therapy, it is crucial whether bacteria can be found or not.
It is important to distinguish whether it is a chronic bacterial, chronic nonbacterial prostatitis or Prostatisis. For the detection of chronic bacterial prostatitis, one uses the four-glass test, where the first Urine, midstream urine, prostatic secretions and urine of prostate are compared. While it is contraindicated in acute prostatitis, to massage the prostate to obtain secretion, since it could delay the germs into the bloodstream, this is needed in chronic prostatitis. Lack of detection of pathogens in the prostatic, it is a prostatodynia. In prostatic fluid, the normal components such as zinc, magnesium and calcium decreased in their concentrations may be increased and the pH value.


Anatomical changes are investigated with imaging techniques.
To exclude changes in the anatomical structures, we often used the uroflowmetry. A residual urine and further clarification may be through a Miktionszystourethrografie.


Therapy
The acute prostatitis is treated with antibiotics for at least 4 weeks.
In acute prostatitis, hospitalization may be necessary. It will be administered antibiotics, especially quinolones (bactericidal antibiotics), possibly cephalosporins (broad-spectrum antibiotic) and aminoglycoside antibiotics. The duration of therapy should be at least 4 weeks. It is important to prevent the development of chronic bacterial prostatitis. Inpatient treatment is often required only at the beginning. Further therapy done at home. The accused should therefore be informed of the potential consequences if he stop taking the antibiotics too soon.


Bed rest and pain management are very important.
In addition, bed rest and have an adequate pain therapy is of great importance. Even mild laxatives are used occasionally, as in an inflamed prostate, bowel movements can often be very painful.


Prostatic are usually treated surgically.
In the study is a prostatic abscess was found, it will operate normally. The abscess may be punctured or split depending on the location and size. This is mostly used to control an ultrasound. The collection of pus must be removed in any case.


3 to 6 months of antibiotics in bacterial chronic diseases are not always sufficient.
The treatment of chronic prostatitis is much more problematic than those of acute bacterial prostatitis. In chronic bacterial prostatitis long term treatment is conducted with specific antibiotics. The treatment lasts 3 to 6 months. Only after about a year can be determined whether the pathogen was completely destroyed. To the prostatic fluid is examined bacteriologically. Found there is no agent, then as the disease cured.


The prostatodynia should be considered a psychosomatic disease.
When abacterial prostatitis without proven pathogen and in the prostatodynia there is still no causal therapy. The goal of treatment in this case, to alleviate the discomfort. These are recommended sitz baths and anti-inflammatory drugs, anticholinergics or alpha-blockers in acute-phase treatment of pain. It is difficult in this context that in many patients the foundation is a psychosomatic ailment that is "manifested in the prostate". This includes stress, sexual problems, expectation anxiety and problems with the partner to the causes. Psychotherapy, stress reduction and biofeedback are means that in many cases provide significant relief.