Chronic Prostatitis

Prostatitis is a general ailment in primary care practice. Chronic prostatitis is an infection that needs prompt treatment and accurate recognition. Acute prostatitis is a more general state, and its etiology is more mysterious. pain in the male perineum can arise from both non-infectious and infectious inflammation and can represent pain referred from retro peritoneal structures and low sacral nerve roots.

Chronic prostatitis is readily verified by the onset of fever, dysuria, perineal pain and diminished urine flow. On normal rectal analysis, the gland is found to be enlarged, boggy and exquisitely tender. Abdominal verification generally discloses striking bladder distention. Some men may show toxic at the time of presentation.

In elder people, the signs are normally those of bladder outflow obstruction, often times associated by pelvic pain. Patients complain of urgency, hesitancy, double voiding, loss of stream volume and force, dribbling and frequency. Younger adult more generally complain of dribbling and dysuria, intermittent discomfort in the perineum, testicle or low back. Some people show initially with painful ejaculations, hematospermia or hematuria. Rectal analysis generally discloses an enlarged prostate with flexible amount of asymmetry, tenderness and bogginess. Incompletely treated or untreated chronic  prostatitis is featured by recurrent symptomatic exacerbation, even though these may be separated by long asymptomatic intervals. This has been known as male chronic pelvic pain syndrome.

Both chronic and acute prostatitis can provoke systemic and urinary tract complications. The severely infected gland may drive to bacteremia or parenchymal infection. Rarely, severe infection will develop to a well defined abscess. Chronic infection can generate small prostatic stones, which may work as a nidus for further recurrent symptomatic bouts of infection and inflammation.

Acute prostatitis is readily evident by the clinical presentation and exquisitely tender prostate found on rectal examination. Nevertheless, chronic prostatitis shows a more hard diagnostic issue, generally resembling, in clinical presentation, other general form of urinary outflow tract obstruction, such as benign prostatic hyperplasia, urethral stricture, prostatic carcinoma. The lower urinary tract irritative signs combined with chronic prostatitis may be seen with urethritis, neurogenic bladder, sphincter dyssynergy, bladder carcinoma.

Therapeutic recommendations

Document an infectious organism and the presence of prostatic inflammation, either with EPS examination, the pre massage post massage test or sequential urinary culturing.

When a bacterial agent is identified, treat with a prolonged course of antibiotics, such as ciprofloxacin, levolflosacin, or dobule strength TMS for 4 to 6 weeks. Doses of the fluroquinolones should be adjusted for renal insufficiency.

After treatment, follow closely for return of infection. A second course of antibiotics with the same or an alternative drug for up to 12 weeks may be necessary in partially responsive infections.

For patients who present with the new onset of chronic abacterial prostatitis, consider a 12 week course of doxycycline, erythromycin or carbenicillin indanyl sodium.
Schedule a return 1 to 2 weeks after the completion of treatment to assess the effects of therapy by checking the EPS or VB3.

Consider an alpha adrenergic blocker such as prazosin, doxazosin, terazosin, tamsulosin or alfuzosin to reduce sphincter resistance. Prazosin, doxazosin and terazosin are more likely to cause clinically significant hypotension.

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Posted in Chronic Prostatitis on March 6th, 2011 by admin | | 0 Comments

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