Clinica Andrologia IANDROMS

The prostate may suffer inflammation or congestion processes which differ from a benign growth (Benign Prostatic Hyperplasia [BPH]) or malignant transformation of the gland (Prostate Cancer). Prostatitis is generally present in young men and its symptomatology may vary, anywhere from alterations in urination (Pollakiuria or frequent urination, weak urine flow, itching, etc.) to painful ejaculation or pain in the perineal area, penis, testicles, or the inferior region of the abdomen (hypogastrium). When Prostatitis becomes chronic it can become a psychic problem affecting the patient, affecting to varying degrees his quality of life.

Prostatitis is classified into the following categories:

1. Acute Bacterial Prostatitis - Generally accompanied by fever and attributed to the presence of bacteria.
2. Chronic Bacterial Prostatitis - Accompanied by varying symptoms of a recurring nature, with bacteria present in urine and prostatic secretions.
3. Chronic Nonbacterial Prostatitis – Bacteria are not present in urine or in prostatic secretions
   
   3.1 Accompanied by Chronic Pelvic Pain Syndrome (CPPS). White blood cells (leukocytes) are present in urine and prostatic secretions
   3.2 Accompanied by non-inflammatory Chronic Pelvic Pain Syndrome (CPPS). White blood cells (leukocytes) are not present in urine or in prostatic secretions
   3.3 Asymptomatic Inflammatory Prostatitis – Neither bacteria nor white blood cells (leukocytes) are present in urine or in prostatic secretions. No symptomatology present, amounting to a casual finding in the study of prostatic tissue generally obtained in the process of elimination for presence of malignant pathologies of the prostate.
   
   

Acute Bacterial Prostatitis is easily treated with antibiotics and anti-inflammatories, and adequately resolved in most cases. The same cannot be said for Chronic Bacterial Prostatitis, given that resistance may impede treatment or symptoms can recur within short intervals. In such cases treatment is prolonged. The worst-case scenario for both patient and physician is Nonbacterial Prostatitis. In this case a large number of drugs (muscle relaxants, antidepressants, analgesics, etc.) and other treatments (Neuromuscular Therapy [NMT], Thermotherapy, Transurethral Needle Ablation [TUNA] of the prostate, etc.) have been applied, sometimes with discouraging results. In some instances treatment with anti-inflammatories and medicine prescribed for symptoms of benign prostate growth can be applied.

In the presence of such prostatic pathologies it is advisable to avoid urinary retention (keep regular urination), avoid remaining in the seated position for prolonged periods of time, especially as with driving, avoid alcohol and fatty or spicy foods, and keep regular ejaculation in order to drain prostatic gland secretions.

Hence, when considering Prostatitis, a physician/doctor should gather an appropriate clinical history and check the prostate by means of a Digital Rectal Examination (DRE). Urine sediment, the collection of a urine culture, before and after a Digital Rectal Examination (DRE), and prostatic secretion samples will allow the detection of bacteria and white blood cells (leukocytes). A semen culture may also be taken, considering that it is partly composed of prostatic secretions. Also in order, would be the request for a prostate ecography, preferably transrectal, in order to detect anomalies of the same (prostatic, etc.).