Prostatitis
Prostatitis: Excerpt from Handbook of Diseases
An inflammation of the prostate gland, prostatitis may be acute or chronic. Acute prostatitis most commonly results from gram-negative bacteria and is easy to recognize and treat. However, chronic prostatitis, the most common cause of recurrent urinary tract infection (UTI) in men, is less easy to recognize. As many as 35% of men older than age 50 have chronic prostatitis.
Causes
About 80% of bacterial prostatitis cases result from infection by Escherichia coli; the rest, from infection by Klebsiella, Enterobacter, Proteus, Pseudo-monas, Streptococcus, or Staphylococcus. These organisms probably spread to the prostate by the bloodstream or from ascending urethral infection, invasion of rectal bacteria via lymphatics, reflux of infected bladder urine into prostate ducts or, less commonly, infrequent or excessive sexual intercourse or such procedures as cystoscopy or catheterization. Chronic prostatitis usually results from bacterial invasion from the urethra. It’s a major cause of recurrent UTI in men.
Signs and symptoms
Acute prostatitis begins with fever, chills, low back pain, myalgia, perineal fullness and discomfort, and arthralgia. Urination is frequent and urgent. Dys-uria, nocturia, and urinary obstruction may also occur. The urine may appear cloudy. When palpated rectally, the prostate is tender, indurated, swollen, firm, and warm.
Chronic bacterial prostatitis sometimes produces no symptoms but usually elicits the same urinary symptoms as the acute form; however, to a lesser degree. UTI is a common complication. Other possible signs and symptoms include painful ejaculation, hemospermia, persistent urethral discharge, and sexual dysfunction.
Diagnosis
Although a urine culture can usually help identify the causative infectious organism and rectal examination findings may suggest prostatitis, firm diagnosis depends on a comparison of urine cultures of specimens obtained by triple-void urine specimens. This test requires three specimens:
❑ one collected when the patient starts voiding (voided bladder one [VB1])
❑ another specimen collected midstream (VB2)
❑ another specimen collected after the patient stops voiding and the physician massages the prostate to express prostate secretions.
A significant increase in colony count in the prostatic specimens confirms prostatitis.
Treatment
Appropriate treatment includes drug therapy and supportive measures. Surgery may be necessary if drug therapy is unsuccessful.
Drug therapy
Systemic antibiotic therapy is the treatment of choice for acute prostatitis. Trimethoprim-sulfamethoxazole, fluoroquinolones, and tetracycline derivatives are used most commonly. If prostatitis is due to a sexually transmitted disease, ceftriaxone and doxycycline or floxacin are used.
If test results and clinical response are favorable, parenteral therapy continues for 48 hours to 1 week; then an oral agent is substituted for 30 more days.
Support measures
Supportive therapy includes bed rest, adequate hydration, and administration of analgesics, antipyretics, sitz baths, and stool softeners as necessary. In symptomatic chronic prostatitis, regular massage of the prostate is most effective. Regular ejaculation may help promote drainage of prostatic secretions. Anticholinergics and analgesics may help relieve nonbacterial prostatitis symptoms. Alpha-adrenergic blockers and muscle relaxants may relieve prostatodynia. Antispasmolytics may be administered for bladder spasms.
Surgery
If drug therapy is unsuccessful, treatment may include transurethral resection of the prostate, which requires removal of all infected tissue. However, this procedure usually isn’t performed on young adults, because it may cause retrograde ejaculation and sterility. Total prostatectomy is curative but may cause impotence and incontinence.
Special considerations
❑ Ensure bed rest and adequate hydration. Provide stool softeners to prevent pain with straining, and administer sitz baths as required.
❑ As necessary, prepare to assist with suprapubic needle aspiration of the bladder or a suprapubic cystostomy.
❑ Emphasize the need for strict adherence to the prescribed drug regimen. Instruct the patient to drink at least 8 glasses of water a day. Have him report adverse drug reactions, such as rash, nausea, vomiting, fever, chills, and GI irritation.
❑ Teach the patient to avoid food and beverages that could increase prostate secretions, such as alcohol and caffeinated beverages and foods.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Asymptomatic inflammatory prostatitis
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Medical Books Excerpts
- Prostatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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