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Chronic prostate diseases (prostatitis, benign prostatic hyperplasia)

Acute bacterial Prostatitis

Acute bacterial prostatitis is an acute infectious inflammatory process in the prostate gland. The most common causes are Escherichia coli, Proteus spp, Klebsiella spp, Enterococci, Pseudomonas spp, Staphylococcus aures, Bacteroides spp. Infection can get into the prostate from distal urethra or bladder by hematogenous or lymphogic ways.


Symptoms:

  • Symptoms of urinary tract infection such as urination disorder, frequent urination, inability to restrain urination after urging to urinate.
  • Symptoms of prostatitis - pain in the lumbosacral area, pain in the perineum, penis, rectum
  • Symptoms of infection - fever, chills, arthralgia, myalgia, tachycardia.
  • Complications: prostate abscess, acute epididymitis, pyelonephritis, acute urinary retention or sepsis.

Diagnostics:

  • General analysis of the average portion of urine
  • Urine culture with the definition of antibiotic susceptibility
  • Blood culture for sterility with the definition of sensitivity to antibiotics
  • Colon study
Treatment: 
  • Bed rest
  • Rehydration
  • Non – steroidal anti-inflammatory drugs (NSAIDs)
  • Administration of antibiotics
  • In case of the development of acute urinary retention suprapubic, urinary diversion is necessary.
  • Treatment begins with broad-spectrum antibiotics (3rd generation cephalosporin).

    For oral administration of antibiotics are used fluoroquinolones (ciprofloxacin 500mg 2 times a day for 28 days or ofloxacin 200mg 2 times a day for 28 days).
In case of intolerance to fluoroquinolones, trimetoprim prescribed 200 mg 2 times a day for 28 days.
  Further observation: in order to exclude possible complications and suspected prostate abscess, transrectal ultrasound or CT scan is encouraged to fulfil. If an abscess is present, perineal or transurethral area drainage needs to make. After recovery, an examination of the urinary system is necessary in order to eliminate the organic background of recurrence or persistence of infection.


Chronic bacterial prostatitis.

Chronic bacterial prostatitis us a chronic inflammatory process in the prostate gland with optional presence of prostatitis symptoms and a history of recurrent urinary tract infection and the absence of anatomical anomalies. Chronic bacterial prostatitis is much more rare condition than chronic pelvic pain syndrome.
Etiology: caused by predominantly gram-negative pathogens of the urinary system Escherichia coli, Klebsiella spp, P. Mirabilis, Staphylococcus aureus, Enterococcus fecalis.

Symptoms:

Recurrent urinary tract infections, urethritis, prostatitis. 

There is a pain syndrome in the genital and pelvic region.

Urinary disorders.

There is no fever or other systemic manifestations.

Diagnostics:
  1. Revision of the history of the disease. The presence of recurrent urinary tract infection or sexual transmitted diseases and the absence of structural changes.
  2. Physical examination. Colon study. On palpation, the prostate can be compacted and painful in the period of exacerbation. If there is not any changes in the prostate gland, it is necessary to conduct differential examinations with other diseases of the urogenital system and the anorectal area.
Laboratory tests
1)The average portion of urine
2) Bacteriological test of urine
3) Four glasses urine sample Meares-Stamey - “Gold Standart” laboratory test of prostatitis
4) Determine the level of PSA.This indicator may increases in the period of exacerbation and within 6-8 weeks after the disease.
5) TRUS  - transrectal ultrasound. It is a “gold standart” in the ultrasound test of prostate diseases.
6) Uroflowmetry or urodynamic study usually uses to exclude other diseases predisposing to the occurence of inflammation of the prostate.
Treatment. 
Antibacterial therapy prescription based on the obtained results of the causative agent’s definition. Drugs of choice are fluoroquinolones. 
  • Ciproflxacin 500 mg 2 times a day for 28 days
  • Or Levofloxacin 500 mg once a day for 28 days
  • Or Ofloxacin 200 mg 2 times a day for 28 days
  • Or Norfloxacin 400 mg 2 times a day for 28 days
Important to remember! In case of pain in the tendon area, antibiotics should be immediately cancelled.
In case  of intolerance to fluoroquinolones can be used doxycycline 100 mg 2 times a day for 28 days or trimetoprim 200 mg 2 times a day for 28 days. 
Further observation: recommended re- conduct the laboratory microbiological and instrumental tests to prevent recurrence of chronic bacterial prostatitis.
Chronic pelvic pain syndrome. This diagnosis is the diagnosis of exclusion of another pelvic pathology. Next diseases should be excluded: active urethritis, urogenital cancer, urethral stricture,  eurourological diseases with detrusir disfunction.
Clinical options: 

With the presence of inflammatory syndrome. If there is more than 10 leukocytes in prostate secretion test, then the treatment with antibacterial drugs will recommend within 2-6 weeks. Without the presence of inflammatory syndrome. Antibacterial therapy is not appropriate.

Asymptomatic inflammatory prostatitis

without the presence of inflammatory syndrome. Antibacterial therapy is not appropriate.
Asymptomatic inflammatory prostatitis

If there is male infertility, microbiological examination of Neisseria gonorrheaea, Chlamydia trachomatis and before surgical treatment of prostate gland, the treatment recommended.

Additional drugs for the treatment of prostatitis.

  1. Alpha-blockers .They can be used in the case of the presence of difficulty urination from three to 12 months.
  2. Non - steroidal anti-inflammatory drugs.
  3. .Food supplements of plant origin can be effectively used as an auxiliary treatment after the elimination of acute inflammatory process and in remission or after the end of antibiotic therapy from one to 6 months due to their anti- inflammatory, anti-edematous and pain-free effects.

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