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What is prostatitis?The term prostatitis is used in generic way to refer to a condition that includes a variety of alterations that range from a bacterial infection, acute or subacute, nonspecific symptoms of lower urinary tract, characterized primarily by genital, perineal pain symptoms urinary as dysuria (difficult, painful and incomplete expulsion of urine) and urinary frequency (increase in the number of urination during the day(, which tend to be small quantity), or sexual dysfunction in its various manifestations.
Prostatitis affects whoProstatitis is parenchymal urinary tract infection most common in men between the second and fourth decades of life. Even if your diagnosis is difficult because of the limitations of the diagnostic methods and to the confusion with the rest of the prostatic pathology, it would represent the most common urological diagnosis in less than 50 years, and the third most common in over 50 years after benign prostatic hyperplasia (BPH) and prostate cancer. Epidemiological data from North America, Europe and Asia suggest that you between 2 and 10% of adults have symptoms consistent with Chronic prostatitis at some point in their lives.
Separately from different types of prostatitis prevalence of 62% for category III (the most frequent), followed by the I/II with 19% and the fourth with 10%.
Types of prostatitisClinically there are several syndromes, prostate; the National Institute of health of us.UU. (NIH), proposed a classification, which is the existing currently dividing prostatic inflammation syndrome in:
- Category I. Acute bacterial prostatitis (acute infection of the prostate gland).
- Category II. Chronic bacterial prostatitis (recurrent urinary tract infection and chronic prostate infection).
- Category III. Chronic nonbacterial prostatitis / syndrome of chronic pelvic pain (pelvic or perineal pain, 3 months minimum, with variable sexual or urinary symptoms without proven infection).
- Subcategory III. inflammatory chronic pelvic pain syndrome.
- Subcategory III b. non-inflammatory chronic pelvic pain syndrome.
- Category IV. Asymptomatic inflammatory prostatitis (evidence of inflammation on biopsy, sperm, prostatic secretion postmasaje or urination postmasaje in the absence of symptoms).
Acute and Chronic prostatitisThe pathogenesis of acute prostatitis is different from the rest of the chronic entities. In the first there is a true parenchymal acute infection of the prostate gland, usually by usual Uropathogenic (mainly e. coli) and that can cause, if allowed to evolve without treatment, a bacterial dissemination that lead to sepsis of a prostatic abscess that would endanger the patient's life or urinary origin.
Conversely, in the Chronic prostatitis different hypotheses are have been shuffling about its etiology.
Symptoms of prostatitisThe various infectious or inflammatory processes that affect the area uretro-prostato-vesicular present with similar symptoms. The most common urinary problems are represented by Argentinean, dysuria and urinary frequency, both daytime and night, painful urination, and even acute retention of urine.
In the case of Chronic prostatitis syndromes sometimes symptoms are scarce or non-existent, only behaving in semen alterations affecting infertility. At other times, dominated by sexual symptoms such as decreased libido, the total or partial loss of erection, painful ejaculation, premature ejaculation, the hematospermia (blood in the semen) or infertility. But the most common is the existence of pelvic pain and urinary symptoms. The pain is referred to disparate areas: suprapubic, perineal, lumbosacral, scrotal, penile and inner side of the thighs.
Of all clinical signs pointed out, none of them is specific for a particular type of prostate condition, except the acute form of this gland infection, in which the clinic presents a very well-defined characteristics with poor general condition, fever, spontaneous perineal pain, dysuria or urination and, occasionally, acute urinary retention.
Diagnosis of prostatitisDifferent tests you can perform to achieve a diagnosis of prostatitis:
Physical examinationRectal only offers specific features in the case of acute infection. Elsewhere, the rectal examination is normal.
In the case of acute infection, prostate is increased in size, is very sensitive to palpation; pain and a vivo micturition reflex are always present.
Simple touch can cause the emission by the urethral meatus of a purulent exudate.
Crop fractionationIt is the method most widely used in the diagnosis of the prostatitis and also the most reliable. It is based on the separate initial fractions and a half of urine. After that is done a prostatic massage, collecting in another sterile container from the gland secretion. Finally, urine gets postmasaje, that dragged the remains of that remaining in the urethra.
The culture of prostatic secretion or urine postmasaje positivity is Definitory of prostatic bacterial infection, while her negativity can represent a diagnosis of non-bacterial prostatitis or, on the contrary, be a diagnostic fallacy.
This consideration obliges to be repetitive in the methodology or to resort to other types of determinations that complement that and cover its possible diagnostic errors.
Cultivation of semenSemen is a set of secretions in which the portion of prostatic origin accounts for about 30% of the total volume. The demonstration by more than 50% of healthy males of microorganisms in semen culture indicates that this test is ineffective when used alone.
Bacterial prostatitis is characterized by the presence in prostatic secretion, postmasaje urine or semen, one or more gram negative bacteria (e. coli, k. pneumoniae, Proteus, are the most common), which do not grow in the initial fractions or media cultures, or presenting counts higher, at least in a logarithmic fraction.
Gram-positive bacteria are responsible for prostatitis-chronic, including e. faecalis.
When, before the clinical suspicion of Chronic prostatitis, the split culture is negative, may correspond to a false result or one of the remaining forms: nonbacterial chronic/painful pelvic chronic syndrome, or asymptomatic inflammatory prostatitis.
The repetition of the study with negative results leads to the diagnosis of other entities depending on the presence (nonbacterial Chronic prostatitis or type IIIa) or absence (pelvic pain syndrome or type IIIb) of leukocytes in prostatic secretion, semen and urine postmasaje. In prostatitis nonbacterial chronic is considered the possibility of attributing their origin to the presence of Mycoplasmas (especially u. urealyticum, u. parvum, Mycoplasma hominis, Mycoplasma genitalum) and chlamydia. However, the results are diverse, especially in relation to chlamydia, because there is no test that isolation is confirmatory serological.
Prostatic exfoliative cytologyConsists of cytological studies of prostatic secretion, postmasaje urine and semen.
UltrasoundIn the prostatitis are different signs ultrasound though, unfortunately, are not exclusive of them and, therefore, can not be attributed to each type of prostatitis and even, on their own, they are not sufficient to establish the diagnosis of the disease.
Ultrasound observed changes are: enlargement of the prostate, the asymmetry of the prostate lobes, increase in the diameter of the periprostatic venous Plexus, hiperecogenicos in the outer prostate nodules, evidence of intraprostatic lithiasis, presence of periurethral hipoecoicos halos or calcifications between the transitional zone and the capsule.
BiochemistryPSA (prostate-specific antigen) blood total increases in acute prostatitis, normalizing with the resolution. On the contrary, in the remaining categories of single prostatitis it is abnormal in 6-15% of cases. In any case, a serum PSA elevated in a young male suggests prostate inflammation, although, except in the acute form, its diagnostic performance is poor, its repetition being advisable before ordering the implementation of a prostate biopsy.
Other studiesProstate biopsy, immune response and the urodynamic study are testing can also be performed for the study of this disease.
Treatment of prostatitisThere are various treatment options according to the type of prostatitis:
Treatment of acute prostatitis or type IConsists of cephalosporins of 2nd and 3rd generation or fluorquinolonas or aminoglycosides parenterally. If there is urinary obstruction should be added to this indwelling urethral or suprapubic cystostomy. If there is improvement with the foregoing establishes oral treatment for 10 days with doxycycline or fluorquinolonas. If there is no improvement, is performed an ultrasound; If you notice a prostatic abscess is a puncture to drain this fluid + antimicrobial first parenteral and then oral treatment, for 14 days, and if nothing is seen on ultrasound the antimicrobial is changed.
Treatment of chronic bacterial prostatitis or type IIIt consists of oral antimicrobial therapy for 6-12 weeks with doxycycline, trimethoprim, or fluorquinolonas. After the above three situations occur:
- Cure: will be monitoring and controls.
- Relapse or no improvement: administered antimicrobial to full dose for 6 months, and performs the assessment of prostate surgery.
- Recurrence: will be antimicrobial treatment at low doses over 6 months.