Chronic protastitis

The incidence of chronic prostatitis is high. It has been estimated that about 35% of all men will be diagnosed with a so called prostatitis at some time in their life. The prostatitis syndrome is a chronic bacterial infection in 5% of patients, an abacterial prostatitis in 65% and a so called prostatodynia in 30%.

In chronic bacterial prostatitis, irritable bladder symptoms usually are most prominent. Fever is unusual. Some patients may complain of painful ejaculation and blood in their ejaculate. Rectal palpation, cystoscopy, x-ray and ultrasound findings are unspecific. Prostate stones are commonly found. Chronic bacterial prostatitis is defined as having a significant number of organisms in the prostatic fluid and in the three glass test after prostate massage. The treatment of choice is antibiotics given over a longer period. Local therapy with antiphlogisitcs often brings rapid symptomatic relief.

Abacterial prostatitis is much more common than the chronic bacterial form and has the same symptoms. There is no history of previous infections. The urine is sterile. Leukocytes are slightly elevated in the prostate secrete, but without bacteria. Chlamydia and mycoplasma are considered possible pathogens. A therapeutic trial with tetracyclines is justified and treatment of the sexual partner is mandatory.

So called prostatodynia usually affects younger men in the 2. to 4. decade of life. Supra and retropubic pain, perineal pain, increased urinary urge, imperative urge and painful ejaculation are most prominent. All examinations including urine and prostatic secretions are normal. An adequate therapy is difficult and antibiotics are not indicated. In case of severe pain urospasmolytics can be administered. General measures, such as avoiding abnormal cooling, hot sitzbaths, physical activity, limiting consumption of alcohol, coffee or carbonated beverages may be tried.