Prostatitis

INTRODUCTION

The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system. The prostate is slightly larger than a walnut. It is surrounding the urethra just below the urinary bladder and can be felt during a rectal exam. It is sheathed in the muscles of the pelvic floor, which contract during the ejaculatory process. The main function of the prostate is to store and secrete a clear, slightly alkaline (pH 7.29) fluid that constitutes 10-30% of the volume of the seminal fluid that, along with spermatozoa, constitutes semen. The rest of the seminal fluid is produced by the two seminal vesicles. Traditionally, the term “Prostatitis” has included both acute and chronic inflammations of the prostate, in which an infective origin is accepted (5-10% of cases), and the term “Prostatitis Syndrome” has included an inflammation of the prostate in which no infective agent can be found (90-95% of cases) and whose origin is multifactorial [behavioral factors (?): sedentary lifestyle, irregular sexual activity, alcool, stress, constipation…] and in most case obscure.
A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.

CLINIC AND RISK FACTORS

The predominant symptoms in bacterial prostatitis (acute or chronic), are Lower Urinary Tract Symptoms (LUTS): frequent need to urinate, difficulty urinating (e.g. weak stream and straining), pain on urination or that increase with urination. In Prostatitis Syndrome the predominant symptom is discomfort or pain in the pelvic region at various locations (perineum, scrotum, penis, lower back). In general prostatitis is an obscure and poorly understood disease because limited physical access to the gland inhibits study. With no certainty about the aetiology, the absence of distinguishing clinical features, non-uniform diagnostic criteria and a protracted treatment course, a plausibile explanation for the condition is far from our grasp. Frequently in prostatitis there is the occurrence of persistent or recurrent episodic “pelvic” pain that is associated with symptoms suggestive of urinary tract or sexual dysfunction. Nowadays we are oriented in considering prostatitis as a “pelvic headache” which can be triggered by a variety of factors:

- Micro-organisms (E. coli, Klebsiella spp., Proteus mirabilis, Enterococcus fecalis, Chlamydia, Ureaplasma, Mycoplama).

- Intestinal dysfunctions, with irregular evacuation and costipation, could represent a favorable element favoring the growth of micro-organisms into the prostate.

- The excessive or continuous consumption of alcool in high dosages represents an important element improving prostatic inflammatory reaction 

- Sedentary life-style, especially if one is seated continuously for many hours.

DIAGNOSIS

A suggested diagnostic urological work-up in prostatitis is: sperm and urine culture, uroflowmetry, eventually four-glass test according to Meares and Stamey.

THERAPY

About prostatitis therapy a causative pathogen is detected by routine methods in only 5-10% of cases, and for whom antibiotic therapy therefore has a rational basis. The remainder of patients are treated empirically with numerous medical (combination treatment of anti-inflammatory, analgesic and alfa-blockers) and physical (local laser therapy) modalities.