Chronic prostatitis and chronic pelvic pain syndrome: a new consensus guideline
Prostatitis is any form of inflammation of the prostate gland. Because women do not have a prostate gland, it is a condition only found in menalthough women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate, and may cause symptoms.
The term prostatitis refers in its strictest sense to histological microscopic inflammation of the tissue of the prostate gland, although historically the term has loosely been used as a rubric die behandelt Prostatitis in Astrachan describe a set of quite different conditions.
To try to remedy this, the NIH devised a new classification system in Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine.
There may be discharge die behandelt Prostatitis in Astrachan the penis. Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Common bacteria are E. This can be a medical emergency in some patients and hospitalization with intravenous antibiotics may be required.
A full blood count reveals increased white blood die behandelt Prostatitis in Astrachan. Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultureswhich are often positive in sepsis.
Antibiotics are the die behandelt Prostatitis in Astrachan line of treatment in acute prostatitis Cat. Antibiotics usually resolve acute prostatitis infections in a very short period of time. Appropriate antibiotics should be used, based on the microbe causing the infection. Some antibiotics have very poor penetration of the prostatic capsule, others, such as CiprofloxacinCo-trimoxazole and tetracyclines penetrate well.
Severely ill patients may need hospitalization, while nontoxic patients can be treated at home with bed rest, analgesics, stool softeners, and hydration. Full recovery without sequelae is usual. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of men, we seldom found chronic die behandelt Prostatitis in Astrachan prostatitis.
It is truly a rare disease. Most of those were E-coli. In chronic bacterial prostatitis there are bacteria in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid expressed prostatic secretions or EPS which are obtained by the doctor doing a rectal exam and putting pressure on the prostate. Die behandelt Prostatitis in Astrachan no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria.
Prostate specific antigen levels may be elevated, although there is no malignancy. These include quinolones ciprofloxacin, levofloxacinsulfas Bactrim, Septra and macrolides erythromycinclarithromycin. The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial. Symptoms may wax and wane. Pain can range die behandelt Prostatitis in Astrachan mild discomfort to debilitating.
Pain may radiate to back and rectum, making sitting difficult. Dysuriaarthralgiamyalgiaunexplained fatigueabdominal pain, constant burning pain in the penis, and frequency may all be present. Frequent urination and increased urgency may suggest interstitial cystitis inflammation centred in bladder rather than prostate. Some patients report low libido, sexual dysfunction and erectile difficulties. Theories behind the die behandelt Prostatitis in Astrachan include autoimmunityfor which there is scant evidence, neurogenic inflammation and myofascial pain syndrome.
In the latter two categories, dysregulation of the local nervous system due to past traumatic experiences or an anxious disposition and chronic albeit unconscious pelvic tensing lead to inflammation that is mediated by substances released by nerve cells such as substance P.
The prostate and other areas of the genitourinary tract: bladder, urethra, testicles can become inflamed by the action of the chronically activated pelvic nerves on the mast cells at the end of the die behandelt Prostatitis in Astrachan pathways.
Similar stress-induced genitourinary inflammation has been shown experimentally in other mammals. Prostatitis researcher Dr Anthony Schaeffer commented in a editorial of The Journal of Urology that: "It is well recognized that even if pathogenic bacteria are present in the prostate, as in men with established chronic bacterial prostatitis, they do not cause chronic pelvic pain unless acute urinary tract infection develops.
Taken together, these data suggest that bacteria do not have a significant role in the development of the chronic pelvic pain syndrome. The clinical observation that antimicrobial therapy reduces symptomatology in men with chronic pelvic pain syndrome is being tested in a double-blinded NIH controlled study. Since antimicrobials may have anti-inflammatory activity, it is possible that these drugs may benefit the patient by reducing inflammation rather than eradicating bacteria.
The bacterial infection theory that for so long had held sway in this field was again shown to be unimportant in another study from the University of Washington team led by Dr Lee and Professor Richard Berger. The study found that one third of both normal men and patients had equal counts of similar bacteria colonizing their prostates.
In the inflammatory form, urine, semen, and other fluids from the prostate contain pus cells dead white blood cells or WBCswhereas in the non-inflammatory form no pus cells are present. Recent studies have questioned the distinction between categories IIIa and IIIb, since both categories show evidence of inflammation if pus cells are ignored and other more subtle signs of inflammation, like cytokinesare measured.
Experimental tests that could be useful in the future include tests to measure semen and prostate fluid cytokine levels. Various studies have shown increases in markers for inflammation such as elevated levels of cytokines, myeloperoxidase, and chemokines. This is a combination of medication using tricyclic antidepressants and benzodiazepinespsychological therapy paradoxical relaxation, an advancement and adaptation, specifically for pelvic pain, of a type of progressive relaxation technique developed by Edmund Jacobson during the early 20th centuryand physical therapy trigger point release therapy on pelvic floor and abdominal musclesand also yoga-type exercises with the aim of relaxing pelvic floor and abdominal muscles.
III prostatitis may have no initial trigger other than anxiety, often with an element of Obsessive Compulsive Disorder or other anxiety-spectrum problem. This is theorized to leave the pelvic area in a sensitized condition resulting in a loop of muscle tension and heightened neurological feedback neural wind-up. Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area die behandelt Prostatitis in Astrachan referred to as trigger pointsphysical therapy to the area, and progressive relaxation therapy to reduce causative stress.
Biofeedback physical therapy to relearn how to control pelvic floor muscles may be useful. Aerobic exercise can help those sufferers who are not also suffering from Chronic Fatigue Syndrome CFS or whose symptoms are not exacerbated by exercise.
Specifically patients with gluten intolerance or celiac disease report severe die behandelt Prostatitis in Astrachan flares after sustained gluten ingestion. Patients may therefore find an exclusion diet helpful in lessening symptoms by identifying problem foods. Studies are lacking in this area. There is die behandelt Prostatitis in Astrachan substantial list of medications used to treat this disorder.
Alpha blockers tamsulosinalfuzosin are moderately helpful for many men with CPPS;  duration of therapy needs to be at least 3 months. Pollen extract Cernilton ] has also been shown effective in randomized placebo controlled trials.
Commonly used therapies that have not been properly evaluated in clinical trials are dietary modification, gabapentin, and amitriptyline. At least one study suggests that multi-modal therapy aimed at different pathways such as inflammation and neuromuscular dysfunction simultaneously is better long term than monotherapy. These patients have no history of genitourinary pain complaints, but leukocytosis or bacteria have been noted during evaluation for other conditions.
Diagnosis is through tests of semen, Die behandelt Prostatitis in Astrachan or die behandelt Prostatitis in Astrachan that reveal inflammation in the absence of symptoms.
No treatment required. The results of these tests were significantly different in prostate cancer and category IV prostatitis in one study. From Wikipedia, the free encyclopedia. Main article: Pelvic myoneuropathy. Die behandelt Prostatitis in Astrachan J. Shoskes D. A female prostatitis?
West J Med. A national survey of physician visits. J Urol. Andrologia 35 5 : J Urol 4 : PMID Tech Urol 5 3 : Prostate Cancer Prostatic Dis 2 3 : Hinyokika Kiyo 36 9 : Urology 67 4 : Retrieved Annu Rev Med. Zhonghua Nan Ke Xue. J Gen Intern Med. Eur Urol.
Ann Intern Med. J Androl. Hinyokika Kiyo. Urology 67 1 : Curr Urol Rep. Hum Reprod Update. Stancik I et al. Category : Male reproductive system. Namespaces Page Talk. Views Read Change Change source View history. In other projects Wikimedia Commons. This page was last changed on 31 Augustat See Die behandelt Prostatitis in Astrachan of Use for details.