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The highly specialized and well-trained urologists at Cedars-Sinai Marina del Rey Hospital review patients with prostatitis and advise an individualized treatment plan for each patient. The patients can choose from a number of non-surgical and surgical treatment options available. The treatment that is best for the symptoms and severity of prostatitis will be considered.
Prostatitis is nothing but an inflammation of the prostate gland. There are several types of prostatitis that have been identified and these include:
Asymptomatic inflammatory prostatitis does not have any symptoms. It can be diagnosed when testing for any other urinary tract or reproductive tract disorders. This type of prostatitis does not need treatment since it does not have any complications.
Generally, surgical treatment is not recommended in chronic prostatitis but in conditions where there are recurrent episodes, transurethral resection of the prostate (TURP) or transurethral vaporization of the prostate (TUVP) may be done to get rid of the infection. The nidus of infection may be in the form of prostatic stones, which are refractory to antibiotic therapy. TURP/TUVP procedure is performed after administration of preoperative antibiotic therapy. Thus, surgery is considered as a last resort when all other conservative treatment methods have been ineffective.
Prostatectomy: this surgery is rarely done and when indicated after failure of pharmacotherapy for 1 year, radical transurethral prostatectomy is performed and is considered effective in men with calculus in their prostate.
In some cases, surgery may be required to treat urinary retention caused by chronic bacterial prostatitis. Surgical removal of scar tissue from the urethra eventually improves urine flow and reduces urinary retention.
The symptoms of each type of prostatitis vary depending on the cause and may not be the same for all patients.
Chronic prostatitis. The main symptoms of chronic prostatitis/chronic pelvic pain syndrome can include pain or discomfort lasting 3 or more months in any of the following areas:
The bladder has no capacity to retain urine which causes increased urination and a weak or an interrupted urine stream.
Acute bacterial prostatitis. The symptoms of acute bacterial prostatitis are severe and appear suddenly needing immediate medical care. Symptoms of acute bacterial prostatitis may include:
Chronic bacterial prostatitis. The symptoms are similar to those of acute bacterial prostatitis, but not as severe and usually develop slowly and can last for a longer time. The symptoms are moderate and may occur after previous treatment of acute bacterial prostatitis or a UTI. The symptoms of chronic bacterial prostatitis may include:
It mainly involves confirming the presence of the pathogen in the urine, testing for the presence of bacterial toxins in the blood (septicemia) or checking the emptying of the bladder.
Urine analysis - the urine sample is either examined under a microscope or is used for culture of bacteria. The secretions from the prostrate obtained by doing a prostatic massage can also be used for examination.
Blood examination - this is done to check the complete blood count, levels of electrolytes, blood urea nitrogen (BUN).
Ultrasonography is used to rule out other conditions including calculi.
Cystoscopy is done to check for cancer.
Voiding Cystourethrography (VCUG) is used for detecting the presence of any anatomical defects of the urethra or bladder.
A biopsy can also be done to check for granulomas.
Any factor leading to urinary tract infection can, in turn, cause prostatitis. Improper function or structure of the bladder can cause prostatitis. Catheterization, conditions causing enlargement of the prostate gland, trauma to the pelvic region can also lead to prostatitis.
Major risk factors associated with the development of prostatitis include:
The causes of prostatitis differ depending on the type.
Chronic prostatitis/chronic pelvic pain syndrome: though the exact reason for chronic prostatitis/chronic pelvic pain syndrome is not known, it is believed that a microorganism, but not a bacterial infection, may cause the condition. Often, chemicals present in the urine, immune response to a prior urinary tract infection, and damage to the nerves in the pelvic region may lead to chronic prostatitis.
Acute and chronic bacterial prostatitis: acute prostatitis occurs suddenly and lasts for a shorter time compared to the chronic type that develops gradually and can last for years. Usually, infection occurs if bacteria from the urethra get transmitted to the prostate.
There is no known preventive method to avoid prostatitis. However, by undergoing regular check-ups, suitable treatment can be started immediately if prostatitis is detected. Research is currently going on for a better understanding of the causes of prostatitis and to develop prevention strategies.
Diet: diet does not play any role in causing or preventing prostatitis. For the treatment of bacterial prostatitis, more liquid intake is recommended. It is better to avoid or reduce the intake of substances which cause bladder irritation.
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