Chronic Prostatitis

Chronic prostatitis is a rare, painful condition in which the prostate is inflamed and/or infected. When symptoms last for 3 months or longer, it is considered chronic. Symptoms may include:

• Discomfort or sharp pain in the groin, testicles, penis, and/or the perineum (the space between the anus and the scrotum)
• Difficulty urinating
• Pain or burning sensation when urinating (dysuria)
• Increased frequency and urgency urinating, especially at night (nocturia)
• Cloudy or bloody urine
• Painful ejaculation (dysorgasmia)
• Flu-like symptoms

OFten a misdiagnosis

Most men labeled with this diagnosis do not have an infection or a prostate disorder, but rather have an undefined pelvic pain syndrome. Men who do have genuine prostatitis require prompt and careful assessment, culture confirmation and close follow up. Left untreated, genuine prostatitis can lead to urinary retention, sepsis, and prostatic abscess.

Prostatitis requires a longer course of antibiotics. Unfortunately, one of the preferred medications has a black box warning stating that it "may cause serious adverse effects". It is therefore essential to confirm this diagnosis by clinical examination, urinalysis and urine culture. If a doctor feels compelled to commit a patient to 4-6 weeks of antibiotics, they better be certain about the identity of the bacteria as well as the susceptibility of that organism to prescribe therapy! These patients also require follow-up testing after the infection subsides. It is important in cases of prostatitis, to exclude a structural abnormality or other predisposing factors, and to confirm the eradication of the bacteria from the urine and/or prostatic secretions.

vista urology's approach to properly diagnosing chronic prostatitis

Our clinic is dedicated to finding the root cause(s) for the symptoms so the therapeutic strategies and prescriptions can be individualized. It is not enough to say, "You have prostatitis". In order to effectively treat the condition, we must formulate the diagnosis by conducting a thorough interview and performing a meticulous, comprehensive clinical exam. A doctor should consider the following questions:

• What predisposed this man to a urinary tract infection or to prostatitis?
• Is the bladder emptying properly?
• Are there risk factors present such as previous straddle injury or surgery which may have caused a urethral stricture (scar within the urinary tube)?
• Are there immunological issues to consider?
• When are imaging studies such as ultrasound or CT scan indicated?
• What are the indications for office cystoscopy?