Prostatitis, or inflammation of the prostate, is a common urologic condition that many clinicians find difficult to treat effectively. It has been estimated that up to half of all men suffer from symptoms of prostatitis at some time in their lives.
At the Center for Male Reproductive Medicine in Los Angeles, we will perform a detailed analysis of all of your symptoms and samples, in order to arrive at an accurate diagnosis. Our treatment plan for you will be tailored specifically to your needs, and may include antibiotics, prostate massage, diet modifications, and/or anti-inflammatory medications. We recommend a natural and holistic approach to this often difficult-to-treat problem.
The prostate is a walnut sized gland that is located beneath the urinary bladder (see picture above). It surrounds the urethra (urine, channel) like a donut. When the prostate becomes inflamed it can intrude on urine flow and cause symptoms. The function of the prostate is to produce fluid and enzymes that contribute to the semen and are needed for male fertility.
Prostatitis occurs in four forms:
Form of Prostatitis
|Acute Bacterial||Fever, chills, burning, back, lower abdominal, testicular or groin pain, general malaise or weakness, difficulty with urination||Increased number of white blood cells||Bacterial growth|
|Acute Bacterial||Same as above without fever or chills||Increased number of white blood cells||Bacterial growth|
|Non Bacterial||Same as above||Increased number of white blood cells||No bacterial growth|
|Prostatodynia||Same as above||No white blood cells||No bacterial growth|
Culture diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in the laboratory. On the other hand, microbiologic diagnosis of chronic prostatitis and prostatodynia represents a particular challenge.
Chronic prostatitis has a poor record of treatment success. Recent literature suggests that the condition referred to as chronic non-bacterial prostatitis (prostatodynia) may actually be caused by an infection. Some patients relate the onset of their symptoms to sexual activity--sometimes associated with acute urethritis, while others have indicated no relationship to sexual activity.
The recent literature suggests there is no clear reason to distinguish prostatodynia from non-bacterial prostatitis. During the past few years, molecular data and cultures performed with special equipment strongly suggested that chronic idiopathic prostatitis may actually be a cryptic bacterial infection of the prostate gland that is usually missed or undetected by routine conventional cultures in clinical micro-biology laboratories. The definition of non-bacterial prostatitis and prostatodynia are still controversial.
Because the origin of the illness is still uncertain, the use of antimicrobial therapy may or may not elicit a short-lived relief of symptoms. A number of organisms have been reported to possibly cause this syndrome: Trichomonas vaginalis, Chlamydia trachomatis, mycoplasma, staphylococci, coryneforms and viruses.
These data are controversial since other researchers have failed to demonstrate the presence of these microorganisms in culture or have found them in rare circumstances. The microbiological work up is further complicated by the presence of inhibitory substances known to exist in prostatic secretions and the history of multiple previous courses of antibiotics.
Bacterial infection of the prostrate gland may occur as a result of urethal infection or by reflux of infected urine into prostatic ducks emptying into the urethra. Other possible routes of infection included invasion of rectal bacteria.
There is an association between bacterial prostatitis and urinary tract infection. When the patient has acute bacteria prostatitis, there is an abrupt onset of fever and genitourinary and constitutional signs and symptoms.
Chronic bacterial prostatitis is a more subtle illness which is characterized by relapsing, recurrent urinary tract infections and persistence of bacteria in the prostate glands despite multiple courses of antibiotics.
A third syndrome, chronic idiopathic prostatitis, (sometimes called a bacterial prostatitis, or non bacterial prostatitis and prostatodynia), may or may not be associated with excessive numbers of inflammatory cells in the prostatic secretions and with lack of bacteria in culture. The prostatic secretions from many patients appear normal.
Dr. Werthman’s approach to treating prostatitis takes into account all of these aspects that may be causing it. We begin with an initial consultation (lasting 1 to 1 1/2 hours), including a detailed treatment history and review of records as many of our patients have been to multiple doctors in the past. A physical examination is performed, and urine and prostate fluid are obtained for microscopic examination and culture. The specimens are cultured on special equipment to allow for the growth of rare and hard to culture organisms. These are left for seven days, where most labs discard the specimens after 48 hours if there is no growth. We are currently investigating new and improved growth and culture media to better diagnose prostate problems.
Based on your symptoms and test results, a urine flow test and measurement of bladder residual urine may be recommended. On occasion the prostate and bladder may need to be examined by ultrasound or cystoscopy.
A treatment regimen including prostate massage, antibiotic therapy, diet modification and anti-inflammatory/immune modulation medications is recommended. We believe in a natural and holistic approach to the problem and are advocates of natural, herbal and bioflavinoid therapies as well as conventional treatments.
Surgical therapy is rarely needed to treat prostatitis. Occasionally a blockage of the ejaculatory duct or seminal vesicle prevents the infection from draining and resolving even with the help of the most powerful antibiotics. In these cases the blockage may need to be removed. The same techniques are used in the treatment of certain causes of male infertility. Male infertility specialists therefore have an increased familiarity and experience with these procedures and can recognize when they need to be used to treat prostatitis. Therapy is custom tailored to the individual patient’s needs.