The term prostatitis summarizes an unequal group of disorders that manifest themselves in a combination of mainly irritative or obstructive voiding symptoms and perineal pain. Some cases are from a bacterial infection of the prostate, while others that are more common, non-infectious from a poorly explainable combination inflammatory factors, spasms of the muscles of the urogenital diaphragm, or both originate. The diagnosis is clinically placed, along with a microscopic examination and culture which is obtained before and after prostate massage urine. If the cause is bacterial, is treated with antibiotics. Not Bacterial Prostatitiden be treated with warm sitz baths, muscle relaxants and anti-inflammatory or anxiolytic drugs.
The term prostatitis summarizes an unequal group of disorders that manifest themselves in a combination of mainly irritative or obstructive voiding symptoms and perineal pain. Some cases are from a bacterial infection of the prostate, while others that are more common, non-infectious from a poorly explainable combination inflammatory factors, spasms of the muscles of the urogenital diaphragm, or both originate. The diagnosis is clinically placed, along with a microscopic examination and culture which is obtained before and after prostate massage urine. If the cause is bacterial, is treated with antibiotics. Not Bacterial Prostatitiden be treated with warm sitz baths, muscle relaxants and anti-inflammatory or anxiolytic drugs. The etiology is bacterial prostatitis, but more often nichtbakteriell related. However, the differentiation between bacterial and non-bacterial Prostatitiden can be difficult, especially in chronic prostatitis. A bacterial prostatitis can be both acute and chronic occur and is usually characterized by typical Harnkeime (z. B. Klebsiella, Proteus, Escherichia coli), possibly by chlamydia due. As these pathogens enter the prostate and this fire is unknown. Chronic prostatitis may be caused by encapsulated bacteria that are not eliminated by antibiotics. A non-bacterial prostatitis can be flammable or non-flammable. The mechanism is unknown, but it could be a partial relaxation of the sphincter and a dyssynergische micturition. The thus created increased micturition could one Urininflux into the prostate cause (and trigger an inflammatory response), or lead to increased autonomic activity in the basin and cause chronic pain without an infection. Classification The prostatitis is divided into four categories (see table: “NIH Consensus Classification System” for prostatitis). These categories, different in two urine samples by the clinical findings and the Vorhanden- or absence of signs of inflammation. The first sample is a midstream urine sample. Thereafter, a digital rectal prostate massage is performed and the patient can then immediately water again. The first 10 ml of this urine represent the second sample. The infection is evidenced by growth of bacteria in the urine culture, the inflammation by leukocytes in urine. The use of the term Prostatodynia for prostatitis without infection is not recommended. “NIH Consensus Classification System” for prostatitis number category characteristics urine findings ago Massage Massage After I Acute bacterial prostatitis Acute symptoms of a urinary tract infection leukocytes +/- + +/- + bacteria II Chronic bacterial prostatitis Recurrent urinary tract infections with the same organism leukocytes +/- + +/- + bacteria III Chronic nonbacterial prostatitis / “Chronic Pelvic Pain Syndrome” First of pain, problems emptying the bladder, sexual dysfunction IIIa Inflammatory leukocytes – + Bacteria – – IIIb non-flammable * leukocytes – – Bacteria – – IV Asymptomatic inflammatory prostatitis is zuf Aellig (in urological examination due to other medical conditions such. B. prostate biopsy, semen analysis) detected. Leukocytes – + Bacteria – – * The previous name was Prostatodynia. + / – = possibly present; + = Present; – missing =. Data from Krieger JN, Nyberg L, Nickel JC: NIH consensus definition and classification of prostatitis. JAMA282: 236-237, 1999. Symptoms and signs The symptoms are different for the individual forms, but usually all show a certain degree of Harnwegsirritation or obstruction and pain. The confusion arises in the form of frequent urination and urinary urgency, whereas the obstruction by the feeling of incomplete emptying of the bladder and the urge, shortly after micturition having to urinate again and expressed in nocturia. The pain is typically projected in the dam, but can also at the tip of the penis, in the lower back or are perceived in the testicles. Some patients complain of a painful ejaculation. Acute bacterial prostatitis often causes systemic symptoms such as fever, chills, malaise and muscle pain. The prostate feels soft and – in circumscribed or diffuse points – swollen, hardened or both on. It can develop a generalized sepsis, which is characterized by tachycardia, tachypnea and sometimes hypotension. Chronic bacterial prostatitis is manifested by recurrent episodes of infection with or without complete healing between each relapse. The symptoms and signs are usually weaker than in acute prostatitis. Chronic nonbacterial prostatitis / chronic pelvic-Pain Syndrome Displays as the main characteristic of pain, often in ejaculation. The complaints may be perceived as strong and often significantly impair quality of life. It can irritative or obstructive symptoms occur. On examination, the prostate can be pressure sensitive, but is usually not plum soft or enlarged. Clinical, inflammatory and nichtinflammatorische types of chronic prostatitis / chronic pelvic-Pain syndrome are similar. Asymptomatic inflammatory prostatitis causes no symptoms and is found randomly on the occasion of other studies on prostate diseases when leukocytes are detectable in urine. Diagnostic urinalysis, except perhaps in acute bacterial prostatitis The tentative diagnosis of prostatitis of type I, II or III is clinically detected prostate massage. Similar symptoms can be caused by urethritis, perirectal abscess or UTI. An investigation is useful diagnostically only in acute bacterial prostatitis. Patients with typical symptoms and complaints of acute bacterial prostatitis often have white blood cells and bacteria in a midstream urine sample. A prostate massage to obtain a post-massage urine sample is unnecessary and may even be dangerous for these patients (although this is not proven) because bacteremia can be induced. For the same reason, a rectal examination should be carried out carefully. In patients with fever and severe weakness, confusion, disorientation, hypotension or cool extremities blood cultures should be. In afebrile patients urine tests range before and after massage from the diagnosis. In patients with acute or chronic bacterial prostatitis, which do not respond well to antibiotics, transrectal ultrasonography and sometimes a cystoscopy may be necessary to preclude, prostatic abscess or destruction and inflammation of the seminal vesicles. In patients having a disease type II, III, and IV (non-acute prostatitis), additional tests such as cystoscopy and urine cytology can (although hematuria is present) and urodynamic measurements (if the suspected neurological abnormalities or bladder sphincter dyssynergia is ) be considered. Therapy According to the etiology, the treatment of different acute bacterial prostatitis patients without toxic signs can be treated at home with antibiotics, bed rest, analgesics, weak laxatives and hydration. The therapy with a fluoroquinolone (z. B. Ciprofloxacin 500 mg p.o. 2 times daily or 300 mg p.o. Ofloxacin 2 times a day) is usually effective and can be given as long, until the results of culture and antibiogram present. Is the success of treatment satisfactory, the treatment is continued for 30 days, to prevent chronic bacterial prostatitis. If a sepsis, the patient must be hospitalized and a broad-spectrum antibiotics iv obtained (eg., ampicillin plus gentamicin). With antibiotics is started after the respective cultures were taken, and they will continue until the resistances are known. With good treatment response is i.v. Therapy continued until the patient for 24 to 48 hours is free of fever, then the therapy usually for 4 weeks continued orally. Additional therapies include NSAIDs and potential alpha-blocker (if urination is bad) and supportive measures such as sitz baths. In rare cases, a prostatic abscess, the surgical relief required macht.Chronische bacterial prostatitis, chronic bacterial prostatitis is treated with oral antibiotics such as fluoroquinolones for at least 6 weeks. Developed The choice of medication is determined by the result of culture. An empirical antibiotic treatment only has a low success rate in patients with dubious or negative cultures. Other therapeutic measures comprise the administration of anti-inflammatory drugs, muscle relaxants (z. B. cyclobenzaprine to eventually relieve spasms of the pelvic muscles), alpha-adrenergic blockers and other symptomatic treatment such as Sitzbädern.Chronische prostatitis / chronic-Pelvic Pain Syndrome treatment is difficult and often disappointing. In addition to considering the above treatments anxiolytics were (z. B. SSRIs, benzodiazepines), sacral nerve stimulation, biofeedback, prostate massage and minimally invasive prostate treatments (such as microwave thermotherapy) with varying results eingesetzt.Asymptomatische inflammatory prostatitis Asymptomatic inflammatory prostatitis requires no Therapy. Conclusion A prostatitis may be acute or chronic bacterial infection or a little-known group of disorders that is usually characterized by irritative and obstructive urinary symptoms, urogenital muscle spasms and perineal pain. Patients who have chronic bacterial prostatitis and patients without toxic sign with acute bacterial prostatitis are treated with a fluoroquinolone, and symptomatic measures. Patients with acute bacterial prostatitis and systemic symptoms suggestive of sepsis are instructed and received plus broad-spectrum antibiotics such as ampicillin. Gentamicin. In men with chronic prostatitis or chronic pelvic pain syndrome anxiolytics (z. B. SSRIs, benzodiazepines), sacral nerve stimulation, biofeedback, Prostate massage and minimally invasive prostate treatments (eg. As microwave thermotherapy) should be considered.