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TeuvoTammela

Chronic Prostatitis

Essentials

  • Antimicrobials are indicated in selected cases only.

Definition and aetiology

  • Painful condition in the male genital area, perineum or pelvic area that has lasted for more than 3 months without findings of a bacterial urinary tract infection
  • Usually (in more than 90% of the cases) the patient has sterile prostatodynia. The condition tends to recur several times a year.
  • The disease may be caused by bacteria residing in the prostatic ducts.
  • Definite aetiology still remains unclear (multi-aetiological).

Symptoms

  • The symptoms are similar to those of acute prostatitis but milder and recurring.
    • Voiding difficulties and burning on urination, increased urinary frequency, feeling of incomplete emptying of the bladder
    • Aching pain in the lower abdomen, scrotum, perineum, glans, or inner thighs
    • Feeling of pressure in the perineum, anus or anterior to the anus
    • Painful ejaculation
    • Sometimes bloody semen Haematospermia
  • Decreased libido, erectile dysfunction

Findings

  • Tenderness of the prostate on digital examination. However, lack of tenderness does not exclude chronic prostatitis
  • Normal urine test results (urinalysis and bacterial culture)
  • Chronic prostatitis may occur simultaneously with benign prostatic hyperplasia Benign Prostatic Hyperplasia.

Treatment Allopurinol for Chronic Prostatitis, Pregabalin for Chronic Prostatitis

  • Avoidance of cold: warm clothing, warm sitz baths
  • NSAIDs
  • Alpha-blockersAlpha-Blockers for Chronic Abacterial Prostatitis
  • 5-alpha-reductase inhibitors
  • Amitriptyline in gradually increasing doses
  • Massage of the prostate and ejaculations sometimes alleviate the symptoms.
    • There is no standardized prostate massage, but one method is to massage both lobes from the lateral side towards the midline for a couple of minutes.
  • Continuity of the doctor-patient relationship; reassurance of the benign nature of the condition; diagnosis and treatment of possible depression
  • Antimicrobial drugs are not indicated for prostatodynia.
  • A fractionated urine sample is taken in frequently recurring cases.
    • First, a urine sample is collected at the beginning of the stream. Then the prostate is massaged and a new urine sample is taken immediately to be microscoped and cultured.
    • If bacteria are detected, treat with a 1-2-month course of sulpha-trimethoprim or fluoroquinolones (starting with e.g. norfloxacin 400 mg twice daily, lowering the dose later on). Potential adverse effects associated with fluoroquinolones should be carefully considered before using them.
    • In case of inflammatory chronic prostatodynia the post-massage sample usually contains leucocytes.
  • If the patient has pyuria without bacterial growth, treat once with a 1-to-2-month course of an antimicrobial drug. According to a recommendation by the EMAhttp://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products, fluoroquinolones should not be used for the treatment of non-bacterial chronic prostatitis. If this is not beneficial, do not give repeated courses of antimicrobials.

    References

    • Franco JV, Turk T, Jung JH ym. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2019;(10):CD012552. [PubMed]
    • Franco JV, Turk T, Jung JH ym. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018;(5):CD012551. [PubMed]

Related Keywords

ATC Code:

N06AA09

G04CB01

G04CB02

J01EE01

J01EE02

G04CA01

G04CA02

G04CA04

M01AB01

M01AB02

M01AB05

M01AB08

M01AB15

M01AB51

M01AB55

M01AC01

M01AC02

M01AC06

M01AE01

M01AE02

M01AE03

M01AE11

M01AE17

M01AE51

M01AE52

M01AG01

M01AG02

M01AX01

M01AX17

N02AJ08

N02BA01

N02BA51

N02BA57

J01MA01

J01MA02

J01MA06

J01MA12

J01MA14

J01MA23

J01MA06

Primary/Secondary Keywords