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
• Decreased libido, erectile dysfunction

Clinical and laboratory findings

• Tenderness of the prostate on digital examination. However, lack of tenderness does not exclude chronic prostatitis
• Normal urine test results

Treatment Allopurinol for Chronic Prostatitis, Pregabalin for Chronic Prostatitis

• Avoidance of cold: warm clothing, warm sitz baths
• NSAIDs
• Alpha-blockers Alpha-Blockers for Chronic Abacterial Prostatitis
• 5-alpha-reductase inhibitors
• Amitriptyline in gradually increasing doses
• Massage of the prostate and ejaculations sometimes alleviate the symptoms.
• Continuity of the doctor-patient relationship; reassurance of the benign nature of the condition and treatment of eventual 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 fluoroquinolones (starting with e.g. norfloxacin 400 mg twice daily, lowering the dose later on) or sulpha-trimethoprim. 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 fluoroquinolones (starting with e.g. norfloxacin 400 mg twice daily, lowering the dose later on) or sulpha-trimethoprim. If this is not beneficial, do not give repeated courses of antimicrobials.

• Cochrane reviews Chronic Prostatitis - Related Resources