Prostate Problems

Prostatitis:  Inflammation of the prostate gland.  This disorder may be acute or chronic.  Acute prostatitis most often results from gram-negative bacteria and is easy to  recognize and treat.  Chronic prostatitis, the most common cause of recurrent Urinary Tract Infection in men, isn't easily recognizable.

Cause:  Primarily from infection by Escherichia coli.  It also results from infection by Klebsiella, Enterobacter, Proteus, Pseudomonas, Streptococcus, or Staphylococcus.

Symptoms:

Acute prostatitis:  Sudden fever, chills, low back pain, myalgia, perineal fullness, arthralgia,  urinary urgency, possibly painful urination, nocturia, cloudy urine.  Rectal palpation of the prostate reveals marked tenderness, induration, swelling, firmness, and warmth.

Chronic prostatitis:  may present no symptoms.  Usually having the same symptoms as an acute prostatitis, but is less severe.
Other symptoms may include:  painful ejaculation, hemospermia, persistent urethral discharge, and sexual dysfunction

Treatment:

Systemic antibiotic therapy

Chronic prostatitis usually requires a long term course of treatment



Epididymitis:  Infection of the epididymis.  The cordlike excretory duct of the testis, is one of the most common infections of the male reproductive tract.  Usually, the causative organisms spread from established UTI or prostatitis and reach the epididymis through the lumen of the vas deferens.  Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis, that spreads through the lymphatic system or, less commonly, the bloodstream.  Epididymitis may spread to the testis itself.

Cause:  Usually results from pyogenci organisms, such as staphylococci, Escherichia coli, and streptococci.  Other causes include:  gonorrhea, syphilis, chlamydial infection, trauma, prostatectomy, and chemical irritation resulting form extravasation of urine through the vas deferens.

Symptoms:

Pain
Extreme tenderness
Swelling in the groin and scrotum

High fever
Malaise

Treatment:

Broad spectrum antibiotic

Analgesics

Ice bag may be applied to the area to reduce swelling and relieve pain

Bedrest may be needed

In older patient undergoing open prostatectomy, bilateral vasectomy may be necessary to prevent epididymitis as a postoperative complication.  When epidymitis is refractory to antibiotic, epididymectomy under local anesthesia is necessary.

Corticosteroids may be prescribed to help counteract inflammation (but their use is controversial)

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