Prostatitis: symptoms, causes and diagnosis

By Cristiano Antonino On Oct 17, 2022

Prostatitis is a disease of the prostate, characterised by severe urinary symptoms, typical of inflammation or infection of the prostate gland

The anatomical part of the human body that is affected by the phlogistic process, most often of bacterial origin, is the prostate, a gland that actively participates in the formation of seminal fluid, and its significant phlogistic state could also lead to a fertility problem.

In fact, about 18 – 20% of all male infertility is attributable to chronic inflammatory states of the prostate gland and seminal vesicles.

The prostate, in fact, produces 30% of the total seminal fluid, enriching it with essential substances that are vital for the survival and quality of spermatozoa.

Inflammation of the prostate, nicknamed by many the ‘Reservoir of Infections’, affects about 38% of sexually active men and is often disabling, despite the fact that there is little explanation for it in the scientific literature.

Many patients suffering from this annoying and disabling disease, which is nothing more than an inflammation, followed many times by an infection of the prostate gland, are treated as ‘imaginary patients’ or even have to live with it.

This is not the case: there are, in fact, various therapies for the treatment of prostatitis and rules for its prevention.

Prostate inflammation: causes and risk factors

Besides the presence of microorganisms, other risk factors come into play in the genesis of inflammation:

Age, as prostate disorders occur more in men over 60, although they can also occur after the age of 40;
Bowel dysfunction, involving irregular evacuation, can promote pelvic congestion and subsequent prostate inflammation;
An irregular, unbalanced diet, accompanied by heavy intake of hard liquor, can lead to intoxication, a phenomenon that promotes the onset of inflammation;
Smoking, which is toxic both directly and indirectly through altering the tissue’s ability to repair and defend itself;
The lack of muscular strain on the prostate region, with sedentariness or ejaculatory abstinence, which reduces the secretory work of the gland;
Excessive muscular strain, such as running, cycling or certain types of work, which subject the body to continuous vibrations;
The weakening of the body’s defensive capacities, brought about by dysfunctions of the immune system or by stress and emotional tension, which favour the spread of infection.

How widespread is Prostatitis?

Acute or chronic prostatitis, also known as chronic pelvic pain syndrome, very frequently of bacterial origin, mainly affects male patients under 60 years of age, who present with irritative-obstructive urination disorders, suprapubic and perineal discomfort, a premature and unpleasant if not painful ejaculation, and a decrease in sexual desire which, most often, is also associated with a decrease in erection.

It has been observed that this pathology is also greatly influenced by the patient’s lifestyle and eating habits: in fact, it favours smokers and people who eat mainly carbohydrates and cheese, and who during sexual activity practice coitus interruptus and have sex with multiple sexual partners.

The different forms of prostatitis

Prostatitis can present itself in Bacterial or non-Bacterial, Acute and Chronic forms.

Acute Bacterial Prostatitis is usually a fast-onset febrile disease, characterised by severe urinary symptoms, in which the gland in question on rectal examination is swollen, enlarged and painful.

Chronic Bacterial Prostatitis, on the other hand, is characterised by persistent and recurrent Bacterial Infections, caused by Bacteria, Fungi and Viruses, which, despite several repeated courses of antibiotic therapy, are not finally eradicated.

Such patients generally present with a long history of irritative symptoms, associated with urination disorders that have arisen almost suddenly.

It can be said, however, that prostatitis is a disease caused, almost always, by microbial agents that may or may not be detectable by laboratory tests.

Chronic non-bacterial prostatitis. This is the most common form. The symptoms are similar to those of chronic bacterial prostatitis with the exception of fever, which is generally not present, and the presence of bacteria in the urine or sperm fluid.

Depending on the presence or absence of white blood cells in the urine or sperm fluid, one speaks of chronic non-bacterial inflammatory prostatitis and chronic non-bacterial non-inflammatory or dysfunctional prostatitis.

Asymptomatic inflammatory prostatitis. This type of prostatitis is characterised by the absence of specific and lasting symptoms and is therefore not diagnosed.

The discomfort, such as an occasional erectile deficit, mild or moderate dysfertility or mild or moderate hypersensitivity of the glans, is of reduced intensity and the inflammation is generally overlooked.

This type of prostatitis seems to be associated with other infectious agents and structural abnormalities of the urinary apparatus, but also with specific lifestyles (a job that subjects the prostate to continuous vibration or efforts made with a full bladder).

Symptoms of prostatitis

The Symptomatology of prostatitis consists mainly of

urination disorders including: imperative urination, nocturia, decrease in the power of the urinary stream, sensation of incomplete bladder emptying, terminal urinary dribbling;
painful state: burning urination – inguinal discomfort with a feeling of tight sleep – scrotal discomfort – perineal pain – suprapubic or bladder discomfort – coccygeal pain – anorectal discomfort – rectal discomfort (can however also be caused by the presence of haemorrhoid glands)
problems in the sexual sphere: decreased sexual desire – erection deficit – premature and painful ejaculation before, during and after intercourse – haemospermia, blood in the seminal fluid
possible decline in fertility due to chemical-physical changes in the prostate secretion, with alterations in the coagulation and subsequent liquefaction of sperm and changes in both the number and motility of spermatozoa.
Painful symptoms are those that the patient feels most easily and are essential for diagnosing prostatitis.

These become more evident as the seasons change and are:

Bilateral or unilateral testicular pain;
Sense of discomfort and heaviness in the Perineum area (area from the testicles to the anus);
Bilateral inguinal pain, like feeling of tight briefs;
Feeling of heaviness in the anus, desire to defecate, but no evacuation.
Acute pain and burning at the tip of the penis, during and after ejaculation.
Suprapubic pain, at the level of the bladder, with constant sensation of incomplete urinary emptying.

Symptoms of the sexual sphere

The symptoms that will be listed below usually occur in patients with chronic prostatitis, who have been suffering from this disease for many years and who present with repeated recurrences.

They also present, given the persistence of the disease, major psychological problems such as,

performance anxiety
Decline in sexual desire;
Slight decrease in erection;
Presence of haemospermia, traces of blood in the semen (presence of stones in the ejaculatory ducts, visible through TransRectal Bladder-Prostatic Ultrasound);
Premature ejaculation (usually caused by the presence of microcalcifications at the level of the Veru Montanu, and in the Para-Urethral area, visible and diagnosable, through the execution of the Trans-Rectal Bladder-Prostatic Ultrasound).

Urinary symptoms

The urinary symptoms that will be mentioned below can occur in both patients with Benign Prostatic Hypertrophy and Prostatitis due to detrusor muscle overactivity.

What differentiates them and directs us to make a differential diagnosis is the time of onset, late for Prostatic Hypertrophy, fast for Prostatitis.

Furthermore, while Prostatic Hypertrophy represents a pathology of obstructive origin, Prostatitis, on the other hand, is of phlogistic/infectious origin.

A situation of obstructive origin, however, can also be found in young patients, as they may show, on a phlogistic or congenital basis, a stiffness of the bladder neck, called Bladder Neck Sclerosis.

Hesitation upon urination;
Imperative and frequent urination, with emission of little urine, pollakiuria;
Terminal dribbling;
Nocturnal urination, nocturia;
Decreased urinary output;
Sensation of incomplete urinary emptying.

The diagnosis of prostatitis is made by:

urological examination with digito- rectal exploration;
bladder-prostate ultrasound t.r. or s.p. with relative dynamic urination study;
evaluation of the post-micturition residual;
uroflowmetry with assessment of post-micturition residual.

The targeted microbiological examinations for the pathology in question are

urine test 1′ cast with culture and ABG for common germs, mycetes, protozoa, mycoplasmas, chlamydia trach.
spermioculture with ABG for common germs, mycetes, protozoa, mycoplasmas, chlamydia trach.;
urethral swab with culture and ABG for common germs, mycetes, protozoa, mycoplasmas, chlamydia trach. and gonococcus.

In the presence of symptoms of decreased sexual desire and erection, blood samples are taken for sex hormone dosage.

With regard to the urological examination for patients with prostatitis, it will be carried out according to the following schedule:

Accurate anamnesis of the patient, with maximum attention to the symptoms he/she reports;
General examination;
Urological examination, with digital rectal exploration (palpation of the prostate gland);
Trans-Rectal Bladder-Prostatic Echography, with relative dynamic study of micturition, associated with Uroflowmetry, all performed with ultrasound equipment and latest-generation biplane probes, studying in particular: Gland volume, Capsular Profile, presence or absence of areas of fibrocalcification, vision of the ejaculatory ducts, their course, regularity of the bladder floor, possible presence of sclerosis of the bladder neck and vision of the prostatic urethra;
Evaluation of Post-Minor Urinary Residue;
Request Specialist Laboratory Examinations, assay in seminal fluid of interleukin IL-8, with Normal Technique or PCR;
Request Specialist Examinations, Meares-Stamey Test, P.S.A. dosage, Total, Free / Ratio, and also request Urethral Swabs, with relative cultures and Antibiogram (ABG), after Prostatic Massage, Spermioculture with ABG, Prostatic Secretion Culture, with ABG, and other, urine test I cast, with Urinoc. and Antibiogram;

In the presence of symptoms of the Sexual Sphere, required dosage of Sex Hormones, Total, Free Testosterone, Deha, Dehas, Lh, Fsh, Prolactin.

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