Chronic prostatitis | Symptoms, causes and treatment options

Chronic prostatitis is a condition caused by a chronic, specific or nonspecific infectious inflammation of the prostate gland. In most cases, chronic prostatitis is a consequence of acute prostatitis that was not treated in time or whose treatment was not complete and regular.

Why chronic prostatitis develops

The causes and contributing factors of chronic prostatitis include:

Gram-negative microorganisms:

• Escherichia coli;
• Pseudomonas aeruginosa;
• Klebsiella;
• Enterobacter.

Gram-positive microorganisms:

• Staphylococcus aureus.

Other microorganisms:

• Chlamydia trachomatis.
• Acute and chronic diseases of the urogenital system;
• Abnormalities of the urogenital system;
• Acute and chronic respiratory diseases;
• Acute and chronic gastrointestinal diseases;
• Endocrine and metabolic disorders such as diabetes mellitus;
• Tumors of the urogenital system and tumors of other origins;
• Immunosuppressive therapy;
• Prolonged sitting;
• Exposure to cold;
• Alcohol consumption;
• Smoking;
• Mechanical trauma, psycho-emotional factors, and stress.

A condition that can develop slowly and silently

In some cases, chronic prostatitis has a slow and asymptomatic progression from the very beginning, especially when the cause is a chronic obstructive process in the urinary tract. In these situations, the pathological process may lead to scarring and sclerosis of the prostatic tissue.

Persistent pain, the main warning sign

Chronic prostatitis is characterized by chronic pain localized in the perineal region, which is the main subjective symptom. The pain becomes more intense when the patient remains seated for a long time. With movement, the pain decreases in intensity or may disappear completely.

Some patients also complain of sexual dysfunction.

Signs of chronic prostatitis include:

• perineal pain;
• pelvic pain;
• fever;
• chills;
• myalgia;
• arthralgia;
• altered general condition;
• urinary retention;
• difficult urination;
• pollakiuria;
• dysuria;
• cloudy urine.

What investigations confirm the diagnosis

The diagnosis of chronic prostatitis is established based on:

• medical history;
• objective findings;
• laboratory tests;
• instrumental investigations;
• radiological and imaging investigations;
• consultations with doctors from other specialties.

Examination of prostatic secretions has particular diagnostic importance. Detecting leukocytosis and microorganisms in the prostatic secretion may confirm the presumptive diagnosis.

Other conditions with similar symptoms

The differential diagnosis includes:

• benign prostatic hyperplasia;
• prostate cancer;
• prostatic tuberculosis.

Biopsy plays an important role in the differential diagnosis of chronic prostatitis from other pathological conditions in general, and from prostate cancer in particular.

What chronic prostatitis treatment may include

Treatment of chronic prostatitis may include:

• general therapeutic and preventive measures;
• etiopathogenic therapy;
• antibacterial therapy;
• local therapy;
• therapy aimed at preventing scar formation and fibrous tissue:
  • lidase;
  • aloe;
  • prostatic massage;
  • physiotherapy procedures;
  • balneological treatment;
• hormone therapy and corticosteroids when necessary;
• symptomatic treatment.

How chronic prostatitis can be prevented

Prevention of chronic prostatitis includes general and specific measures aimed primarily at combating or preventing urogenital infections and the factors that contribute to the development of chronic prostatitis.

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Author: Marcel Balagura, urologic surgeon, Doctor of Medical Sciences

Invitro Diagnostics Medical Center
Chișinău branch, 168 Alba-Iulia Street