Which are the symptoms?
Clinically, the acute and chronic forms present with different symptoms. Acute prostatitis is frequently manifested by difficulty in initiating urination (hesitation), burning during urination (stranguria), increased frequency of urination (pollakiuria), even at night (nocturia), inability to postpone urination (urgency), feeling of incomplete bladder emptying and severe pain in the lower abdomen. Some patients also complain of blood in the semen and painful ejaculation. Finally, in some cases fever with chills may be present.
In the chronic form, symptoms persist for a period longer than three months. Usually the patient does not complain of fever, but irritative symptoms (pollakiuria, nocturia, urgency, stranguria) and pelvic pain are present. These symptoms have a profound negative impact on the patient's quality of life.
- Urination hesitation (difficulty starting urination)
- Stranguria (burning during urination)
- Pollakiuria (increased frequency of urination)
- Nocturia (need to urinate during the night)
- Urgent urination (inability to delay urination)
- Feeling of incomplete bladder emptying
- Gravative pain in the lower abdomen
- Pelvic pain
- Painful ejaculation
How is it diagnosed?
Diagnosis of prostatitis is based on anamnestic data, physical examination and instrumental evaluations. In particular, it is useful to ask questions about the patient's sexual habits (risky intercourse, change of partner, etc.). A rectal examination will also show a very painful prostate.
As part of the diagnosis of prostatitis, laboratory tests such as the search for bacteria in seminal fluid and urine and the culture of urine and / or prostate fluid obtained as a result of prostate massage (Stamey test) can also be helpful. In the course of prostatitis, an increase in blood values of Prostate Specific Antigen (PSA) could be recorded. The picture can possibly be completed by a transrectal prostatic ultrasound and uroflowmetry with ultrasound evaluation of the post-voiding residue.
How is it treated?
Therapy in patients suffering from prostatitis varies according to the form of prostatitis (acute vs. chronic) and etiology. In particular, patients with bacterial prostatitis will benefit from antibiotic therapy with drugs that easily reach the urinary tract (e.g. broad-spectrum penicillins and fluoroquinolones). Antibiotic therapy can also be modulated on the basis of the antibiogram, once the pathogen responsible for the infection has been identified. Therapy should also usually be continued for 3-4 weeks. Finally, chronic bacterial prostatitis requires prolonged courses (even 6-8 weeks) of antibiotics that are able to easily penetrate the prostate capsule. In some cases of acute bacterial prostatitis, hospitalization and intravenous antibiotic therapy may be required. In addition, if prostatitis affects episodes of urine retention and inability to empty the bladder, placement of a suprapubic cystostomy catheter may be necessary. The condition in the form of chronic abacterial prostatitis may improve with the use of antibiotics, anti-inflammatory and alpha-blocking drugs, possibly associated with phytotherapeutic drugs. Also, the condition with these forms of inflammation of the prostate gland can in some cases improve with the help of therapy, which includes a combination of a psychological approach and physiotherapy.