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Chronic prostatitis

Does chronic prostatitis ever go away?

Does.chronic prostatitis ever go away?

Often, the infection will not go away, even after taking antibiotics for a long time. Your symptoms may come back when you stop the medicine. If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it.

Chronic prostatitis

Chronic inflammation of the prostate (Chronic Prostatitis – CP) or as it is called today: syndrome of chronic pelvic pain (Chronic pelvic pain syndrome – SPPS) is a very common phenomenon.

In recent years, given the increasing awareness of people about this phenomenon, the significant increase in the percentage of infected people, and its negative impact on the quality of life, it was decided to push the issue forward through the establishment of a research body (CPCRN) that worked on introducing two innovations:

  1. Classification of chronic prostatitis into small groups.
  2. Definition of the different symptoms of the disease (CPSI – Chronic Prostatitis Symptom Index).

Here is the new NIH Prostatitis Classification:

NIH – I – National Institutes of Health

Acute bacterial prostatitis, which occurs in 5% of men with prostatitis.

Treatment: Good results are shown with appropriate antibiotic treatment. Where the antibiotic treatment should be continued for a longer period, ranging between 20-30 days, after the acute inflammation subsides , in order to avoid developing a chronic infection.

NIH – II

Inflammation of the prostate bacterial chronic (Chronic bacterial prostatitis), a contamination caused by prostate bacteria, continuous or repeated in the form of waves. This infection is considered milder , but it is persistent and bothersome. This inflammation is diagnosed by culture or by microscopic imaging of white blood cells (leukocytes) in the secretions of the prostate.

This infection is treated with high doses of antibiotics appropriate for the sensitivity of the germ, which are taken orally for a period of at least 4-6 weeks. After the end of treatment, a culture test should be performed to ensure that the germs have been eradicated.

NIH – III

CP – Chronic Non – Bacterial Prostatitis / Chronic Pelvic Pain Syndrome – CPPS, in this case the presence of inflammation is not proven. This case is the most difficult in terms of accurate diagnosis and provision of appropriate treatment, and therefore it has been divided into two subgroups:

  • NIH – IIIA – syndrome , chronic pain Inflammatory (Inflammatory Chronic Pain Syndrome)

This group is characterized by the lack of direct evidence for the presence of bacteria, but there are indications of the presence of infection such as the presence of white blood cells in the secretions of prostate fluid (EPS), and in the urine produced by massaging the prostate, called (Voided bladder urine VB-3) and in semen. .

  •  NIH – IIIB – Non Inflammatory Chronic Pelvic Pain Syndrome

No evidence of inflammation, no white blood cells or any other evidence of inflammation in prostate secretions, in VB-3 or in semen. It should be noted that unlike patients in groups I and – II, those belonging to group III were not found to cause infections inside the prostate, according to what was proven by the recognized experiments to prove the presence of bacteria.

In practice, defects in prostate secretions (EPS) are the first objective features of group III prostatitis. Chronic pain is the objective characteristic of this group of patients. Unfortunately, the vast majority of patients with prostatitis belong to this group: NIH – III.

NIH – IV

Asymptomatic Inflammatory Prostatitis – AIP, in this inflammation, the patient does not have any symptoms, but white blood cells can be found in the secretions, or in the prostate tissue , during the investigation of other disorders. This group of patients does not pose a problem and does not always require treatment.

Due to the large number of symptoms, and in order to obtain homogeneous nomenclature, the indicator of symptoms of chronic prostatitis called:

NIH-CPSI) – NIH Chronic Prostatitis Symptom Index). This indicator examines the three most important elements in patients with chronic prostatitis, which are:

Pain: its location, intensity, and frequency.

Symptoms that appear during urination: excessive irritability, obstruction, or both.

Quality of life: the effect of the syndrome on the patient’s quality of life.

Each of these components is evaluated individually:

0-21 marks For Pain.

0-10: For Urinary Domain.

0-12: For Impact on Quality of Life.

0-43: Total.

Diagnosis of chronic prostatitis

The diagnosis of chronic prostatitis is based on the history of the disease, an examination of the prostate and a urine examination. In certain cases, the strength of urine flow and the volume of urine remaining after urination can be checked, and urine cytology, urodynamics and cystoscopy can also be performed.

Chronic prostatitis treatment

How to treat chronic prostatitis :

Antibiotic therapy: Antibiotics are effective for treatment of groups I, II and NIH-III/A. While there is disagreement about the effectiveness of antibiotics in treating NIH III/B prostatitis. Some research indicates the necessity of treating patients who belong to this group with antibiotics directed against unfamiliar organisms. Therefore, according to these researches, treatment is given with antibiotics for two weeks, and in the event of an unfamiliar germ, treatment must be continued for an additional 2-4 weeks. It is not recommended to treat with antibiotics for a long time (without proof of the presence of germs) for fear of developing strains of bacteria that are resistant to antibiotics.

Treatment with alpha blockers: So far, there are no studies and research that prove the efficacy of treating prostatitis with alpha blockers, but there are many publications and reports that support treatment in this way. Although there is no scientific evidence for the efficacy of treatment with alpha blockers, the current hypothesis is that treatment with these drugs may be useful as part of the treatment of NIH IIIA / IIIB prostatitis. In addition, there is no consensus that alpha-blocker therapy can be offered to all patients or only to patients with obstruction. Treatment with alpha-blockers is given for 3-6 months in all patients, while treatment is given for a longer period of time in patients with obstruction, even if it is relatively minor.

Physiotherapy: During treatment with antibiotics and anti-inflammatory treatments, new and different physical therapies are used such as heating, microwaves, blood flow improvement, biofeedback, prostate massage, pelvic base massage and acupuncture. These treatments are based on different theories that explain pathophysiology, and they can relieve the pain experienced by the patient. There are reports of success of this treatment, but not significantly.

Not providing treatment: It is common practice not to provide treatment to patients who belong to group IV NIH and who do not show symptoms of the disease, regardless of the results of tests that may indicate the presence of infection. Specific treatment is offered only if pathogens (infections) such as gonorrhea neisseria and Chlamydia trachomatis are proven .

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