New York’s Prostatitis Clinic
New York Urology Specialists’ Prostatitis Clinic offers state-of-the-art treatment approach to managing chronic prostatitis, a diagnosis that causes a lot of frustration to patients and doctors alike. At New York Urology Specialists our experienced urologists have extensive experience caring for men with chronic prostatitis and pelvic pain. When in need of a second opinion for chronic prostatitis and chronic pelvic pain as well as interstitial cystitis, top physicians refer to New York Urology Specialists.
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men with chronic prostatitis and pelvic pain. He has published some of the most cited papers on fungal prostatitis and atypical infections of the prostate.
What is Prostatitis?
Prostatitis is swelling and irritation of the prostate gland. The condition is called bacterial prostatitis when it is caused by an infection with bacteria. It is the most common urologic diagnosis in men younger than 50 years and is also common in men over 50 years. The estimated prevalence of prostatitis in the US is approximately 5 to 9%. Prostatitis contributes to approximately 8% of urology office visits. The disorder severely impairs the overall quality of life in the afflicted men. [1,2,4]
Types of Prostatitis
Prostatitis can be classified into the following 4 types based on the National Institutes of Health International Prostatitis Collaborative Network classification system.
- Acute bacterial prostatitis (ABP): It accounts for approximately 5% of cases of prostatitis cases and results from the growth of bacteria within the prostate gland. It is often associated with UTI or STD (sexually transmitted diseases). Men with urinary catheters, diabetes mellitus, immunosuppression, are at higher risk for bacterial prostatitis.
- Symptoms include fever, chills, lower abdominal pain, painful, frequent and urgent urination, painful ejaculation, and presence of blood in semen (hematospermia). It may also be associated with epididymo-orchitis.
- A prostatic abscess is a rare manifestation of acute bacterial prostatitis. Symptoms include pain, fever, malaise and fluid collection in the prostate detected on DRE or CT scan. Usually, patients are hospitalized and treatment includes intravenous antibiotics and evacuation of the abscess fluid either percutaneously or surgically by TURP.
- Diagnosis includes physical examination (abdomen, external genitalia, perineum, and prostate) for signs of tenderness, urine culture, blood culture, and C-reactive protein test.
- Treatment includes oral antibiotic therapy with antibiotics either intravenous or oral antibiotics such as Bactrim, Cipro, or doxycycline. In addition to antibiotic therapy, non-steroidal anti-inflammatory drugs (NSAIDs) may offer both pain relief and more rapid resolution of symptoms.[1,3]
- Chronic bacterial prostatitis (CBP): It may result from ascending urethral infection, a spread of rectal bacteria or from a remote source, undertreated acute bacterial prostatitis or recurrent urinary tract infection.
- Symptoms include genitourinary pain or discomfort, recurrent urinary tract infections, painful and frequent urination.
- Diagnosis includes physical examination (abdomen, external genitalia, perineum, and prostate), pre- and post-prostatic massage urine samples for analysis and culture (prostate massage is performed by stroking the prostate with firm pressure from the periphery to the midline on both the right and left sides of the prostate gland. More than 20 leucocytes per high powered field on the post-massage urine sample is suggestive of chronic bacterial prostatitis), and microbial culture.
- Treatment: Oral antibiotic therapy with trimethoprim, cephalexin, amoxicillin-clavulanic acid. In addition to antibiotic therapy, NSAIDs may alleviate pain, alpha-blockers may diminish urinary obstruction, and reduce future occurrences.
Surgical therapy is only the last resort and is used for obstructions and prostatic calculi in conjunction with a persistent bacterial presence in the prostate. Transurethral resection of the prostate (TURP) is indicated only in men whose the prostatic fluid persistently grows the same bacterium, and only after the confirmation of the prostatic origin of the bacterium by prostatic biopsy. [1,5]
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): It is more common than either acute bacterial prostatitis or chronic bacterial prostatitis.
- Symptoms can vary widely and include pelvic pain or urinary symptoms for >3 of the previous 6 months with no evidence of bacterial prostatitis or urinary tract infection in that time. Symptoms may also include one or more of the following: painful, frequent, or urgent urination, weak urinary stream; pain in the perineum, pain in the lower abdomen, testicles or penis; hematospermia (blood in semen or sperm ejaculate).
- Diagnosis includes physical examination (abdomen, external genitalia, perineum, and prostate), pre- and post-prostatic massage urine samples for analysis and culture (prostate massage is performed by stroking the prostate with firm pressure from the periphery to the midline on both the right and left sides of the prostate gland. More than 20 leucocytes per high powered field on the post-massage urine sample is suggestive of chronic bacterial prostatitis (CBP), and microbial culture
- Treatment approaches vary but may include physical therapy with trigger point release, SSRI, alpha-blockers (tamsulosin, alfuzosin, silodosin) and sometimes antibiotics used alone or in combination appear to have the greatest improvement. In addition, anti-inflammatory medications may also be useful..[1,2,5]
- Asymptomatic inflammatory prostatitis (AIP): It is inflammation of the prostate in the absence of genitourinary tract symptoms (asymptomatic). It is often diagnosed incidentally during the evaluation of elevated PSA or abnormal DRE during prostate biopsy. The clinical significance of this type of prostatitis is unknown and is usually left untreated. [1,3]
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