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Urology (Expert Forum)
Re: Prostate problems
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Re: Prostate problems
by HFHS-MD-AK, Jan 01, 1995 12:00AM
Posted By HFHS M.D.-A.K. on August 29, 1998 at 18:16:02:
In Reply to: Prostate problems posted by Bob E on August 21, 1998 at 09:53:02:
Hi I one day had burning in my urine, and then it got worse and then very frequent and low pressure. Then I had a fever. I went to the Dr he said my prostate was a little larger than normal, he gave me some antibiotics (Trovan) I've been on them for 4 weeks. Well i feel much better no burning or urgency in urinating. I still have a weird feeling where I think my prostate is like an achy feeling but don't feel it when i sit down, I mean it doesn't feel big. Usually you can feel it like a object up you butt. Any way I coild just be imagining things. I have no pain, my urine pressure is fine. When I ejaculate no pain but the volume is low.
Can Trovan give you any of these symptoms?
How long can prostititis last?
Please help
Bob
-------------------------------------------------------------------------
Dear Bob,
Men with prostatitis syndromes are frequent patients in the urologic office. Initially, they should you should be screened with a urinalysis, urine culture. If no bacterial pathogen is found then a special urine analysis with three samples should be performed. This sounds like your first episode of prostatitis symptoms and most likely it is bacterial prostatitis. It is very important to treat these infection with an indicated antibiotic, such as Trovan to eliminate the infection completely. If not you may develop chronic bacterial prostatitis with recurrent infections. There is another category that is a little less specified, known as nonbacterial prostatitis and a fourth category known as prostadynia. The three part urine sample would put you into a category of which type of prostatitis you have. I will briefly discuss each type below.
Acute bacterial prostatitis you probably do have because this has been going on for a short period of time. This accounts for less than 5% of cases. Symptoms would include fever ,chills, malaise, and myalgia similar to what you describe. Local symptoms are frequency, urgency, low back pain and outlet obstruction (difficulty urinating). Digital rectal exam is exquisitely tender. The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus. Any fluoroquinolone antibiotic would be a good choice for therapy, however you need to take it for the indicated period of time, 3-4 weeks.
Chronic Bacterial prostatitis is defined by recurrent urinary tract infections and persistence of pathogenic bacteria in prostatic fluid. Primary complaints consist of genitourinary pain (1%), dysuria or painful urination (16%), clear urethral discharge (12%), recurrent UTI (9%), and sexual dysfunction (1%). Physical exam is usually normal, however the three part urinalysis shows a high number of white cells on one of the three samples. This may be what your doctors are telling you(>20 WBC/HPF in the expressed prostatic secretions). The most common organism found is E.coli in 80% of cases. Chronic bacterial prostatitis is simply a bacterial infection that persists.Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time.
Nonbacterial prostatitis is an inflammatory condition of unknown etiology. The symptoms are similar to those of chronic prostatitis. This group of patients outnumber all other patients with prostatitis. Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but also lipid laden macrophages. These are cells that are not characteristically seen in the prostate secretions. There may be a chemical irritation as a basis of this disease.
A trial of antibiotics may be tried but conservative measures such as over the counter anti-inflammatory agents (Motrin, Advil, Aleve) are indicated.
Prostadynia is a term used to define patients with proststitis type symptoms. Typically these patients are younger and have variable urinary complaints. There is no specific etiology of this disease. Again conservative measures should be tried and possibly some limited dietary restriction of caffeine, alcohol, and spicy foods. Anti-anxiety medications can be quite effective here. Other talked about treatments include zinc and saw palmetto, however neither of these therapies have been proven.
I think you have a treatable condition and it is important to take the full course of antibiotics as you have. This will limit the chances of this infection becoming a chronic condition. Trovan itself in not responsible for the symptoms you describe, it is most likely the secondary inflammation from the infection. Only time will tell if you treatment has been effective. I think you have been treated properly and I wish you luck.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its suburban locations (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword: Prostatitis
In Reply to: Prostate problems posted by Bob E on August 21, 1998 at 09:53:02:
Hi I one day had burning in my urine, and then it got worse and then very frequent and low pressure. Then I had a fever. I went to the Dr he said my prostate was a little larger than normal, he gave me some antibiotics (Trovan) I've been on them for 4 weeks. Well i feel much better no burning or urgency in urinating. I still have a weird feeling where I think my prostate is like an achy feeling but don't feel it when i sit down, I mean it doesn't feel big. Usually you can feel it like a object up you butt. Any way I coild just be imagining things. I have no pain, my urine pressure is fine. When I ejaculate no pain but the volume is low.
Can Trovan give you any of these symptoms?
How long can prostititis last?
Please help
Bob
-------------------------------------------------------------------------
Dear Bob,
Men with prostatitis syndromes are frequent patients in the urologic office. Initially, they should you should be screened with a urinalysis, urine culture. If no bacterial pathogen is found then a special urine analysis with three samples should be performed. This sounds like your first episode of prostatitis symptoms and most likely it is bacterial prostatitis. It is very important to treat these infection with an indicated antibiotic, such as Trovan to eliminate the infection completely. If not you may develop chronic bacterial prostatitis with recurrent infections. There is another category that is a little less specified, known as nonbacterial prostatitis and a fourth category known as prostadynia. The three part urine sample would put you into a category of which type of prostatitis you have. I will briefly discuss each type below.
Acute bacterial prostatitis you probably do have because this has been going on for a short period of time. This accounts for less than 5% of cases. Symptoms would include fever ,chills, malaise, and myalgia similar to what you describe. Local symptoms are frequency, urgency, low back pain and outlet obstruction (difficulty urinating). Digital rectal exam is exquisitely tender. The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus. Any fluoroquinolone antibiotic would be a good choice for therapy, however you need to take it for the indicated period of time, 3-4 weeks.
Chronic Bacterial prostatitis is defined by recurrent urinary tract infections and persistence of pathogenic bacteria in prostatic fluid. Primary complaints consist of genitourinary pain (1%), dysuria or painful urination (16%), clear urethral discharge (12%), recurrent UTI (9%), and sexual dysfunction (1%). Physical exam is usually normal, however the three part urinalysis shows a high number of white cells on one of the three samples. This may be what your doctors are telling you(>20 WBC/HPF in the expressed prostatic secretions). The most common organism found is E.coli in 80% of cases. Chronic bacterial prostatitis is simply a bacterial infection that persists.Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time.
Nonbacterial prostatitis is an inflammatory condition of unknown etiology. The symptoms are similar to those of chronic prostatitis. This group of patients outnumber all other patients with prostatitis. Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but also lipid laden macrophages. These are cells that are not characteristically seen in the prostate secretions. There may be a chemical irritation as a basis of this disease.
A trial of antibiotics may be tried but conservative measures such as over the counter anti-inflammatory agents (Motrin, Advil, Aleve) are indicated.
Prostadynia is a term used to define patients with proststitis type symptoms. Typically these patients are younger and have variable urinary complaints. There is no specific etiology of this disease. Again conservative measures should be tried and possibly some limited dietary restriction of caffeine, alcohol, and spicy foods. Anti-anxiety medications can be quite effective here. Other talked about treatments include zinc and saw palmetto, however neither of these therapies have been proven.
I think you have a treatable condition and it is important to take the full course of antibiotics as you have. This will limit the chances of this infection becoming a chronic condition. Trovan itself in not responsible for the symptoms you describe, it is most likely the secondary inflammation from the infection. Only time will tell if you treatment has been effective. I think you have been treated properly and I wish you luck.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its suburban locations (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword: Prostatitis
