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chronic prostatitis
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chronic prostatitis

  : : : : : Hello,
  : : : : : I posted a message on 9/01/98 and have a followup question.  
  : : : : : Can Prostatitis be passed back and forth between partners?
  : : : : : My wife and I would like to know if I am going to have to use
  : : : : : precautions and for how long?
  : : : : :
  : : : : : Also, what medications are available for sitting discomfort?
  : : : : :
  : : : : : Any help would be appreciated.
  : : : : :
  : : : : : Thank you.
  : : : :
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  : : : : Dear Steve,
  : : : : Men with prostatitis syndromes are frequent patients in the urologic office.  Initially, they should be screened with urine analysis, urine culture, urine cytology, and uroflowmetry.  If no bacterial pathogen is found then a special urine analysis with three samples should be performed.   There are several types of prostatitis, infectious prostatitis, either acute or chronic.  There is another category that is a little less specified, known as nonbacterial prostatitis or a third category known as prostadynia. The three part urine sample with prostate massage would put you into a category of which type of prostatitis you have.  I will briefly discuss each type below.
  : : : : Acute bacterial prostatitis  accounts for less than 5% of cases.  Symptoms would include fever ,chills, malaise, and myalgia.  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.
  : : : : Chronic Bacterial prostatitis is defined by recurrent Urinary tract infection and persistence of pathogenic bacteria in prostatic fluid.  Primary complaints consist of genitourinary pain(61%),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 urine analysis shows a high number of white cells on one of the three samples(>10WBC/HPF in the EPS)  The most common organism found is E.coli in 80% of cases.  Chronic bacterial prostatitis is simply a bacterial infection that recurs and is chiefly due to the ductal structure of the prostate you were born with.
  : : : : 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 with chronic prostatitis and 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 all lipid laden macrophages.  These are cells not characteristically seen in the prostate secretions filled with fat.  There may be a chemical irritation as a basis of this disease.
  : : : : A trial of antibiotics should be tried but conservative measures such as over the counter anti-inflammatory agents(Motrin, Advil, Aleve), hot sitz bathes and support should be offered.
  : : : : Prostadynia is a term used to define patients with proststitis type pain without specific findings related to the prostate.  Typically these patients are younger and have variable urinary complaints.  There is no etiology of this disease established and therefore a generalized work-up should be done.  Again conservative measures should be performed in addition to some limited dietary restriction of caffeine,alcohol, and spicy foods.  Other talked about treatments include Zinc  and Saw palmetto however neither of these therapies have been proven.
  : : : : As you can see the prostate infection can go on for a long time.  At different times, the urinary problem may subside with antibiotics however it will often return.  My recommendations are, follow with a urologist and make sure you get a full coarse of therapy.  After a full course of therapy you should not be able to pass a urinary tract infection to her.  If she is getting infections after intercourse, she should see her doctor for advice.  You should not be getting infections from her, you may be having recurrence of your own disease that was not successfully treated.
  : : : : 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 satellites (1 800 653-6568).
  : : : : Sincerely,
  : : : : HFHS M.D.-AK
  : : : : *keyword:Prostatitis
  : : : I have a few follow up questions:
  : : : Is getting an EPS or 3 part urinalysis important.  So far my urologist has not done this.
  : : : You indicated that antibiotics work 30 - 50% of the time for bacterial prostatitis.  What happens if you are in the wrong 50% ?  Also if the infection reoccurs what is usually done (more antibiotics?)
  : : : My urologist has told me that I may have to have a cystoscope done. What
  : : : will this tell him and when is it generally indicated. Also, I have
  : : : heard that this is a very uncomfortable procedure, could you tell me what is involved. (My doctor said that it is done with me awake.)  Are there any complications in having this procedure done?
  : : : If I want to change urologists, what is the best way to find a specialist that deals with this problem?
  : : :
  : : : Thank you very much, this has been very frustrating.
  
  : There was a reply by : HFHS M.D.-AK
  : : : *keyword:Prostatitis
  : : I have a few follow up questions:
  : : Is getting an EPS or 3 part urinalysis important. So far my urologist
  : has not done this.
  : : You indicated that antibiotics work 30 - 50% of the time for bacterial
  : prostatitis. What happens if you are in the wrong 50% ? Also if the
  : infection reoccurs what is usually done (more antibiotics?)
  : : My urologist has told me that I may have to have a cystoscope done.
  : What
  : : will this tell him and when is it generally indicated. Also, I have
  : : heard that this is a very uncomfortable procedure, could you tell me
  : what is involved. (My doctor said that it is done with me awake.) Are
  : there any complications in having this procedure done?
  : : If I want to change urologists, what is the best way to find a
  : specialist that deals with this problem?
  : :
  : : Thank you very much, this has been very frustrating.
  
  : Doctors,
  : There was a reply Re: Re: Re: Chronic Prostatitis - HFHS M.D.-SAL 9/23/98 (0) with no information in it to my RE RE.  
  Doctor(s),
  
  What is perineal myalgia?
  You indicated that antibiotics work 30 - 50% of the time for bacterial
  prostatitis. What happens if you are in the wrong 50% ? Also if the
  infection reoccurs what is usually done (more antibiotics?).  Are low dose antibiotics sometimes used?
  
  Thank you.
--------------------------------------------
Dear Steve,
Perineal muscle myalgia is the pain experienced in the perineum (are between the urethra and the rectum) caused by keeping the muscles in this area under tension. It is the result of anxiety and requires relaxation of these muscles, usually with an anti-anxiety medication.
I think that you need to sit down with your urologist and deal with the specifics of your situation. There are several urologic textbooks which discuss prostatitis much more completely than we can in this forum. Try the library at your local hospital.
This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital  and its suburban locations (I-800-653-6568).
Sincerely,
HFHS M.D.-SAL
*keyword: perineal muscle myalgia





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