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Enlarged Prostate

An Overview of Enlarged Prostate and Common Causes!  

Prostatitis

Prostatitis is a term that refers to various inflammatory conditions affecting the prostate. And these include chronic and acute bacterial infections and even instances when there are signs and symptoms of inflammation without evidence of infections. Individuals with acute bacterial  prostatitis typically present with pus in the urine (pyuria), bacteria  in the urine (bateriuria) and typical symptoms and signs of infections . Chronic bacterial prostatitis is diagnosed by culturing the secretions obtained from prostate massage. Acute bacterial prostatitis is more common in younger men while chronic bacterial prostatitis is more common in elderly men. Also common in patients with catheters.

Causes Of Enlarged Prostate

Causes Of Enlarged Prostate

Symptoms Of Enlarged Prostate
Benign Prostatic Hyperplasia
Prostatic Carcinoma

Prostatitis
Benign Prostatic Hyperplasia (BPH)
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Acute Bacterial Prostatitis

Acute bacterial prostatitiis generally affects younger men and is characterized by fever, chills, painful urination, urinary frequency, urgency ( sudden, compelling urge to urinate that brooks no delay), and extremely tender prostate which may be boggy on examination. Vigorous Prostatic massage which may produce purulent secretions (and therefore aid in the diagnosis) should be avoided because this may result in bacteremia (presence of bacteria in the blood stream). The causative organisms can often be identified by simply doing urinalysis, Gram's staining and urine culture. The infections are commonly due to gram negative organisms such as E.coli and Klebsiella. Initially, patients are placed on intravenous antibiotics such as trimethoprim-sulfamethaxazole, cephalosporins or aminoglycosides. Patients often recover promptly, but some cases of acute prostatitis may result in abscess formation, vesiculitis or septicemia.

Chronic Bacterial Prostatitis

Chronic bacterial  prostatitis is the most common cause of recurrent urinary tract infections in elderly men, and the diagnosis is established by culturing prostatic secretions. The most common organisms implicated are E.Coli, Proteus and Klebsiella pneumoniae and Enterococcus species. Unlike acute bacterial prostatitis, patients may not show any symptom and the prostate may feel normal on exam. Sometimes, affected individuals may present with obstructive symptoms, perineal pain and infections may spread to the bladder causing increase frequency of urinating, urgency and pain while urinating. The diagnosis is often established by culturing the prostate secretions. Patients are often treated with trimethoprim-sulfamethaxazole or a quimolone antbiotics such as levofloxacin or ciprofloxacin. Relapses are quite common even if the patient is placed on prolonged treatment regimen. Sometimes, treatment may require prostate resection.

Non Bacterial Prostatitis

Individuals who present with  sign and symptoms of prostatitis but with no bacterial growth when the prostate secretion is cultured ( and has no history of recurrent bacterial prostatitis) are classified as having non bacterial prostatitis. The infectious agents are unknown, but  involvement of Chlamydia trachomatis and Ureaplasma urealyticum have been postulated but not conclusive. Most cases of non bacterial prostatitis occur in young sexually active men. The effectiveness of antimicrobial agents is questionable and uncertain, but some patients do benefit from 4-6 weeks of Doxycycline and symptomatic control, including sitz baths.

Prostatodynia

Some patients may have symptoms and signs of prostatitis , but no evidence of prostatic inflammation and cultures of the urine yield nothing. These patients are said have Prostatodynia. These patients are not given antimicrobial agents, because there is no infection. The management is purely symptomatic and supportive.


References


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