This Acute Inflammation Of The Prostate Caused By Bacteria

Acute bacterial prostatitis

This acute inflammation of the prostate caused by bacteria and is accompanied by fever and severe discomfort. Affected are often, but not exclusively men under 50
Acute bacterial prostatitis can be a very serious disease and usually requires a high dose of antibiotics. In immune compromised (eg by HIV infection or chemotherapy ) and acute prostatitis may occur that is not caused by bacteria but by other pathogens (eg, fungi). This form is subsequently ignored.

Causes and development

Cause of acute prostatitis are bacteria. There are different types into account, most are intestinal bacteria. Because the germs usually enter through the urethra into the prostate, because there is a direct connection between the two institutions. The starting point is therefore often an inflammation of the urethra ( urethritis ), the bladder ( cystitis ) and the glands in the vicinity of the urethra. Even through sexual intercourse pathogens can invade the urethra. Another favorable for the invasion of bacteria act harnstauende changes in the urethra (eg stricture , stenosis ) and a tight foreskin (phimosis, promotes bacterial colonization and can impede urine flow).

A second path leads from an inflammation of the epididymis ( epididymitis ) or the seminal vesicles ( Spermatozystitis ) on the seminal ducts in the prostate. Rarely reach the bacteria from sites of inflammation in other parts of the body via the bloodstream, the prostate (for example, teeth, tonsils) or via lymphatic vessels (from the large intestine from the anus). Even after urological procedures such as catheterization, cystoscopy ( cystoscopy ) or sampling (prostate biopsy ) may cause acute bacterial prostatitis.

Signs of disease

Occur more or less sudden severe symptoms as a bladder infection, followed by high fever with chills: Frequent urination ( pollakiuria ), difficulty urinating ( dysuria ), weakened urinary stream (possibly to acute urinary retention = ischuria ), urethral burning on end of urination, painful urination ( Algurie ) and an irresistible urge to urinate ( urinary urgency ).

Other characters are pressure or pain in the perineum and rectal urgency, and pain during bowel movements, sometimes a slight urethral discharge and pain during ejaculation (ejaculation ). In addition, usually the signs of inflammation of the prostatitis to be released (see above).

Investigation

In the digital rectal examination ( DRE , scanning the finger through the rectum) the prostate is painful to pressure usually soft and swollen with slightly tense capsule and elapsed contour.
The urine examination showed abundant blood, inflammation and mucosal cells (erythrocytes, leukocytes, epithelial cells) and mucus, cellular debris and bacteria. For this one typically uses the mid-stream urine ( MSU ). In the three-glass test is befänden masses of bacteria in the first and third Harnportion in the four glass test in prostatic fluid. Both, however, involve a prostate massage (not shown) in the acute stage is contraindicated (see also for these samples urine tests ). Cultures means the type of bacteria and their resistance are (resistance) against antibiotics (antibiogram) accurately determined, if necessary.

The blood test shows an increase of white blood cells (leukocytosis) and the inflammatory protein ( CRP ). Also, the PSA value increases slightly. He returned to normal slowly after resolution of prostatitis. If any provision is planned, it should therefore at least three months thereafter at (see also PSA test ).

The transrectal ultrasound ( TRUS ) can be used to exclude a purulent melting in the prostate gland ( prostatic abscess are used). Further investigations are required only occasionally in the acute stage, possibly in relation to the triggering inflammation.

Treatment

The most important measure is the immediate, high-dose administration of an antibiotic. The drug is optionally be changed after the arrival of the susceptibility and should be given on the normalization of temperature and laboratory values ​​out for 2-4 weeks. Against the complaints are anti-inflammatory and antispasmodic drugs and pain killers and laxatives into consideration.

When the urine flow from the bladder is obstructed by swelling of the prostate, may be necessary temporarily a urinary diversion by catheter. In order not to favor the inflammation, best through the abdominal wall (suprapubic catheter). Possible further measures directed against the triggering inflammation or complications.

Course and complications

In the treatment of the symptoms usually disappear rapidly. Rarely there is a purulent melting in the prostate gland, a prostatic abscess that needs to be treated immediately. Also rare is the further spread of inflammation, such as on neighboring organs, the epididymis ( epididymitis , descending on the seminal tract) or in the bloodstream ("blood poisoning", urosepsis).

More often, however, the acute changes into a chronic bacterial prostatitis, especially when there is inadequate treatment (see next section). Therefore, it is important to consistently take the medication, particularly the antibiotic by the physician, and to avoid everything that a resurgence of inflammation favors (eg cooling down in the pelvic area, severe strain on the pelvic floor).