Chronic Prostatitis
Chronic prostatitis is characterized by symptoms that have an insidious onset with frequency and urgency, sensation of "burning" or urethral dysuria and sometimes fever, over months in most patients.
Often there is redness of the urethral meatus and the surrounding mucosa, and some discharge indicative of urethritis. Many patients complain of urinary stream and dribbling postvoid thin, vague vague pain of varying intensity and the feeling of coldness or perineal heaviness is a common manifestation in these patients. The location is repeating deep perineum, inguinal area, suprapubic, scrotum and penis, all very vague and imprecise. The pain at the end of ejaculation or hematospermia is also repeated in its manifestations and can affect your sex life.
DRE appears soft or fibrotic prostate, sometimes with some crackling and granular consistency due to the presence of granules. Sometimes in the vast majority of patients digital rectal examination is normal. In prostatic secretion may occur polymorphonuclear leukocytes and macrophages. Often there are also plenty of desquamated epithelial cells of prostatic acini or ducts. To avoid contamination of the urethra, the patient is asked to urinate before the massage.
The secretion is squeezed and stretched out on a slide, stained and observed under a microscope.
Prostate biopsy is not indicated in the diagnosis of patients suspected of chronic prostatitis, as this is usually focal and not palpable. Yes is indicated when suspicious areas are palpated (to differentiate a tumor from a chronic granulomatous prostatitis, for example).
Chronic bacterial prostatitis is characterized by the presence in the fraction prostate postmasaje urine or semen, of one or more gram-negative bacteria do not grow in the early or middle fractions of urine.
The microorganisms identified in chronic bacterial prostatitis are:
- Aerobic Gram-negative bacilli: Escherichia coli, Enterobacter, Pseudomonas, Klebsiella.
- The role of gram-positive rods is doubtful.
- There is still debate with Ureaplasma urealyticum an organism widely distributed in the male reproductive tract Chlamydia trachomatis, and since it has been shown to cause most of urethritis and epididymitis in men under age 35. Also found high levels of chlamydia-specific IgA in 45% of the ejaculates of men with symptoms of nonbacterial prostatitis.
Chronic prostatitis may be due to bacterial prostatitis has not healed well, a chronic inflammation of the prostate or stress (to contract the pelvic floor muscles) and irregular sexual activity continuously, with retention of ejaculation.
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