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Diagnosis and treatment of chronic prostatitis


Diagnosis and treatment of chronic prostatitis

Diagnosis and treatment of chronic prostatitis

Causes of chronic prostatitis

The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. The entry of microorganisms into the prostate in most cases occurs through the urethra - as a result of the reflux of urine into the ducts of the prostate gland (intraprostatic urine reflux).


- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation

- Changes in urination - difficulty urinating, frequent urination in small portions, a feeling of incomplete emptying of the bladder.

- The patient may complain of both a number of symptoms and any symptom in particular. An increase in body temperature is uncharacteristic (or slightly).


Microscopic and bacteriological examination of urine samples obtained from different parts of the genitourinary tract and prostate secretion. A possible alternative is to donate the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate partially (at least 1/3) consists of the prostate gland. This method is more comfortable for patients, especially if they categorically refuse a rectal examination or perform a diagnostic massage of the prostate gland in order to obtain prostate secretion.

During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. That is, it is impossible to rely on the result of a rectal examination for the diagnosis of chronic prostatitis.

Treatment of chronic prostatitis

Antibiotics of the fluoroquinolone group are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic therapy is 4 to 6 weeks. Such a long course is justified by scientific data indicating a decrease in the likelihood of recurrence of the disease.

With identified sexually transmitted infections, such as chlamydia trachomatis, an antibiotic of the macrolide group is prescribed.

There is evidence of reduced relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the prostatic ducts in the urethra and causes inflammation of the prostate tissue and pain. Such patients are recommended to prescribe alpha-blockers.

Other methods that have been shown to be effective in only one or a few studies, or are still under investigation, include:

- pelvic floor muscle training - some evidence suggests the effectiveness of special exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;

- acupuncture - a small number of studies indicate the advantage of acupuncture compared with placebo in patients with chronic prostatitis;

- extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective and bone tissue, is widely used in the treatment of diseases of the musculoskeletal system, has recently been used in urology, its effectiveness is under study;

- behavioral therapy and psychological support - since chronic prostatitis is associated with a poor quality of life and the development of depression, these methods can improve the patient's psychological state and help reduce some of the symptoms of the disease.

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