Treatment of prostatitis

The term prostatitis is applied to a series of disorders, ranging from acut e bacterial infection to chronic pain syndromes, in which the prostate glan d is inflamed. Patients present with a variety of symptoms, including urina ry obstruction, fever, myalgias, decreased libido or impotence, painful eja culation and low-back and perineal pain. Physical examination often fails t o clarify the cause of the pain. Cultures and microscopic examination of ur ine and prostatic secretions before and after prostatic massage may help di fferentiate prostatitis caused by infection from prostatitis with other cau ses. Because the rate of occult infection is high, a therapeutic trial of a ntibiotics is often in order even when patients do not appear to have bacte rial prostatitis. If the patient responds to therapy, antibiotics are conti nued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for c hronic nonbacterial prostatitis, in which nonsteroidal anti-inflammatory dr ugs, alpha-blocking agents, anticholinergic agents or other therapies may p rovide symptomatic relief.