One of the most common infections affecting men is infections of the prostate gland. This is the gland that is the size of a walnut located at the base of the bladder that surrounds the urerthra or the tube in the penis that transports urine from the bladder to the outside of the body.
There are two kinds of bacterial prostate infections: acute and chronic, but only a few of men with symptoms of prostatitis actually have a documented bacterial infection.
An acute infection of the prostate is characterized by high fever, lower abdominal pain, marked urinary frequency, urgency, muscle aches and pains, pain going down the inner aspect of the thigh, and sometimes urinary retention. The patient looks very ill and the prostate is exquisitely tender on rectal examination. Because it is very difficult for antibiotics to penetrate the prostate and cure the infection, it is important that you take culture specific antibiotics for about six weeks. If the symptoms don’t subside within a few days of starting antibiotics, it is important to be sure that a prostatic abscess is not present as this is a urologic emergency and requires a surgical procedure to drain the abscess. At this stage, it can be difficult to be sure on examination, but an abdominal ultrasound or CAT scan can usually make the proper diagnosis.
In chronic bacterial prostatitis, the symptoms are more subtle. The patient’s main complaint is usually frequency of urination, aching in the prostate or testicles and pain of fullness in the lower abdomen. Patients with chronic bacterial prostatitis usually have a history of a bacterial urinary tract infection. The diagnosis is made by doing a special examination of the urine and prostatic secretions known as bacterial localization cultures. This is done by splitting the urine sample into different segments. You begin to urinate and catch the first few drops in a specimen container. Then you continue to urinate and obtain a sample in the middle of urination (a mid-stream sample). You stop urinating and then your doctor examines the prostate with his finger in the rectum. He presses on the prostate with a technique called prostatic massage. This causes some fluid, called expressed prostatic secretions, to leak from the tip of the penis. These secretions are put into another container and, finally, you finish urinating and the last urine specimen is obtained. All of the samples are sent for analysis and culture. If there are white blood cells or pus cells and bacteria in the prostatic secretions, but not in the urine, a diagnosis of chronic bacterial prostatitis is made. Treatment is prescribing culture specific antibiotics for 6-12 weeks.
Bottom Line: Prostate infections are a common affliction of men. The diagnosis is made with a careful history and physical examination. For bacterial infections the treatment is antibiotics that are specific to the bacteria in the prostate.
Dr. Neil Baum's Urology Blog 