Question Title: prostatis

Dear Robbi,

Men with prostatitis syndromes are frequent patients in the urologic office. Initially, they should be screened with urine analysis, urine culture, urine cytology, and uroflowmetry. If no bacterial pathogen is found then a special urine analysis with three samples should be performed. You have had prostatitis symptoms for about five years now and you may or may not fit into the category of infectious prostatitis, either acute or chronic. There is another category that is a little less specified, known as nonbacterial prostatitis or a third category known as prostadynia. The three part urine sample would put you into a category of which type of prostatitis you have. I will briefly discuss each type below.
Acute bacterial prostatitis you probably do not have because this has been going on so long and you have had mulitple courses of antibiotics. This accounts for less than 5% of cases. Symptoms would include fever ,chills, malaise, and myalgia. Local symptoms are frequency, urgency, low back pain and outlet obstruction(difficulty urinating). Digital rectal exam is exquisitely tender. The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus.
Chronic Bacterial prostatitis is defined by recurrent urinary tract infection and persistence of pathogenic bacteria in prostatic fluid. Primary complaints consist of genitourinary pain(61%),dysuria or painful urination(16%), clear urethral discharge(12%), recurrent UTI(9%), and sexual dysfunction(1%). Physical exam is usually normal, however the three part urine analysis shows a high number of white cells on one of the three samples. This may be what your doctors are telling you(>10WBC/HPF in the EPS) The most common organism found is E.coli in 80% of cases. Chronic bacterial prostatitis is simply a bacterial infection that recurs and is chiefly due to the ductal structure of the prostate you were born with.
Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time.
Nonbacterial prostatitis is an inflammatory condition of unknown etiology. The symptoms are similar to those with chronic prostatitis and this group of patients outnumber all other patients with prostatitis. Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but also lipid laden macrophages. These are cells not characteristically seen in the prostate secretions filled with fat. There may be a chemical irritation as a basis of this disease.
A trial of antibiotics should be tried but conservative measures such as over the counter anti-inflammatory agents(Motrin, Advil, Alieve), hot sitz bathes and support should be offered.
Prostadynia is a term used to define patients with proststitis type pain without specific findings related to the prostate. Typically these patients are younger and have variable urinary complaints. There is no etiology of this disease established and therefore a generalized work-up should be done. Again conservative measures should be performed in addition to some limited dietary restriction of caffeine,alcohol, and spicy foods. Other talked about treatments include Zinc and Saw palmetto, however neither of these therapies have been proven.
To answer your last question on further work-up or should anything else be done, my only thoughts include a cystoscopy to rule out any anatomic abnormality such as a deformed or high bladder neck. This would also eliminate bladder cancer as a cause of your symptoms. You might also try a course of an alpha blocker such as Flomax, Cardura, or Hytrin.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Prostatitis