What are the causes of chronic prostatitis?
The basic cause of chronic prostatitis is that damaged prostate tissue becomes swollen and inflamed again and again whenever suitable conditions arise.
The biggest cause of the disease is microorganisms. Microbes travelling up the urethra during sexual intercourse (Chlamydia, Mycoplasma, Enterococcus, Candida, E. coli, viruses, etc.) reach the prostate tissue. At this stage some patients have a yellow-green discharge from the penis and severe burning when urinating. This type of the disease can be called prostatitis caused by microbes. This stage is very important: the microbes must be adequately treated before they start to damage the prostate tissue. Otherwise they enter the prostate tissue and block the ducts inside the prostate. The microbes may give no symptoms for a long time, but the prostate whose tissue has been damaged becomes inflamed and causes the patient various problems, because the prostate sits anatomically beneath the bladder, surrounded by important vascular structures and the nerve network running to the penis. This type of prostatitis is called bacterial prostatitis, and 30% of patients are in this category.
The most common type of prostatitis is non-bacterial prostatitis. Is there perhaps a bacterium in the non-bacterial group too that we simply cannot detect? This question is still debated worldwide and has no clear answer yet.
Patients with non-bacterial prostatitis have exactly the same complaints as those with the bacterial type; only the cause differs. Examples include staying in wet shorts for a long time, sitting on a cold surface for a long time, intense stress, not ejaculating for a long time or squeezing the penis during ejaculation to stop the sperm from coming out, doing weight-bearing sports with a full bladder, and serious emotional stress (separation, living away from home).
How is chronic prostatitis diagnosed?
For a diagnosis of chronic prostatitis the patient must first be listened to very carefully. Most patients have consulted at least five different doctors without receiving a diagnosis. A discharge from the penis after unprotected intercourse, throbbing pain in the perineal region (the area between the testicles and the anus), persistent testicular pain and penile pain after ejaculation should draw our attention to prostatitis.
Digital examination of the prostate is very important for diagnosis. During this examination the patient is very uncomfortable and feels severe pain radiating to the penis and testicles.
The prostate tissue is massaged to express prostatic fluid, which is sent to the laboratory for analysis (PCR-Androflor test and urethral discharge culture). The fluid obtained after prostate massage is also examined under the microscope for the presence of leukocytes (inflammatory cells). If there are more than 5 leukocytes, prostatitis is suspected.
The most important criteria for diagnosis are the patient's history, leukocytes in the prostatic fluid, digital examination of the prostate and laboratory results. An MRI is sometimes performed for prostate inflammation, but clinically this has no meaning, because there is also a group of patients who have inflammation in the prostate without any complaints.
