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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Hi Everybody.

Few weeks back, I discovered an acute prostititis over a chronic one. I was really surprised not to have noticed that before and I could recall the discomforts I may have from time to time without really knowing its origin.

Two months back, I was suffering from a lower back & hips pain. As it was linked to a tiredness and some anxiety I automatically told my self that it has certainly a visceral origin. When visiting the Urologist, he examined me manually and the prostate touch was painful and the echography showed Acute over a chronic prostatitis. I was put under Bactrim for 8 weeks + Brexin for the inflammation. After I finished the treatment, I still feel occasionally frequent need of urination, tiredness and some time a feeling of uncomfort in my lower back and hips. Also, and since few days, some problems in the erection linked as well to a net decrease in sexual appetite. Knowing that normally I have sexual activities several times a week and have constantly a good appetite in this sense.

I am a bit confused and whether I still have a the acute prostatitis or what I am living now are symptoms related to the chronic ones.

Thanks for your comments and advise.

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Replies to This Discussion

Joe, from a clinical perspective, you're not really making the argument for chronic prostatitis. It all sounds pretty acute. And from a radiological perspective, it's not even clear which criteria are being used here to diagnose chronic prostatitis. So it's not clear that you have chronic prostatitis, unless the radiologist can clarify how he diagnosed chronic prostatitis. Again, either way, your clinical story doesn't really fit with chronic prostatitis. And either way, a trial of antibiotics certainly makes sense. Keep us posted, please. And see if you can get more details and information from your doctor(s) about what was seen.

Hi

Thanks a lot for your feedback. The echography shows a multiple calcifications attesting of anterior priostatitis not correctly treated. I ve the following concerns:

- Can the calcifications cause recurrent infections and how to get rid of them?

- I am feeling an uncomfort at the levels of my hips, especially when I am driving + some picking picking at th elevel of the scrotum + decrease in sexula appetite + a Iritability and sadeness. Could it b erelated to the fact the acute prostatitis is back and I need further treatements with antibiotics?

 

BR//Joe

 

 

Let's distinguish an ultrasound finding from clinical symptoms. The reality is that calcifications are found in many men who have absolutely no symptoms. For example, we seem them routinely in asymptomatic men who are having prostate biopsy on suspicion of prostate cancer. So finding calcifications does not denote prostatitis symptoms, let alone prostatitis symptoms not correctly treated.  They are a nonspecific finding, not a diagnostic finding.

 

To your question, bacteria and yeast and viruses, not calcifications, cause infection. And sure, your symptoms are consistent with recurrent (acute or chronic) prostatitis, although depression and loss of libido from any reason is another possible explanation of symptoms, including symptoms manifesting in somatic sensations, such as hip discomfort. Your doctor(s) can help you explore which is the "chicken" and which is the "egg."

Thanks for your reply.

When my doctor put me under BActrim, he told me that this is the only antibiotic that could penetrate teh prostate. Another doctor told me that Bactrim is a quite old Antibiotic and not anymore effective as most of teh bacteria could have developed resistance to it? To waht extent the opinion of both doctors are accurate?

 

BR

Joe

If only Bactrim gets in, then why do so many cases of acute prostatitis respond completely to quinolone antibiotics?

Yes, Bactrim is older than cephalosporins, fluoro-quinolones, and other antibiotics. It still kills sensitive bacteria. Either way, if a patient has acute prostatitis, and no bacteria are available for culture and measurement of antibiotic sensitivity (as is often the case), then unless a patient lives in an area where most bacteria are resistant to Bactrim but sensitive to quinolones, an emprical trial of Bactrim is not unreasonable.

Hi

What would be the best option forward knowing that I was 6 weeks under Bactrim and I did no exams apart from the echography? What shall I suggest to my doctor in order to deepen the analysis.

BR

 

Joe

You are reporting a range of prostate signs and generalized symptoms, ranging from back pain to fatigue to anxiety to reduced libido to prostate tenderness. Since each of these can be either a cause or effect and since each can be caused by many things, this situation is too subtle and complex to be fully assessed in a thread like this. Either way, these signs and symptoms need a broad consideration, which I am in no position to make. See what your doctors say and let us know.

Hi

Just saw my doctor today. He asked me to do a spermoculture and ATB to better define the antibiotique for teh next treatement. I was wondering if I should also do an ECBU to see of the urine has a bacteria as well!

Looking forward for any comment

BR

Joe

what is an ECBU?

I think in frensh "Test cytobactéréologique des urines."

Hi

9 months after accute crisis I had, so far I am experiencing in a chronic manner the bellow issues:

1- continuous numbling in teh scortum area

2- Some time pain in testicles, reliefed by ejaculation.

3 Sporadic erectil disfunction

4- sporadic thigh discomfort

5- Discomfort above the hips

6- Sporadic increase in urination frequency

The urologists I saw just said I ve nothing to worry about, especially when abdominal Echography was almost normal, except the prostate seize 23 CC (although they said it is normal) and 18 CC still in bladder after urination (mesured by Echorgraphy as well). Also in teh echography, we can see "légère Hypotonie des cavités pyelocalicielle". The urologist says as far as te kidney are ok and no expansions is noticed we shoudl not care about that.

 

My concern now is thatif I am having a chronic inflamation of teh prostate, what shall I do to get rid of it. What shoudl be the best way forward to adress this never ending story.

Thanks for your support Joe

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