Chronic Prostatitis

Case report:

A 60-year-old patient appears in practice and complaining about for several days existing painful urination, back pain, pressure in the perineal region, occasional urinary retention and postejakulatorische pain. These symptoms had appeared more frequently in the past two years and it had been repeatedly detected in urine bacteria.

Diagnosis:

On physical examination, no pathological findings will be charged. Heart rate and body temperature are normal, and the kidneys bearings are not knocking or pressure sensitive. Rectal exam the prostate is enlarged and painful to touch moderately. Because of the suspicion of a prostatitis are at full bladder initially the first 10 ml of urine, obtained after 10 ml of midstream urine and the prostatic. In microscopic examination the first urine sample and also the prostate secretion granulocytes and bacteria be detected increases. Bacteriological growth in these two urine or secretion samples E. coli in a germ count of 107 / ml. The susceptibility testing results insensitivity of this germ compared to cotrimoxazole (various trade names) and amoxicillin (Amoxypen others).

Pathogenesis:

A chronic bacterial infection of the prostate is a relatively rare urogenital. Not infrequently, there are other chronic anatomical or functional disorders in the urinary tract. In men with recurrent urinary tract infections often, however, should be etiologically necessarily thought of the existence of chronic prostatitis.

Therapy:

The frequently isolated pathogens in chronic prostatitis are enterobacteria, Pseudomonas aeruginosa and Enterococci. The significance of Staphylococcus saprophyticus is controversial. In the resistance situation of the detected in this patient E. coli antibiotic therapy with ciprofloxacin (Cipro, etc.) at a daily dose of 2 x is introduced 500 mg / d. The duration of therapy of chronic prostatitis should be at least four weeks at a distinct disease and frequent relapses up to 16 weeks to be treated. Tilt the patient even after prolonged antibiotic treatment for frequent relapses, a Suppressionsbehandlung such should daily cotrimoxazole (BACTOREDUCT etc.) at a dose of 1 Forte tablet or nitrofurantoin (Furadantin others) 100 mg 1 - 2 tablets a day to be made.