Touching on the topic Chronic Prostatitis in the previous series is like opening a Pandora's box. What was mentioned was just the tip of the iceberg. Chronic Prostatitis is a common, resource draining & a very debilitating disease. Various epidemiological studies have revealed it to be a cause for more office visits than BPH or Carcinoma Prostate. It simply means inflammatory conditions of the prostate gland.

Age Group:
The diagnosis of prostatitis has been responsible for up to 25% of all genitourinary complaint related office visits. It is the most common urological diagnosis in men less than 50 years. It has been clearly demonstrated that patients diagnosed with chronic prostates have quality of life impact similar to patients suffering from MI, Angina or Crohn's disease.

Symptons:
Most individuals with chronic prostatitis present with vague symptoms & it is difficult to differentiate various categories on the basis of symptomatology alone. Although episodic & fluctuating, the symptoms are usually present for a long period of time (by definition, at least 3 months) & consist of genitourinary pain & variable irritative & obstructive voiding symptoms.

Apart from serial urine examinations TRUS (Transrectal ultrasound) has proven the best approach to visualize the prostate gland in cases of acute or chronic inflammation.

Causes:
The main reason is urinary tract infection. The Prostatitis Collaborative Network Workshop recognized the Chronic Pelvic Pain syndrome (CPPS). It may be inflammatory or non-inflammatory. The important thing to understand is that chronic prostatitis can also exist in the absence of any evidence of infection or inflammation of the prostate. The various reasons could be dysfunctional voiding, chemical, neuromuscular, autoimmune or intraprostatic duct reflux.

One sees a significantly higher prevalence of prostatic calculi, particularly diffuse calcifications in patients with inflammatory vs. non inflammatory CPPS (chronic pelvic pain syndrome). These prostatic stones similar to kidney stones may be impregnated with pathogens that are shielded from antibacterial agents & thereby lead to recurrent prostatitis as well relapsing UTI (urinary tract infections)

General Treatment:
Antoimicrobial therapy remains the mainstay for treatment of acute bacterial prostatitis, but its role in chronic prostatitis remains under scrutiny depending upon the type of chronic prostatitis.

In CBP (chronic bacterial prostatitis) full dose antibiotic treatment is the treatment of choice. The optimum duration of treatment should be 12 weeks & if the symptoms do not respond, repetitive prostatic massage in conjunction with antibiotics should be used. A suppressive dose of antibiotic needs to be continued for a long time in cases of recurrence or those having no response even after 3 months of full dose antibiotics. Surgery is always the last resort where associated precipitating factors like bladder neck problems, stricture urethra, documented repetitive prostatic infection with prostatic calculi or when standard antibiotic therapy has failed.

In inflammatory chronic pelvic pain syndrome (CPPS) the patients are initially give antibiotics for 6 weeks, which should be continued for another 6 weeks if there is a favorable response. If no response then alpha-blockers, anti-inflammatory agents, & repetitive prostatic massage, finestride, phytotherapy, & lifestyle changes are used as a second line therapy.

In non-inflammatory CPPS, patients are subjected to one course of antibiotic (4 weeks) before attempting another form of therapy. Others include the same second line therapy as above with addition of analgesics & muscle relaxants. Also essential is supportive therapy in the form of biofeedback, relaxation exercises, psychotherapy, & lifestyle changes.

Conclusion:
Chronic prostatitis is truly a quality of life disease. It is a gift of the metro life. Even high-strung type A personalities are much pone to it. Infact Yoga may really prove to be useful in theses cases where antibiotics have not helped much.