Prostatitis Syndrome

Sindrom prostatitisa čest je klinički entitet i naziv je za niz poremećaja funkcije prostate. O sindromu prostatitisa govorimo stoga što je etiologija bolesti nepoznata, a dijagnostički kriteriji nisu čvrsti. Klinički se očituje simptomima donjeg dijela urogenitalnog trakta i perineuma. Osnovni kriterij za podjele unutar sindroma prostatitisa su klinički simptomi i znakovi te prisutnost leukocita i bakterija u selektivno uzimanim uzorcima mokraće i u eksprimatu prostate metodom koju su opisali Meares i Stamey. Antimikrobno liječenje indicirano je u bolesnika s akutnim bakterijskim prostatitisom, kroničnim bakterijskim prostatitisom i kroničnim upalnim nebakterijskim prostatitisom kojeg je dio i bakterijski prostatitis s uzročnikom nedokazanim klasičnim metodama. Bolesnike s akutnim bakterijskim prostatitisom i s akutnom egzacerbacijom kroničnoga bakterijskog prostatitisa treba odmah liječiti empirijskom antimikrobnom terapijom. U bolesnika s kroničnim bakterijskim prostatitisom treba pričekati mikrobiološki nalaz te primijeniti ciljanu antimikrobnu terapiju. Zbog širokog spektra djelovanja te farmakodinamskih i farmakokinetskih osobitosti, antimikrobna sredstva prvog izbora za liječenje upalnih bolesti prostate su fluorokinoloni: ciprofloksacin i ofloksacin. Efikasnost provedenog antimikrobnog liječenja treba kontrolirati 4-6 tjedana (rano praćenje) i 6 mjeseci (kasno praćenje) nakon završene antimikrobne terapije. Liječenje sindroma kronične neupalne boli u zdjelici bez dokažljive infekcije uključuje fitoterapiju, higijensko-dijetetske mjere, mikrovalnu termoterapiju, alfaadrenoreceptorske antagoniste, mišićne relaksanse, analgetike, nesteroidne antiflogistike, inhibitore 5-alfa-reduktaze, promjenu načina života, psihoterapiju i spazmoanalgetike. Svim bolesnicima s kroničnim oblicima sindroma prostatitisa savjetuje se izbjegavanje alkohola, gaziranih pića, jakih začina, vožnja biciklom, izbjegavanje hladnoće, posebice sjedenje na hladnome.Prostatitis syndrome is a frequent clinical entity, comprising a series of functional disorders in prostate. We speak about this syndrome because its etiology is still unknown and diagnostic criteria are not firmly established. It is clinically manifested with the symptoms of lower urogenital tract and perineum. The basic criterion for classification within the prostatitis syndrome are clinical symptoms and signs, as well as the presence of leukocytes and bacteria in selectively taken samples of urine and in prostate exprimate by using the method described by Meares and Stamey. Antimicrobic treatment is indicated in patients with acute bacterial, chronic bacterial, and chronic inflammatory non-bacterial prostatitis, a part of which is bacterial prostatitis with cause unproved by classical methods. Patients with acute bacterial prostatitis and acute exacerbation of chronic bacterial prostatitis must be immediately treated with empirical antimicrobic therapy. In patients with chronic bacterial prostatitis, microbiological finding must be obtained and then target antimicrobic therapy should be applied. Due to the wide spectrum of activity, as well as pharmacodynamic and pharmacokinetic properties, antimicrobic drugs of the first choice for the treatment of prostate inflammatory diseases are fluorokinolons, ciprofloxacin and ofloxacin. The efficacy of performed antimicrobic therapy should be followed up 4-6 weeks (early follow-up) and 6 months (late follow-up) after the completed antimicrobic treatment. The treatment of chronic non-inflammatory pelvic pain syndrome without provable infection includes phytotherapy, hygienic dietary measures, microwave thermotherapy, alpha-adrenoreceptor antagonists, myorelaxants, analgesics, non-steroid antiphlogistics, 5-alpha reductase inhibitors, change of life style, psychotherapy and spasmoanalgesics. All the patients with chronic types of prostatitis syndrome are advised to avoid alcohol, carobanted beverages, strong spices, cycling, coldness, particularly sitting on cold surfaces