MEN'S HEALTH MATTERS:Often there are no symptoms when there are bacteria in the prostate
Q I am 47 and have had a lot of discomfort in my bladder area and behind my scrotum and have discomfort when passing urine. My GP told me I had chronic bacterial prostatitis. What does it mean?
A Chronic bacterial prostatitis is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. It is a relatively rare condition that usually presents with an intermittent urinary tract infection-type picture.
Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.
In chronic bacterial prostatitis there are bacteria in the prostate, but usually no symptoms. The prostate infection is diagnosed by culturing urine (confirming infection in the lab) as well as prostate fluid (expressed prostatic secretions) which are obtained by the doctor performing a rectal examination and putting pressure on the prostate.
Prostate specific antigen (PSA - blood test for prostate cancer) levels may be elevated, giving rise to concerns that there may be an underlying prostate cancer which is not usually the case.
Treatment requires prolonged courses (four-eight weeks) of antibiotics. Persistent infections may be helped in 80 per cent of patients by the use of alpha blockers - drugs used for urinary symptoms due to prostate enlargement - or long- term low-dose antibiotic therapy.
Recurrent infections may be caused by inefficient urination (benign enlargement of the prostate, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.
Over time, the relapse rate is high, exceeding 50 per cent. A study in 2007 showed that repeated courses of combination antibiotics may eradicate infection in 80 per cent of patients with clinical remission extending throughout a follow-up period of 30 months for 94 per cent of these patients.
Q I have had loin pain for many months. My GP arranged for an X-ray and this has shown that I have a 1cm stone in my right kidney. He is arranging for me to see a urologist with a view to having this treated on the "Stone Machine".
What is this treatment and what does it involve?
A The treatment is Extracorporeal Shock Wave Lithotripsy (ESWL). This machine uses shock waves to break a kidney stone into small pieces allowing them to pass more easily through the urinary tract.
You will be asked to lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound to precisely locate the stone. High-energy shock waves are focused on the stone. These shock waves pass through your body without injuring your internal organs to break the stone into small pieces.
The treatment usually lasts 20-40 minutes. You will hear a "clicking" noise and feel something like a "flicking" on your back/front. The power or intensity may increase during the procedure so that the stone can be completely broken. You may receive sedatives or pain killers before and after the procedure.
If your stone was bigger than you describe, a stent may be placed under general anaesthetic prior to ESWL. A stent is a small, short tube of flexible plastic mesh that holds the ureter (the narrow tube that drains urine to the bladder from the kidney) open. This helps the small stone pieces to pass without blocking the ureter.
ESWL is usually an outpatient procedure. It may take a few days or weeks for all the stone fragments to pass from your body and you may have mild discomfort as the small fragments pass through the urinary tract.
In general ESWL is used on people with a kidney stone (4mm-2cm) that is causing pain or blocking the urine flow. It may be harder for ESWL to break up a stone that has moved into the ureter and your urologist may push the stone back into the kidney with a small instrument (ureteroscope) under general anaesthetic and then use ESWL.
ESWL is successful in fragmenting stones up to 1cm in size in nine out of every 10 patients. ESWL is usually not used if you are pregnant, have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, have kidneys with abnormal structure or function, weigh over 300lbs, or have an abdominal aortic aneurysm (dilatation of the main artery in the abdomen).
Anti-platelet (aspirin) and anti-coagulant tablets (warfarin) often need to be stopped up to two weeks prior to the procedure.
Complications of ESWL include discomfort, caused by the passage of stone fragments, blocked urine flow as a result of stone fragments becoming stuck in the urinary tract, urinary tract infection, bleeding around the outside of the kidney.
Often only one treatment is required, but stones that are large or are in difficult locations may require multiple treatments.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Mr Rowan Casey, specialist registrar in Urology, St Jamess Hospital, Dublin