I believe the following is an accurate assesment.

found @ http://www.ptcc.info/anatomy.htm

jrh

Complicated Neighborhood Relationship

The prostate is a subsidiary gland organ in male genitourinary system. It is
adjacent to the Seminal Vesicles, Vas Deferens, urethra, bladder and rectum,
so chronic prostatitis often follows after infections of other genitourinary
organs and prostatitis often comes with Seminal Vesiculitis. Because urethra
is connected to the outside, bacteria could easily penetrate to the prostate
through urethra and cause infection.

Negligence of genital sanitation, indulgences on sex, stones of genitourinary
organs, piles and abscess around anus could spread the infections to the
prostate. Even the infection of the prostate has been cured in time, there are
still threats of recurrences because its neighbors are not so friendly.

Anatomic Complexity

The chestnut-shaped prostate is located deep inside the pelvic floor, sits
right below the bladder and is wrapped around the urethra. The prostate is a
fibro-muscular exocrine gland, a male accessory reproductive gland of the
genitourinary. It is a compound tubuloacinar gland composed of 25-30 small
tiny acini or sacs located in the periphery of the prostate, and each
glandular unit is connected to the outside by a tiny duct, which opens into
the urethra at each side. The prostate is covered by a thin vascularised
fibrous sheath, which surrounds a fibromuscular layer continuous with the
smooth muscle surrounding the bladder.

When bacteria penetrate into the acini and grow there, the swelling and
inflammation caused by the infection closes off the acini, causing it not to
"shed" bacteria, and protecting the bacteria inside from antibiotics. That is
the reason why antibiotics are not effective in treating chronic prostatitis.
With Systematic Treatment, antibiotics are able to penetrate the membrane of
the prostate, thus killing the bacteria inside the acini and reopen the acini.
Dead bodies and pus are then flushed out of the body through urethra.

Pathological Complexity

It is normal that bacteria live in penis urethra and the membranous urethra.
Normally, they could also live in the prostate. A portion of chronic
prostatitis is nonbacterial; for example, Chlamydia, Mycoplasma, virus, yeast
or autoimmune diseases could be one of the causes. If treated by antibiotics,
patients' health will be impaired and it could take a long time without a
permanent cure. Some of the patients develop tiny calculus in the prostate and
couldn't easily be resolved by oral antibiotics. Blockage of prostate glands
by calculus could also induce the recurrence of infection.

The clinical reasons for bacterial prostatitis are:

   * Bacteria enter the urethra and reach the prostate
   * Blood infection, tooth infection, tonsil infection, upper respiratory
tract infection, skin disease
   * Pathological changes near the prostate (rectum and anus infection
through lymphatic glands)
   * Acute prostatitis to chronic prostatitis
   * Complications from Cystitis or Pyelonephritis
   * Excessive drinking, cold, excessive sex life and harmful sexual habits,
damage in perineum, chronic constipation.
   * Penis urethra blockage and difficult urination.

All of the above could lead to nonbacterial hyperemia of the prostate and
create a perfect environment for the invasion and propagation of bacteria.

Complex Relationships between Immunity and Pathogens

The severity of chronic prostatitis depends on immunity of the body and
strength of pathogen. The level of defense of the immune system significantly
determines whether one will get infection, the severity of infection and the
difficulty of treatment.

The common factors on the level of defense are heavy drinking, frequent
masturbation, long distance cycling, siting too long, excessive fatigue,
getting a cold and negative thought.

Different pathogens have different strength on human body. For example,
Staphylococcus epidermis and E. coli are called conditional pathogens. These
pathogens could infection our body only when the immune system is very weak.
Conversely, the strongest pathogens could infect almost everyone, such as
Chlamydia, Mycoplasma and Gonococcus. The traits of a particular pathogen,
amount of invaded pathogen and the growth of them are also the factors. Spicy
and high-protein food promotes the growth of pathogen and increases the chance
of getting prostate infection.

The majority of chronic prostatitis cases are mixed infection. Bacterial and
nonbacterial prostatitis has an unusual close relationship and could swap
reciprocally, that is exactly the core problem of treating chronic
prostatitis. Effective treatment and prevention are not possible if one is
ambiguous of the relationship between the two of them.

Doctor-patient Relationship Complexity

Because of the difficulties in treating chronic prostatitis, lots of so-called
urologists and doctors come up with many new ways to treat prostatitis, for
instance, excessive intravenous drip of antibiotics and long period of use of
antibiotics, creating resistant strains. Patients become not sensitive to many
antibiotics and lose confidence on formal effective treatment.

Some patients depend solely on medicine in a superstitious way without knowing
that the basis of infection is the drop of immunity and resistance of the
body. Lack of exercise, abnormal habits, excessive sexual activities/drinking
and overnight mahjong games all add to the difficulties in treatment.

Classification of Prostatitis

There are 3 clinical prostatitis syndromes, which we differentiate based upon
symptoms and cultures:

1) Acute Prostatitis - NIH category I

Characterized by an acute febrile illness often associated with chills,
sweats, suprapubic pain, urinary frequency, poor stream and often acute
urinary retention. The prostate is swollen, extremely tender and should not be
massaged. Bacteria are readily grown from the urine. Patients may require
admission to hospital for intravenous hydration and antibiotics. A suprapubic
catheter may be required to alleviate urinary retention. All antibiotics
penetrate into the prostate equally well during the acute attack. Eradication
of the bacteria leads to complete resolution of symptoms. Failure to improve
within 48 hrs may indicate the presence of an abscess.

2) Chronic Bacterial Prostatitis - NIH category II

This clinical syndrome is characterized by recurrent urinary tract infections
by typical common bacteria (eg. E. coli). Cultures of prostatic fluid in
between these episodes of infection typically are the same pathogens. Symptoms
include pain, urinary frequency, weak stream and impotence. Fertility may also
be impaired.

Eradication of the causative bacteria with prolonged courses of antibiotics
usually leads to complete resolution of symptoms, however the recurrence rate
is high. Antibiotics must be chosen with high lipid solubility and a high pKa
(eg sulphas, quinolones, erythromycin, tetracycline). Infected prostatic
stones, obstructed seminal vesicles or dysfunctional voiding with high urinary
residuals may all contribute to the recurrent infections. Probably fewer than
5% of men with chronic prostatitis have this clinical syndrome.

3) Chronic Pelvic Pain Syndrome - NIH category III

By far the most common clinical syndrome, it is primarily characterized by
pain which may be penile, scrotal, perineal, rectal, suprapubic or in the
lower back. There may also be a weak urinary stream, frequency, nocturia,
urinary urgency and erectile dysfunction. Ejaculation may relieve symptoms or
may significantly worsen them. A history of acute prostatitis is rare.
Cultures of prostatic fluid may find bacteria, but not those that are usually
considered to be common bacteria.

Microscopic examination of the prostatic fluid may reveal significant
inflammation (NIH category IIIa) or not (NIH category IIIb). Some men may
improve with antibiotic therapy although most do not. There is NO agreement in
the literature over the cause and best treatment for this disorder. A review
of the literature shows in fact that many investigators hold strong and
mutually contradictory opinions.

Possible Causes of Chronic Pelvic Pain Syndrome (CPPS)

a) Infection

It has long been suspected that despite negative cultures, CPPS is caused by
microorganisms that are either not considered to be uropathogens (e.g. Gram
positive bacteria) or are difficult to culture (e.g. Chlamydia, Mycoplasma,
Ureaplasma, Anaerobes and fungi). These organisms can always be found in the
prostate of men with CPPS. The controversy is whether they always, sometimes
or never represent the cause of the symptoms and what the incidence is of
these organisms in healthy men without CPPS.

b) Inflammation

Men with CPPS often have fluctuating levels of white cells in their prostatic
fluid. While inflammation can be a response to infection, it can also be in
response to other types of injury such as trauma or represent an autoimmune
reaction. Some believe that CPPS is a true autoimmune disorder, an inability
of the inflammatory response to shut itself off after an infection has been
cleared. Others believe that reflux of urine into the prostate produces a
chemical injury that elicits the inflammation.

c) Neuromuscular

Men with CPPS have been shown to have spasm of the pelvic floor muscles
(voluntary) and the smooth muscles around the base of the prostate and bladder
(involuntary). In some patients this may be a reaction to the infection and/or
inflammation occurring in the prostate, in others it may be the primary
problem itself. Physical exam may show that most of the tenderness is in the
pelvic sidewall rather than the prostate itself.





Back to top

Prostatitis Treatment Center China
Gate 3, City Stadium, Xiangtan City, Hunan Province, China
Email info@ptcc.info

Copyright© 2002 Prostatitis Treatment Center China All Rights Reserved.
Designed by eBusiness Work Shop

"MB"  wrote..

Maybe your initial prostate condition has spread and you now have IC, (
intersitial cystitis )? You mention pain around bladder area. Bring it up
with your doctor.

By the way......how did it clear up for 2 weeks in September?

Regards.