Erectile Dysfunction and the prostate

Prostatitis (Prostate) Prostatitis routinely requires longer treatment course than bladder infections or kidney infections. Prostatitis is a very difficult disease to treat for several reasons. The prostate is a relatively protected site in the body from medications. This means that treatment of infections requires long courses of medications with very strong antibiotics.The diagnosis is made by a combination of physical examination, urine culture, and expressed seminal fluid. Non- bacterial prostatitis is a condition that has been extensively studied but not well understood. The prevailing thought at this time is that treatment for Chlamydia with doxycycline or tetracycline may eradicate the prostatitis. Men with prostatitis syndromes are frequent patients in the urologic office. Initially, they should be screened with urine analysis, urine culture, urine cytology, and uroflowmetry. If no bacterial pathogen is found then a special urine analysis with three samples should be performed. There are several types of prostatitis, infectious prostatitis, either acute or chronic, nonbacterial prostatitis or a third category known as prostadynia. Acute bacterial prostatitis accounts for less than 5% of cases. Symptoms would include fever ,chills, malaise, and myalgia. Local symptoms are frequency, urgency, low back pain and outlet obstruction(difficulty urinating). Digital rectal exam is exquisitely tender. The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus. Chronic Bacterial prostatitis is defined by recurrent Urinary tract infection and persistence of pathogenic bacteria in prostatic fluid. Primary complaints consist of genitourinary pain(61%),dysuria or painful urination(16%), clear urethral discharge(12%), recurrent UTI(9%), and sexual dysfunction(1%). Physical exam is usually normal, however the three part urine analysis shows a high number of white cells on one of the three samples(>10 WBC/high power field in the expressed prostatic secretions) The most common organism found is E.coli in 80% of cases. Chronic bacterial prostatitis is simply a bacterial infection that recurs. Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time. Nonbacterial prostatitis is an inflammatory condition of unknown etiology. The symptoms are similar to those with chronic prostatitis and this group of patients outnumber all other patients with prostatitis. Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but all lipid laden macrophages. These are cells not characteristically seen in the prostate secretions filled with fat. There may be a chemical irritation as a basis of this disease. A trial of antibiotics should be tried but conservative measures such as over the counter anti-inflammatory agents(Motrin, Advil, Aleve), hot sitz bathes and support should be offered. Prostadynia is a term used to define patients with prostatitis type pain without specific findings related to the prostate. Typically these patients are younger and have variable urinary complaints. There is no etiology of this disease established and therefore a generalized work-up should be done. Again conservative measures should be performed in addition to some limited dietary restriction of caffeine, alcohol, and spicy foods. Other talked about treatments include Zinc and saw palmetto however neither of these therapies have been proven. As you can see the prostate infection can go on for a long time. At different times, the urinary problem may subside with antibiotics however it will often return.

About 50% of men ever have good quality spontaneous erections after (RP) Radical Prostatectomy according to some studies. This percentage varies according to whether or not attempts to spare nerves were made during the prostate surgery. Erections can be stimulated by erotic/ fantasy or direct physical contact. Erections encountered during sleep occur during the REM ( rapid eye movement) phase of sleep: when you dream. Patients with nocturnal or erections upon awakening are assumed to have normal anatomical/ biological penile function, and significant diseases which affect the blood vessels, nerves and hormones are ruled out. Another important contributor to erections is psychological input. Psychological factors can affect erections in a negative way. Examples of psychological factors include guilt, emotional conflict and performance anxiety. Here are some cases in point: 1. Some men have normal erections with their girlfriend, but not with their wife. 2. Men who are worried if they are going to be able to perform sexually are more easily self defeated.

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