The truth about male cystitis . . .

HERE are the other key problems that can affect the prostate — and what to do about them . . .

PROSTATITIS

THIS is often known as ‘male cystitis’ because patients experience similar symptoms to the women’s complaint, such as a need to urinate frequently and a stinging sensation.

In fact, there are two entirely different types of prostatitis that can cause such symptoms.

SIGNS AND SYMPTOMS: A high fever, aches and pains, a slight discharge from the penis, pain passing urine and an urgent desire to urinate, with symptoms appearing over a few days.

This is inflammation of the prostate gland and is a rare condition affecting just two in every 10,000 men at some point in their lives. Caused by bacteria that normally live harmlessly in the bowel getting into the prostate gland via the urinary tube in the penis.

TREATMENT: A four-week course of antibiotics plus painkillers, which can be repeated if the infection persists.

SIGNS AND SYMPTOMS: Pain around the groin, mild pain on urination plus an urgent desire to urinate; erectile dysfunction, pain on ejaculation and loss of libido. It also raises levels of prostate specific antigen (PSA).

between one in two and one in three men is affected by chronic prostatitis at some point, and many are offered the wrong treatment, according to new guidelines published by Prostate Cancer UK in september.

up to one in ten cases of chronic prostatitis is caused by a bacterial infection; for the rest, it’s a ‘pain syndrome’ generated by a complex interaction of muscles, nerves and bony structures within the pelvis.

While prostatitis causes low mood, it may also be triggered by depression and anxiety.

TREATMENT: An initial four-week course of antibiotics and simple painkillers. It these don’t work, men should be offered neuropathic medication that treats pain caused by problems with signals coming from the nerves. Men may be offered viagra-type medication as well as cognitive behavioural therapy (CBT). Those who do not respond should be referred at an early stage to a pain-management specialist offering a multidisciplinary approach including physiotherapy and CBT.

The key is to avoid repeated and ineffective courses of antibiotics, says Dr Jon Rees, a somerset GP specialising in urology and chair of the Prostatitis expert Reference Group, which produced the new guidelines.

ENLARGED PROSTATE

SIGNS AND SYMPTOMS: Difficulty starting to urinate, a frequent need to urinate and a feeling the bladder is never fully emptied. Also known as benign Prostatic hyperplasia (BPH), the condition is an inevitable part of ageing. over the years, prostate cells multiply; the cells grow inward and tighten around the urethra. by age 50, one in two men have BPH.

There’s no exact moment when urinary problems point to an enlarged prostate.

‘A man should consult a doctor if urination feels abnormal or has an impact on his quality of life,’ says Dr Rees.

TREATMENT: Medication that blocks the effects of a form of testosterone, called dihydrotestosterone (DHT), can shrink the prostate. other medication can relax the bladder muscles to make it easier to pass water.

There is concern that the herbal remedy saw palmetto (a native American remedy), which is highly recommended by some experts, can lower levels of PSA — so taking this could mask prostate cancer.

surgery is recommended for those with urinary symptoms that interfere with normal life. Two months ago, NICE approved a new medical technique, TURis (transurethral resection in saline), a technology which is safer and more effective than the previous technique, TURP. one of the main differences is the solution used to flush out blood and debris during the procedure. TURP uses glycine; TURis uses a saline solution, which is much less absorbable and less likely to cause complications.

TURis is being rolled out across the nhs. It has been approved for anyone with moderate to severe BPH that does not respond to medication.