Prostatite
Table of Contents
Definizione
La prostatite è un’infezione acuta o cronica della prostata.
La prostata è una ghiandola che fa parte dell’apparato uro-genitale maschile. Si trova sottola vescica e circonda l’uretra. Per la forma e le dimensioni ricorda una castagna (pesa circa 20 g), con una lunghezza di 3 cm, una larghezza di 4, uno spessore di 25 mm.
Eziologia
- Infezioni batteriche:si diffondono nella prostata dall’uretere o dalla vescica; la via linfoematogena sembra meno frequente. Gli agenti patogeni sono quelli delle infezioni urinarie ( colibacillo e altri germi gram negativi, enterococchi). Le infezioni batteriche della prostata sono acute o croniche. Sono la causa principale di infezioni urinarie recidivanti nell’uomo.
- Infezioni non batteriche:la causa rimane spesso sconosciuta. “Chlamydia trachomatis”alcune specie di microplasmi e” Ureaplasma”potrebbero avere un ruolo patogenico importante nella prostatite acuta e cronica non batterica; possibile trasmissione per contatti sessuali.
Prostatite granulomatosa
- Forma tubercolare: secondaria a tubercolosi urogenitale; più raramente per via ematogena da una tubercolosi polmonare. I casi avanzati possono distruggere la prostata ed invadere le vescicole seminali.
- Forme non tubercolari:presenza di granulomi a cellule giganti, ma senza casco né bacilli tubercolari. Si tratta di una reazione del tessuto prostatico ad un’infezione.
Sintomi
PROSTATITE ACUTA:
- Quadro dicistiteacuta con febbre
- Brividi
- Disuria
- Pollachiuria
- Dolori rettali e perineali aggravati dalla defecazione
- Ematuria macroscopica o microscopica frequente
- Leucocituria elevata.
All’esplorazione rettale, la prostata è molto dolente, può essere diffusamente o irregolarmente ingrandita; la presenza di una zona fluttuante è segno di ascesso. Leurinocolture, soprattutto dopo il massaggio prostatico, permettono spesso di individuare il germe responsabile. La prostatite acuta ha la tendenza a evolvere verso la cronicità. Il patogeno responsabile di circa l’80% delle prostatiti è l’Escherichia coli.
PROSTATITE CRONICA
- Anamnesi di infezioni urinarie ripetute
- Dolori perineali
- Disuria
- Pollachiuria
- A volte stato subfebbrile
- Stato depressivo
- Impotenza
- Le urine presentano solo anomalie minori, rimangono spesso sterili.
Diagnosi
Accurata indagine anamnestica di uno studio batteriologico delle secrezioni genito-urinarie, di
un’ecografia prostatica transrettale e di un’esplorazione della prostata. La prostatite cronica richiede la diagnosi differenziale con l’adenoma e il carcinoma della prostata. Nella prostatite la prostata risulta ingrandita, dolente, soggetta alla fuoriuscita di liquido prostatico.
Terapia
Antibioticoterapia: la terapia antibiotica è la terapia di scelta per la prostatite acuta. Gli antibiotici più usati nel trattamento della prostatite batterica sono i fluorochinolonici ed il cotrimossazolo per 3-4 settimane.
Nel caso diprostatite cronica battericasi procede con una terapia antibiotica di maggiore durata, minimo 6-8 settimane.
Misure generali: riposo in caso di prostatite acuta; analgesici, antinfiammatori, correzione della stipsi, evitare bevande etiliche e alimenti piccanti. Rapporti sessuali protetti.
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