1. Information About Prostatitis
   
2. Categories of Prostatitis
   
3. Acute Bacterial Prostatitis
   
4. Chronic Bacterial Prostatitis
   
5. Prostato-Vesiculitis
   
6. Chronic Non-Bacterial Prostatitis
   
7. Prostatodynia
   
8. Treatment of Prostatitis

Prostate-Vesiculitis could be present in association with chronic prostatitis or as an isolated disease.

• weak erection
• premature ejaculation
• sometimes pain in the back which irradiates in the sacrum
• dysuria
• spermatorrhea.

During each examination of the prostate gland, an attempt should be made to examine the seminal vesicles. The vesicles are located under the base of the bladder and diverge form below upward. Normally, the vesicles are not palpable, but when inflamed they over distend and may feel cystic or indurated.

Seminal vesicles are seldom affected separately. It's probably because whenever the prostate or even the epididymis become infected, the seminal vesicles also become infected. The prostate, seminal vesicles, and epididymis are connected with each other like connected channels. They are also connected by vascular and lymphatic vessels and nerve fibers. The majority of the nervous fibers innervating the prostate gland depart from 3-rd and 4-rd sacral segments of the spinal cord, while some of the sensory fibers emanate from the 11th and 12th thoracic segments of the spinal cord. The nervous plexus of the prostate gland and seminal vesicles have anastomoses with the hypogastric, hemorrhoidal, cavernous, and vesical plexuses. Taking into account the anatomy of these organs, the pain emerging in the prostate gland, seminal vesicles, and epididymis can radiate to the back, flank, lower part of the abdomen, perineum, and external genitalia. Thus, the existing close connection between nervous supply of the epididymis and the lumbar and sacral plexuses can explain the complaints of the patients of pains in perineum and groin. Normally, the seminal vesicles aren't palpated during rectal examination. In case of enlargement and infiltration it is necessary to suspect an inflammatory or malignant process.

It would be interesting to know that the difficulty of diagnosis lies in the fact that the secretions of the seminal vesicles always mix with the secretions of prostate gland. Therefore, the growth culture from these secretions cannot exactly indicate which of these organs is infected. However, Dr. G. Korik has described the use of a cytological method since 1970 to aid in diagnosis of infection and inflammation in the seminal vesicles. It is well-known that the seminal vesicles are lined by cubic or cylindrical epithelia. After the massage of the seminal vesicles some of these cells get into the secretions. Using Dr. G. Korik's method one can determine the inflammatory changes in these cells and diagnose them.

The seminal fluid consists of the secretion from the testicles, epididymis, bulbourethral glands (Cowper's glands), periurethral glands (Littre's glands), prostate and seminal vesicles. During ejaculation the secretion releases in the strict order. The initial portion of the seminal fluid consists of the prostate secretion. Mid portion of the seminal fluid consists of the high-concentrated sperm from testicles, epididymis and vas deferens. The secretion of the seminal vesicles composes the last part of the seminal fluid. The cytological investigation of the last portion of the seminal fluid helps to diagnose inflammation of seminal vesicles.

The inflammation of epididymitis is a common diagnosis. It is often made on the basis of clinical examination. The epididymis is anatomically connected with the bladder, urethra, and the prostate gland. Very often, infection can penetrate into the epididymis from these organs by the blood vessels, lymphatic vessels, and the vas deferens. The inflammation tends to descend from the posterior urethra by vas deferens to the epididymis. Any patient harboring a chronic posterior urethritis is at risk for recurrent attacks of epididymitis, prostatitis, or vesiculitis.

Massage of the prostate should be done separately from stripping of the seminal vesicles. After the massage, bacteriological and microbial examination should be done along with determination of the antimicrobial sensitivity of the microorganisms cultured. When prostatitis is present, the seminal vesicles should also be examined. Drainage of the prostate gland and seminal vesicles will relieve the symptoms and it is an effective treatment for this condition in addition to the use of antimicrobials.

Self massage is not recommended, because during acute prostatitis it may actually result in the worsening of infection to, or including, peritonitis.

Impotence is one of the major complications of chronic prostatitis and prostatovesiculitis. The prostate is an important sex organ with anatomical and physiologic connections to the other accessory organs, and has an important role in erection and ejaculation. All of these organs share a system of circulation, nerve connections, lymph channels, and fluid circulation. It is clear that in the presence of inflammation these organs do not work properly and the patient presents with complaints of premature ejaculation, painful erections, and weak orgasmic sensations.

When inflammation of the prostate is disseminated to the posterior urethra, verumontanum, seminal vesicles, epididymis, and testicles, the clinical picture of prostatitis changes with the development of additional complications and a different character of the pain, discomfort, and of course, impotence. Inflammation of the epididymis and testicles, the place of production of testosterone, can lead to a decrease in the production of testosterone including a decrease in the circulating level of testosterone. More interestingly, the low level of testosterone also worsens the inflammation in the prostate gland. In some of the latest Urology literature, prostatitis has been shown to cause an elevation in the PSA level as seen with benign prostatic hypertrophy (BPH) and Prostate Cancer.

In our statistics, one-third of patients with prostatitis complain of weak erection and half of them complain on changing of ejaculation and orgasm, and another one-quarter complain of a decrease in libido. Impotence as a result of the inflammation of the prostate gland and the accessory organs can also lead to psychological problems and a neurosis, and in these cases the services of a psychotherapist are required.