Prostatitis Frequently Asked Questions

Note: This FAQ has not been updated since 1997 and it was not perfect then. Any volunteers?

I About sci.med.prostate.prostatitis II About this FAQ III What is the prostate and what is prostatitis? IV What are the symptoms of prostatitis? V How is prostatitis distinguished from prostate cancer and BPH? VI How common is prostatitis? VII Are there different kinds of prostatitis? VIII What causes prostatitis? IX Can prostatitis be cured? X What can be done to alleviate symptoms? XI Why is this newsgroup necessary? XII How can we work towards a cure? XIII What is a DRE? XIV Is there some way to make bike riding less painful? XV Is there some way to make sitting more comfortable? XVI What happens during a TRUS? XVII What happens during a cystoscopy and why should I have one? XVIII What can be done to prevent Prostatitis XIX What is Prostate Drainage and why does it help? XX Can prostatitis be sexually transmitted? XXI Does vasectomy lead to prostatitis XXII How can I post a question to the newsgroup if I don't have a news reader or news service XXIII Are the newsgroup posts archived anywhere The Glossary I. ABOUT SCI.MED.PROSTATE.PROSTATITIS The newsgroup alt.support.prostate.prostatitis was founded in the summer of 1994 as a forum for those interested in the causes and treatment of prostatitis. Besides that, it has become a center for discussion of political and public awareness actions we can take to work towards finding cures for chronic prostatitis. Because some servers have blocked all alt. newsgroups the name was changed in 1995 to sci.med.prostate.prostatitis. This list was not intended for the discussion of prostate cancer or benign prostate hypertrophy (BPH) (see section 3). Prostate cancer is discussed in the group sci.med.prostate.cancer. BPH is discussed in sci.med.prostate.bph. Recently there has been some blurring of the distinction between prostatitis and BPH and there is some indication that these may be different phases of the same disease. BPH sufferers are therefore urged to monitor both groups. Those interested in discussing other medical topics should use the sci.med newsgroup or the appropriate alt.support newsgroup. II. ABOUT THIS FAQ An initial draft of this FAQ was prepared by John Koch in November 1994. This FAQ is not an official statement of policy, and even less a statement of absolute truth. It is meant simply to orient newcomers. This FAQ was extensively revised by Ron Kinner in Jan 1997. This FAQ also includes a Glossary which defines words and abbreviations often seen in the newsgroup or at the doctor's office. If your question is not found in the index then check the Glossary for key words. In an attempt to reduce download times the glossary may be stored separately from this FAQ. This FAQ will be posted to sci.med.prostate.prostatitis on or about the 1st and 15th of every month. Corrections and amplifications to this FAQ should be sent to ronk@planet.ho.att.com. Questions about statements made in the FAQ are welcome, but are likely to be more productive if posted to the newsgroup for discussion by the group. This FAQ was last updated Jan 31, 1997. III. WHAT AND WHERE IS THE PROSTATE? The prostate is part of male sexual anatomy. It is a walnut-sized gland which surrounds part of the urethra (the "tube" that carries urine from the bladder to the penis). The prostate is located approximately 2 inches inward from the anus. The prostate is made up of many small glands which are connected together like small bunches of grapes. There are somewhere between 20 and 60 of these bunches called acini in the prostate. Each bunch connects to the urethra. The prostate has several functions. It manufactures and stores a portion of the seminal fluid in the acini. This fluid provides lubrication, protects the sperm, and has an antibacterial effect. It blocks the flow of urine during sex and insures that the seminal fluid flows in the correct direction. It delivers its portion (1/6) of seminal fluid during sex by contraction of the smooth muscle in the prostate. It acts as a junction for seminal fluid produced by the seminal vesicles and testicles. The ejaculatory ducts which combine these outputs pass through the prostate to the urethra. During ejaculation, contractions of the smooth muscle in the prostate force the fluid out of the acini and into the urethra where it mixes with the secretions from the seminal vesicles, the testicles, and other glands and is carried to the tip of the penis. Prior to ejaculation, ringlike muscles in the part of the prostate closest to the bladder will tighten to prevent urine from flowing and to insure that the ejaculant goes where it should and does not pass into the bladder. The prostate provides around one sixth part of the seminal fluid. (Around four sixths of the fluid comes from the two seminal vesicles located slightly above and to the left and right of the prostate. (These can also become infected.) The remainder of the fluid is made up of secretions from other small glands in the urethra with only one percent coming from the testicles.) There are three bad things which can happen to the prostate: - -prostate cancer. A cancerous tumor may appear in the prostate. Normally these are very slow growing and often if discovered late in life, the attitude is something else will probably kill you before it does, so don't worry about it. Quickly increasing readings on the PSA test (over a period of several months) may indicate the presence of cancer. A TRUS and biopsy may be performed to be sure. (In Germany there was some controversy about the wisdom of a biopsy. One doctor (who was shouted down by his peers) suggested that a biopsy might actually cause the cancer to spread by releasing cancerous cells into the blood. Biopsies have also been known to introduce bacteria into the prostate. A recent study of removed prostates shows that often the cells around a biopsy puncture die.) The most common treatment is surgical removal of the prostate and the seminal vesicles. This makes many men impotent and some may have problems with urine leakage. A new treatment using three X-ray beams appears to be just as effective and have fewer side effects. Other treatments which may be used to fight the cancer or prevent its growth are implantation of radioactive beads, chemotherapy, removal of the testicles (Orchiectomy), radiation, and drugs such as PROSCAR which prevent the body from using testosterone. For more information on prostate cancer see the newsgroup sci.med.prostate.cancer, the website athttp:///www.prostate.com , and the Glossary entries for PSA and Prostate Cancer. -- benign prostatic hypertrophy (BPH), which is a non-cancerous increase in size of the prostate. This increase in size impacts the urethra and can partially or totally block urine flow. It appears that some cases of BPH may be forms of prostatitis. Patients with the same symptoms are often diagnosed with prostatitis if they are under 50 and with BPH if they are older. There is also speculation that untreated prostatitis can eventually become BPH. There is a newsgroup: sci.med.prostate.bph. See also Glossary entries for BPH, Saw Palmetto, Alpha 1 Blockers, TURP, TUNA, TULIP. -- prostatitis, which is an inflammation of the prostate or a pain in the prostate similar to that caused by an inflammation (see sections IV & VII). IV. WHAT ARE THE SYMPTOMS OF PROSTATITIS? There are a variety of symptoms and problems associated with prostatitis. Each case seems to be different and each sufferer can have a different list of symptoms and problems. Most men will not have all of the symptoms at one time. The symptoms can be continual or they may come and go. Some men may have prostatitis and not have any of the symptoms. Many of the symptoms can be caused by other diseases so a doctor should be consulted. A. Urinary problems(The first 14 of these are caused by the swollen prostate partially blocking the urethra and are common to BPH.): pain when urinating increased frequency urgency difficulty in starting urination difficulty in completely emptying the bladder waking at night one or more times to urinate weak stream split stream interruptions during urination (stop and start) dribbling or difficulty in stopping cleanly (large wet spot on underwear) bloated feeling frequent bladder/kidney infections bladder stones blood in the urine dehydration (caused by attempting to reduce the frequency by cutting back on fluid intake) itching sensation at the tip of the penis burning sensation between the legs sand like particles in urine B. Pain/ache/discomfort(Besides the pain caused by the swollen prostate, there are several nerves which pass through the area and which can be stimulated by the pressure of the swollen prostate. This results in pain which may be far removed from the prostate (referred pain). Also the infection can spread into the epididymides (the spiral ducting from the testicles to the vas deferens) and into the testicles and seminal vesicles: centered in the perineum (the area between the anus and the base of the penis) in the penis in one or both testicles (with or without swelling) in the scrotum in the lower stomach in the lower back. just above the anus before, during or after ejaculation. when sitting during bowel movements when walking when riding a bike C. Sexual problems. (Besides the obvious problem that it is hard to enjoy sex when ejaculation (or arousal) causes pain several major blood vessels run through the area and may be constricted making it hard to have or maintain an erection.) Several of the popular drugs which may be prescribed by a doctor in an attempt to increase urine flow (notably Hytrin and Proscar) can both have adverse effects on your sex life. Some women have reported burning sensations from their partner's semen. Premature ejaculation has also been reported. D. Fertility problems.Sperm count and mobility can be seriously reduced by prostatitis. The sperm must pass through a narrow duct in order to get to the urethra. This narrow passage can be squeezed shut by the swelling in the prostate. The prostatic secretion of an infected prostate is much thicker and its pH varies considerably from the normal value. This has a detrimental effect on the mobility of sperm. If the infection spreads to the epididymides these may become blocked with pus or scar tissue. E. Psychological problems:These may just be caused by the frustration of being told that it's all in your head or that nothing can be done so just live with it or there may be some hormonal imbalance at work. Depression Stress Low Libido Apathy F. Miscellaneous Problems: Urine smells strong or bad Semen smells bad Semen appears lumpy or yellowish Discoloration of the penis Semen volume low Retrograde ejaculation (usually as a side effect of treatment.) Blood in semen G. Chills and fever.(Generally only in the acute form) THIS IS A MEDICAL EMERGENCY!Get medical help immediately. V. HOW IS PROSTATITIS DISTINGUISHED FROM BPH AND PROSTATE CANCER? Some of the same symptoms may be caused by BPH or prostate cancer or prostatitis. To tell the difference, a doctor will usually perform a digital rectal exam(putting a rubber-gloved finger up the rectum to feel the outside of the prostate for lumps, hardness, and size) and order a PSA blood test. (See "What is a DRE" and the Glossary entry for PSA). In some cases where the PSA is very high (Generally over 4.0 is the usual rule of thumb though this may vary depending upon the patient's age or race.) or appears to be climbing steadily, a TRUS and biopsy may be scheduled to rule out prostate cancer. (See "What is a TRUS" elsewhere in this FAQ.) If cancer is not indicated by the results of the DRE, PSA, TRUS, or biopsy but the prostate is enlarged prostatitis or BPH can be assumed to be the problem. If the problem is confined to urinary tract symptoms (see above) and the patient is over a certain age (it appears 50 is the magic number per Dr. O'Leary at Harvard) then the patient is told he has BPH. Otherwise he has prostatitis. Kohnen and Drach found some inflammation in 98% of 162 surgically resected hyperplastic [BPH] prostates so the possibility that most if not all BPH is (or originates with) prostatitis can not be ruled out. A cystoscopy, in which a tube is inserted through the penis to look at the prostate from the inside is sometimes done to determine if there is inflammation or some physical blockage. (See "What is a Cystoscopy" elsewhere in this FAQ). During a digital rectal exam (DRE), the doctor may press on the prostate to force out some of the fluid; the fluid can be examined for signs of infection. See "What is a DRE" and "Why should the EPS be Cultured?" The presence of white blood cells in the EPS is considered a definite sign of prostatitis, however, absence of white blood cells does not mean that prostatitis is not present. The acini can be so badly clogged that none of the EPS comes from infected acini. It sometimes takes several prostate drainages before the white blood cell count becomes significant. VI. HOW COMMON IS PROSTATITIS? It is estimated that at least 40% of men's visits to urologists are caused by prostatitis. It can affect young men, while BPH and prostate cancer are more typical of older men. Because prostatitis varies in severity and because it has attracted little attention from researchers, no one knows how many men suffer from it but the usual statistic quoted is that over 50% of all men will suffer from it sometime in their life. VII. ARE THERE DIFFERENT KINDS OF PROSTATITIS? Most discussion of prostatitis divides it into four types. However, they are often hard to tell apart, and the dividing lines are often not clear. The general feeling in the newsgroup is that they are all aspects of the same disease. Acute bacterial prostatitis comes on quickly, can cause intense pain, fever, and chills, can require hospitalization, but is usually "cured" quickly with antibiotics. (Some newsgroup members have reported that their supposedly cured acute bacterial prostatitis turned chronic after the cure.) Chronic bacterial prostatitis is less intense, but is not cured quickly by antibiotics alone. Examination of the urine and prostatic fluid, particularly via the Meares and Stamey technique or the Feliciano technique, indicate that disease-causing bacteria and/or fungi are present in the prostate. The condition may clear up after several months of antibiotics, or it may not. Often after treatment with antibiotics alone the condition will go dormant for a while then return immune to the original antibiotic. The symptoms of chronic nonbacterial prostatitis are the same, but no disease-causing bacteria can be identified via the Meares and Stamey technique. Signs of inflammation are seen. The Feliciano technique often reveals the presence of bacteria or fungi in these cases. In prostatodynia (which means simply "prostate pain"), there is no sign of inflammation, even though there is pain in the prostate. The Feliciano technique often reveals the presence of bacteria or fungi in these cases. VIII. WHAT CAUSES PROSTATITIS? There are many theories about the causes of prostatitis. The most popular theory among the members of the newsgroup is Dr. Feliciano's. His theories are, however, not yet widely accepted by urologists in the US. Per Dr. Feliciano, prostatitis is usually caused by an infection of the prostate. Sometimes the infection is caused by common bacteria and fungi which are usually considered benign. The infective agent can be acquired in a variety of ways: Sex, poor hygiene, contamination during an operation, swimming in polluted water, or some other unknown mechanism. Dr. Feliciano believes that the bacteria and fungi which cause prostatitis can be passed back and forth between sexual partners so that both should be treated at the same time. The prostate has some 20-50 smaller fluid producing glands called acini. Per Dr. Feliciano when an infective agent enters an acinus, the acinus quickly becomes blocked. It is not clear whether this is an attempt by the body to isolate the infection or a side effect of the infection. The infected acinus, once blocked, begins to swell as fluid accumulates. The infection and swelling of a single acinus may not be noticeable. Only when the number of infected acini reaches a certain percentage of the total does it seem that the infection begin to cause problems. Note that each acinus can be infected individually so that there may be more than one infectious agent involved. There is some speculation that in some men the infection happens so slowly that the prostate and the surrounding tissue and nerves are able to adjust and the only symptoms may be a slightly restricted urine flow. This restriction may happen so gradually that the patient does not realize that anything is wrong. This is likely to be diagnosed as BPH especially if the patient is over 50. In others, when the infection spreads more rapidly, the swelling is more sudden and the effect can be quite painful. When all of the infected acini are not completely clogged they may leak a caustic fluid which causes a burning sensation in the urethra and may account for the sexual partner's complaints of semen causing a burning or itching sensation. Once clogged the acini seldom unclog on their own even if the body manages to defeat the trapped bacteria. The body attempts to fight the bacteria by coating them with calcium much like an oyster coats a grain of sand to make a pearl. These calcium coated bacteria can combine into a prostate stone or may, if the acinus opens for some reason (perhaps after a DRE or a hard bowel movement which actually massages the prostate), be added to the urine where they give the appearance of sand in the urine. Other plugs can form made up of solidified prostatic fluid and urine. The fluid from infected acini is also much thicker and has a pH value much different than normal. This and any blockage of the ejaculatory ducts caused by the swelling can reduce sperm count and mobility. A recent study (J. C. Nickel & J. W. Costerton (Department of Urology, Queen's University, Kingston, Ontario, Canada.) Bacterial localization in antibiotic-refractory chronic bacterial prostatitis. Prostate 23: 107-14 (1993)[93391211] of biopsies of prostatitis patients) revealed "…exopolysaccharide coated microcolonies of bacteria firmly attached to the ductal and acinar walls. This implies that even unblocked acini can harbor bacteria which are protected from antibiotics by a sugar like coating and may explain why the disease is so hard to treat. A second theory, based on the discovery that only housebroken dogs have prostatitis, is that holding the urine damages the prostate in some way. The assumption is that pressure builds up and forces urine backwards into the acini where it combines with prostatic secretions to cause clogs to form. The urine can also carry bacteria into the prostate. This flow of urine backwards into the acini is called reflux. Lending additional support to this theory is the fact that a drug used for gout sufferers, allopurinol, is sometimes helpful in the treatment of prostatitis. A third theory, based on the fact that certain middle European countries where the diet is high in zinc have much lower levels of prostatitis, is that a zinc deficiency reduces the prostate's ability to resist an infection. A fourth theory, based on the fact that prostatitis was once known as the monk's disease, is that a sudden reduction in the average number of ejaculations per time period or a complete stoppage of ejaculations can lead to "old" prostatic secretions hardening and forming clogs. As monks were also prone to long vigils the reflux theory may also have some support here. Recent information is that new recruits into the armed forces are prone to prostatitis. Whether this is because the sudden enforced celibacy and lack of privacy (making masturbation difficult) causes the problem or whether the sudden opportunity to "visit ladies of the evening" when given a pass into town increases the chance of infection is not known. A fifth theory is that many cases of prostatitis are caused by auto-immune reactions. Auto-immune prostatitis has been demonstrated in laboratory animals. Anatomical problems have also been cited as the cause in a few patients. A stricture (narrowing of the urethra) can cause symptoms which mimic prostatitis. Overly tight sphincter muscles have also been blamed. The real cause of prostatitis may be some mixture of all of the above and may vary for each patient. The one thing we are sure of is that it is not "…all in your head." XIX. CAN PROSTATITIS BE CURED? Dr. Feliciano, a physician in the Philippines who has successfully treated several of the newsgroup members along with some 4000 Filipino sufferers, believes most (if not all) prostatitis (and most BPH)is caused by an infection. He has developed a special adaptation of the usual DRE which he calls "prostate drainage." This drainage has two purposes: 1. It provides a sample of the infectious agent for culturing and 2. It opens the acini and allows them to get rid of the infected material while at the same time allowing fresh antibiotic laden fluid to enter. He cultures the prostatic fluid and then prescribes one or more antibiotics or antifungals based on the results of the culture. He also continues culturing the fluid throughout the treatment in order to see whether a different antibiotic or antifungal might be required. He believes the EPS should be completely sterile so that any bacteria found (no matter how benign or common they are thought to be elsewhere in or on the body) may be the cause of the infection. Throughout the course of the antibiotic treatment, he continues his drainage technique. When the White Blood Cell (WBC) count drops to zero and the cultures come out clean the patient is considered cured. In most cases all symptoms of prostatitis disappear during the treatment and do not return. The Feliciano treatment is not widely known or accepted. Some members of the newsgroup reported complete cures after visiting Dr. Feliciano. Others have reported only partial or no relief of symptoms. A number of the men who made the long trip to the Philippines were part of a scientific study to determine how good Dr. Feliciano's treatment really is. The results of the study will be released in the near future. In the meantime, several of the members of the prostatitis newsgroup have developed their own variations of Dr. Felciano's treatment. Ron has been doing the drainage by himself with no antibiotics and reports that the symptoms have gone away and the prostate has shrunk considerably. He has created a Do It Yourself Prostate Massage FAQ which is available on the prostatitis website or go straight to: http://www.prostatitis.org/doityourself.html Scott who started about the same time but who had a friendly doctor who prescribed a combination of Augmentin and Bactrim and arranged for cultures reports that he considers himself completely cured but plans to continue the drainages for a while just to be sure. Ken and John and many other members have loving spouses who are willing to do the drainage for them. Ken reports no cure but a definite relief of symptoms. John, too, is feeling better. Mike has found a commercial product "the Crystal Clear Wand" which allows even a man with short arms to drain his own prostate. He reports a big improvement. John's wife says the wand makes it easier. Though not yet widespread the full Felicano treatment of prostatic drainage, EPS culturing, and using sensitivity testing for antibiotic selection is now available in certain areas of the United States. The following is a selection of other treatments which have been reported by members of the newsgroup to be of some use. Usually more detailed information is available in the glossary: Antibiotics:A wide selection of antibiotics have been tried. Sometimes they help, sometimes they don't and sometimes they help for a while and then don't do anything. See the glossary for information on the various antibiotics which are used against prostatitis. NOTE: Dr. Feliciano is strongly against the use of any antibiotics without the accompanying drainage and sensitivity testing. He believes (and his experience with members of the newsgroup certainly seems to back up his belief) that use of antibiotics without the drainage just results in antibiotic resistant infections which are harder to cure. Anti-inflammatory steroid drugs: Sometimes Prednisone or other anti-inflammatory drugs are given in the belief that if the inflammation can be reduced the problem may go away. Generally have no effect but there have been reports of "cures." Antifungals: Diflucan is the most commonly used antifungal drugs. Per Dr. Feliciano, antibiotics pave the way for a fungal infection by killing off the bacteria which normally hold them in check. He prescribes Diflucan routinely, usually in the end phase of the treatment, in order to prevent a fungal infection of the prostate. Fungal infections of the prostate often reveal themselves by sores which form near the tip of the penis, especially in men with intact foreskin. Sometimes the foreskin becomes painful to withdraw. Saw Palmetto Extract: Provides relief in many men for BPH type symptoms such as weak stream, urgency, nocturnia. Zinc supplements:The role of zinc in prostate health is unclear. The prostate is one of the big users of zinc but additional zinc in the diet does not seem to show up in prostatic secretions when prostatitis is present. May have more benefit as a preventive than a treatment. Chinese Herbs:Recently several sufferers have reported that certain Chinese herb preparations (Kai Kit Wan, Sexoton)have been of use. The theory is that something in them opens the acini and allows them to drain more easily. Jim who is undergoing long term drainage from his doctor reports that after he took them, his doctor reported that the prostate seemed smaller and easier to drain than before. There is a page on the website dedicated to Chinese herbs. http://www.prostatitis.org/chinesepills.html. Tranquilizers:Valium and other common tranquilizers are often prescribed in the belief that stress is a factor in prostatitis. Sometimes there is some benefit but this may be more the result of lowered blood pressure. See alpha-blockers in the glossary. Alpha-blockers: Originally developed to lower blood pressure it was found that as a side effect many also reduce the tension of smooth muscle in the prostate thus resulting in better flow rates and a more complete emptying of the bladder. Hytrin. Cardura. Surgery:Generally not recommended for prostatitis except for the removal of strictures downstream from the prostate. Unless the complete prostate is removed the problem usually remains and may get worse as scarring of the acinus openings into the urethra may result in more clogging and swelling instead of less. Microwaves:Results are similar to surgery. Balloon Dilation:Provides symptomatic relief of urinary flow restriction. A balloon type device is inserted in the urethra via the penis opening and positioned in the narrowed area where it is expanded. This opens up the passage and improves flow. However, effects are usually temporary. X. WHAT CAN BE DONE TO ALLEVIATE SYMPTOMS? When prostatitis is not cured, several things can be done to help alleviate symptoms. Not all of them work for everyone, and the best techniques for you must be found through trial and error. Water:It is important to drink plenty of water. The natural reaction to urgency and frequency problems is to cut back on fluid intake. However, this is a mistake. You risk dehydration and the urine becomes so strong that a bladder infection is more likely. Drinking lots of fluid keeps the retained urine in the bladder fairly dilute and reduces the risk of bladder infection and dehydration. Prostate Drainage:Draining the prostate regularly can often provide some or complete relief of symptoms. (XIX) Dietary changes:Caffeine, alcohol, spicy foods and/or acidic foods may irritate the prostate, and most doctors recommend either eliminating them or using them very lightly. Some doctors recommend the Gillespie diet used in cases of interstitial cystitis, which avoids acidic foods such as citrus fruits and tomatoes. (See the book, _Living with Cystitis_, by Dr. Lauren Gillespie.) Several newsgroup readers claim yeast reduction diets have helped them. Avoid decongestants and antihistamines:Sudafed, Tavist-D, Contact, Afrin etc. are all labeled with warnings in fine print not to use if you have an enlarged prostate or BPH. This warning should be written in large letters on the front of the package. These appear to cause the prostate to contract which decreases urine flow. There is also some evidence that they tend to make the prostatic secretion thicker and more prone to forming clogs. Exercise:Often walking will help. Frequent ejaculation:Frequent ejaculation (2-3 times per week) is recommended in many sources, particularly when using antibiotics. Hot sitz baths:.Hot sitz baths, in which the perineum is bathed in a pan of very hot water for at least 20 minutes, seem to reduce pain in many cases. Avoid constipation:Large hard bowel movements can press on a swollen prostrate and cause considerable pain. Eat more bran (found in any bran cereal and in most whole grain bread) and try to train yourself to be as regular as possible. Note: Some men have reported that a large hard movement, while painful at the time, actually brought some relief of symptoms. It is thought that the hard movement acts as a sort of primitive prostate massage and promotes drainage. Analgesics:Over-the-counter analgesics (aspirin, Tylenol, Nuprin, Aleve, etc.) may help control pain. Stress reduction:Symptoms can worsen because of psychological stress, and changing your situation to avoid stress and reduce blood pressure, meditation or biofeedback techniques have helped some men. Ice:Ice packs sometimes help when heat doesn't. Several readers have even been told by their doctors to put an ice cube into water until it has lost its sharpness and shrunk to a reasonable size and then insert the ice into their rectum. They report hours of relief from the pain. Chinese Herbs:Kai Kit Wan and Sexoton are sometimes helpful.http://www.prostatitis.org/chinesepills.html . Acupuncture:A few readers have found some relief through acupuncture. Antidepressants:Prescription antidepressants, taken daily at a level lower than that normally prescribed for real cases of depression, have also helped in some cases. Other alternative herbs and treatments:See the Alternative FAQ. XI. WHY IS THIS NEWSGROUP NECESSARY? Compared with prostate cancer, prostatitis has had little attention from researchers. It is not life-threatening, and it is difficult to treat. Most urologists are unwilling to put much effort into determining its causes and providing treatment. We hope to use this forum to push for further research on prostatitis, with a view to finding cures by the year 2000. Many men are embarrassed by the problems caused by prostatitis, and put off seeing doctors or discussing the problems with friends and family. This newsgroup is a place where we can exchange information and help make each other's lives a little easier. XII. HOW CAN WE WORK TOWARDS A CURE? Call, write, or email your Congress Member or Senator. Tell him or her how badly research into the causes and treatment of prostatitis is needed. Many now have their own webpages with email links: To find the master list of House member's pages, go to: http://www.house.gov/MemberWWW.html Senate addresses are at: http://www.senate.gov/senator/members.html Support the Prostatitis Foundation with a (US tax deductible) check: 680 South Federal St., Suite 601 Chicago IL 60605 In May, 1995, members of this newsgroup founded The Prostatitis Foundation. Relying on volunteers the foundation is working to increase research into this ignored disease and provides a clearing house for prostatitis related information. The foundation provides the website at http://www.prostatitis.org which currently contains more than 10 megabytes of information on prostatitis including an archive of all significant postings to the newsgroup. Illinois State President - DadOfSix@aol.com Wisconsin President - Maverick@msn.fullfeed.com Artist and Production Manager - Oahu67@msn.fullfeed.com Keeper of FAQ - JohnnK@aol.com and ronk@planet.ho.att.com Scientific advisor: Brad Hennenfent, MD, FACEP 680 S. Federal St., Suite 601 Chicago, IL 60605 Telephone: (312) 554-0629 Fax: (312) 786-9437 Email: BCapstone@aol.com XIII.WHAT IS A DRE? A DRE (Digital Rectal Examination) is a procedure where the doctor inserts his finger (the Digit) in the patient's anus (the entrance to the Rectum) in order to feel the condition of the prostate. While this sounds rather uncomfortable it is not as bad as it sounds, especially if you know what to expect. The patient drops his underpants and bends over the examination table resting on his elbows. Some doctors believe it makes the whole procedure a little easier if the patient stands with his feet turned so that the toes are inward (pigeon-toed) and may so instruct the patient. While the patient is getting comfortable the doctor puts on a latex glove and applies a large amount of KY jelly to the index finger. The index finger is applied to the target area and slowly pushed inside. Once the finger is inserted as far as it will go the doctor presses downward and moves his or her finger around to judge the size, shape, and degree of firmness of the prostate. It is also possible to detect small nodules or growths which may indicate the presence of cancer. The doctor will usually ask if the pressure on the prostate hurts. The patient should reply as truthfully as possible. This is not the place for male stoicism! A painful, swollen, prostate may have an abscess which could make further examination very dangerous. The doctor should (but many unfortunately do not, preferring instead to immediately prescribe an antibiotic and get on to their next patient) next press hard enough to force some prostatic fluid out for further tests. It is important not to tense up during this procedure. The patient may feel like he is about to urinate all over the nice clean floor but this will not happen. He may feel a few drops of prostatic fluid moving up the penis and if the doctor presses hard enough a few drops may actually land on the floor. The doctor expects this to happen and will be pleased and not annoyed or angry. (I wish doctors would put a paper towel or something on the floor to catch any "spillage" and explain what they are trying to do but most seem to think the patient already knows and we men like to pretend we already know it all so we don't ask. It was not until my 6th DRE that I finally understood what the doctor was trying to do and that was only after he complained about not getting any EPS. And I was so proud of holding it back and not making a mess on the floor! Oops!) The patient should relax as much as possible and allow the fluid to come out. The doctor will usually collect this fluid either on a microscope slide, on a swab, or in a small jar. This is the same EPS which Dr. Feliciano's drainage method attempts to get. When the examination is completed the patient is given a box of tissues and is expected to wipe off the excess jelly before pulling his underpants back up. Some doctors will immediately examine the specimen under a microscope to see if there are any white blood cells (WBC). This is generally considered a sign that there may be an infection present. Ideally the fluid will be sent to a lab for culturing and sensitivity testing to determine first, what the pathogen is, and second, which antibiotics can kill it. It may take up to a week or more to get the results of the culturing. XIV. IS THERE SOME WAY TO MAKE BIKE RIDING LESS PAINFUL? Suggestions from fellow prostatitis sufferers who still ride: Jonathon: Try the seats with cushions only on the outside. Often sold for women bikers. Ken: Keep the saddle tilted down in front as far as it will go. Terry TSI and Serfa seats work for me. Elliot: Use after market gel pads. Also try a light hard seat. Someone else suggested trying one of the bikes you ride laying down. XV. IS THERE SOME WAY TO MAKE SITTING MORE COMFORTABLE? Doughnut cushions are recommended by many sufferers. These were originally designed for hemorrhoid sufferers but work well for prostatitis too. Usually available at drugstores and pharmacies for a nominal cost these come in foam and inflatable versions. Other sufferers say a hard chair is easier on the prostate. XVI. WHAT HAPPENS DURING A TRUS? A TRUS (TransRectal UltraSound) uses ultrasound to check the prostate for tumors and cysts. This is a common test which you may experience at your doctor's office. Really not much worse than a DRE. The following is an excerpt from a posting to the newsgroup in which a fellow sufferer shares his experience: Jim: I went in the room with the ultrasound machine, and the nurse asked me to sign a consent for the ultrasound and another for a biopsy. I said, wait a minute, I'm a motivated patient and I'll undergo any pain, but a biopsy doesn't seem appropriate. We want to try to get rid of bacteria already in the prostate, not introduce new ones. She went and spoke to the doctor and came back and said, OK, no biopsy. She said usually when they do the ultrasound, they're looking for cancer, etc. I mention all this because it speaks to two newsgroup themes: the nurse is not accustomed to taking prostatitis seriously, and the more the patient knows and speaks up, the better. In this case, I don't think the doc planned to do a biopsy. He came in at this point and I commented something about giving him the manila folder before he scrubbed. He said he wasn't going to scrub, his hands were probably a lot cleaner than my rectum. The ultrasound probe did not look quite Dr. Tarfusser's cartoon. It was like a stick with a knob, kind of like the grip end of a baseball bat, but only a couple centimeters on the largest diameter of the ellipsoidal knob. The screen of the electronics showed the doc's name and mine. So, I stripped to an undershirt and got on the table with butts toward the electronics. The doc came back, I tried to relax. Somebody put a condom (or similar) over the probe, then some slippery goo, then the doc maneuvered the knob into the rectum. I felt just a moment of pain and then it was your basic weird medical experience. I asked the doc if I could have a picture, he said yes. Then he spent quite a while scanning different things. The instrument had a flat keyboard (waterproof, cleanable). He worked the probe with his right hand, commented that he couldn't type very fast with just the left hand. So, he's working this thing around, then stopping to go tap-a-tap with the other hand, I guess reaching across. We chat pleasantly about what he sees: a small cyst (not sure about the term) on a seminal vesicle that he might treat if the drainage, etc, doesn't cure me. Big stones near the urethra, including some in "the front" of the prostate where he says the massage can't reach. (I'm not clear what this means.) But apparently there are some stones that might yield to crushing and pushing them out. He also sees a small anomaly in the prostate (abscess?) that is apparently a cancer candidate ("food for thought," he says). In the end, he decides there is no cancer or cyst that will prevent us from proceeding with the drainages. XVII WHAT HAPPENS DURING A CYSTOSCOPY AND WHY SHOULD I HAVE ONE? A cystoscopy uses a flexible fiber optic device which is inserted into the urethra via the opening at the end of the penis. It allows the doctor to visually examine the complete length of the urethra plus the bladder for polyps, strictures, abnormal growths and other problems. For a male this is probably the scariest test there is. The thought of having something pushed down that little hole in the penis makes the skin crawl but as the following posters agree it is not that bad in practice. However, do insist on the most sterile settings and procedures. It is possible to introduce bacteria into your bladder and prostate this way. Patients are usually given a 3 day course of a powerful antibiotic to prevent an infection. This is important so insist on it. John: I've had this numerous times. The first two were under anesthesia. The last few have been office procedures with local deadening. My experience has not been as bad as it may sound. It's not that there is *no* pain or discomfort. There is, but it isn't anywhere near extreme. My office procedures have gone as follows. (1) A nurse gives a betadine wash, then inserts some deadener into the urethra, puts a clamp in place, and leaves for 15 minutes or so. The insertion of the deadener may be the most uncomfortable part of the whole procedure, but it doesn't take very long and it isn't all that bad. (2) During the cysto itself, I have been uncomfortable but not in much pain. Again, this doesn't take very long - a few minutes - perhaps less than 5. (3) You may have a little blood on urinating, and possibly a little pain, for a few days. Roger: I have had two cysto's. Since I have other kidney problems in addition to my prostatitis, then for me they are merited. If you have a problem, even if it turns out to be only prostatitis, then you need to have the proper check-up. You need to know what is going on in there. The cysto will check for physical problems, obstructions, stones, etc. Is it painful? No, only for the ego. I found it deeply embarassing and for my second trip, I elected to be put under. After the drugs wear off, your first few urinations will be A LOT OF FUN! The cysto did nothing for me related to prostatitis, but just eliminated cancer and urethral obstructions. Ed: in my case, cystoscopy turned out to be of the utmost importance and benefit as it disclosed a malignant polyp in my bladder which had simulated very well the symptoms of BPH and/or prostatitis. There was no blood in my urine which is a classic indicator of bladder cancer. According to my urologist, the urine test for cancer was negative prior to the cystoscopy. So, I cast a definite vote for having it done. It is not comfortable but not as bad as you think it will be. Good luck! Don: I've had cystoscopic exams every three months for the past four years because of a recurring bladder cancer. IT IS VITAL THAT YOU DETERMINE IN ADVANCE WHAT KIND OF EQUIPMENT YOUR UROLOGIST WILL USE. If he uses a flexible telescoping cystoscope, the process is psychologically demeaning, but painless. (Stretching a stricture is not painless, but I know it can often be done quickly in a doctor's office and kept open by occasional restretching.) If he has a rigid cystoscope RUN, do not walk, to another urologist; I found those agony. In either case, I found it is important to drink a lot and keep the urine dilute to avoid discomfort on urination. When I tried not to drink, so I didn't have to urinate, it really hurt when I did for the first day. Now I drink a lot of iced tea and pee away without discomfort. Be sure to get a good antibiotic for a 2-3 days following a cystoscopic exam. Avoids infection from the process. Really, with a flexible telescoping cystoscope it is no big deal. WV: An attempted cystoscopy was unsuccessful because of a narrowing or stricture at the bladder neck which prevented entry into the bladder and revealed that the stricture was indeed the cause of my symptoms. Once the stricture was relieved via mechanical dilation the prostatitis symptoms were gone and a normal cystoscopy was possible without undue discomfort. It's my (largely uninformed) opinion that many prostate symptoms are caused by strictures, especially at the bladder neck, and can be easily eased with dilation or a quick transurethral "snip" by a good urodoc. Mine has suggested such a procedure but so far I have opted for periodic "stretches" and not the knife. Quite satisfactory. The "flex" scopes which are now used are virtually painless ...unlike the old "iron bar of a few years ago. I think it should be used early on to look for scarring, strictures and other problems in the urethra that could be causing the symptoms. I believe these are quite common and largely overlooked until late in the diagnosis process. In my case it was after 8 months of Bactrim and floxin that they decided to scope it. All those months of discomfort and worry when it was something simple all along. XVIII WHAT CAN BE DONE TO PREVENT PROSTATITIS While it is too late for most of us, many of us have sons or brothers who we would like to save from this disease. Those who do find a cure are also interested in not catching it again. The following suggestions are based on a combination of Dr. Feliciano's theory of the causes of prostatitis and on some other material discovered during research for this FAQ. Good hygiene is a must. Always use clean underwear and bathe or shower daily. If not circumcised, the foreskin should be pushed back and the glans washed daily. Wash hands BEFORE handling the penis and after using the toilet. Never swim or bathe in polluted water. Avoid unprotected sex. Use condoms at all times. If you don't use a condom, limit exposure to E coli bacteria by avoiding the anal area of your partner. (Make sure you and your partner have bathed or showered since the last bowel movements. Dr. Feliciano recommends a betadine wash once daily to prevent a recurrence in his cured patients.) Urinate soon after sex. Never have unprotected sex with anyone suffering from a urinary tract, bladder, or kidney infection, interstitial cystosis, venereal disease, or yeast infection. Keep up your body's resistance by making sure you have enough zinc, copper, and vitamin C in your system. (Note: White spots on the fingernails are considered a sure sign of a zinc deficiency.) Drink plenty of fluids and void them as soon as you feel the urge. Do not try and hold it because it is not convenient. Exercise and get enough sleep. Avoid the use of over-the-counter and prescription cold and allergy medicines which have a warning not to use with enlarged prostate, prostatitis, or BPH. These may contribute to acini clogging. Have an ejaculation at least two or three times a week even if you have to masturbate. If your arms are long enough to do a DRE on yourself, learn to inspect and drain your own prostate. Regular drainage may keep the acini from clogging up and becoming infected. Know the early signs of prostate trouble and get treatment immediately. (Slower urination, more frequent urination, waking regularly at night to urinate, bad/strong smelling urine, increase in wet spot on underwear.) XIX WHAT IS PROSTATE DRAINAGE AND WHY DOES IT HELP? The prostate is made up of many small glands called acini. Normally these produce and store a small amount of fluid and the overproduction is allowed to drain into the urethra where it is thought to perform an important antibacterial service. During an ejaculation the stored fluid is forced out by contractions of the smooth muscle of the prostate. If an acinus becomes clogged, for whatever reason, it no longer has any way to get rid of the overproduction, but continues to produce fluid. This cause the pressure inside of the acinus to increase so that the acinus gradually begins to fill up and expand like a balloon. Eventually the limit of expansion is reached and the acinus becomes hard like a ball with too much air pumped into it. One bloated acinus probably has little effect since they are very small but when enough become clogged the inside of the prostate gets crowded and the urethra which passes through the prostate begins to feel the effect. Prostate drainage is a method of relieving the pressure by forcing the acini to drain thus relieving the pressure. The principle is very similar to squeezing a pimple to open the pore. Prostate drainage appears outwardly like a DRE. The same position is assumed by both parties. The main difference is that instead of lightly pressing on the prostate, the doctor puts as much pressure as he or she can (or as much as the patient can stand whichever is less) on a small area of the prostate. Starting at the far (most inside) left (or right) as much pressure as possible is applied to the prostate. The gloved finger is then moved slowly to the center of the prostate. Then the finger is pulled out a little and the movement repeated until the whole lobe of the prostate has been treated. Then the movement is repeated on the other lobe. Finally the prostate is drained down the center line from deepest to shallowest end. If done properly and with enough pressure (and if the patient relaxes), several drops of prostatic secretion will appear at the end of the penis. (If no drops appear, a gentle stroking of the perineum from back to front will usually force out enough for culturing.) Sometimes it takes several consecutive drainages before the first drops begin to appear. Drainages should be on a regular basis, ideally 2 days apart but no more than three. A hot sitz bath before the drainage is a good idea. Sexoton and Kai Kit Wan (Chinese herb pills) may actually make the drainage more productive. Drainages do not necessarily have to be done by a doctor. Self drainage is also possible with long arms or the use of the "Crystal Clear Wand." A partner can also do the drainages. See http://www.prostatitis.org/doityourself.html XX CAN PROSTATITIS BE SEXUALLY TRANSMITTED? If you ask a doctor you will probably be told that it cannot. Perhaps this is because women have no prostate so technically speaking this is true. However, if the prostatitis is bacterial or fungal in origin then it is quite likely that the pathogen, whatever it may be, can be passed back and forth between partners. There have been many postings to the effect that "my spouse had this disease and then I got prostatitis" or the reverse "I have prostatitis and every time I visit my girl friend she comes down with a UTI or yeast infection." While these episodes do not prove that it can be transmitted sexually it seems strange that the most doctors feel so strongly that it can not. Some doctors, however, do say that the prostatitis pathogens can be passed back and forth between couples. Dr. A. E. Feliciano is a strong advocate of this theory and for that reason prefers to treat both partners at the same time. Backing up his theory is a recent study which claimed that 30% of all American women were vaginal carriers of some of the same bacteria known to cause prostatitis. Another study using a more sensitive test than usually available has shown that around 15% of American women are infected with Chlamydia and that their male partner had a 68% chance of also having the disease. Chlamydia has also been known to cause prostatitis. Other doctors, seem to say both yes and no. Dr. Alexis Te of Columbia-Presbyterian Medical Center in NY on his website at: http://cpmcnet.columbia.edu/dept/urology/prostatitis.html says: "Acute and chronic infectious prostatitis are not usually considered sexually transmitted diseases." but then later in the same article he says: "You are at higher risk for getting prostatitis if you…engage in rectal intercourse or oral sex…" It would seem to be wisest to assume that it is sexually transmittable in either direction and take the usual "safe sex" precaution of using a condom. XXI DOES A VASECTOMY LEAD TO PROSTATITIS? A very controversial question. The usual answer is no. However, there have been many reports of prostatitis developing after a vasectomy. Whether this is coincidence or not is hard to determine. But it seems reasonable to assume that any intervention surgical or otherwise in the area of the prostate has the potential to introduce bacteria or other pathogens into the area. Per Dr. Alexis Te of Columbia-Presbyterian Medical Center in NY on his website at: http://cpmcnet.columbia.edu/dept/urology/prostatitis.html "You are at higher risk for getting prostatitis if you recently have had a medical instrument, such as a urinary catheter or tube, inserted during a medical procedure,…" Patients undergoing biopsies of the prostate are routinely given strong doses of antibiotics to ward off infection which might be introduced into the area by the procedure. XXII HOW CAN I POST A QUESTION TO THE NEWSGROUP IF I DON'T HAVE A NEWS READER OR NEWS SERVICE? If your internet service offers the newsgroups but you don't have a news reader program (or you can't get Microsoft's to work) you can get a nice news reader (NewsXpress 2.0) free from http://www.malch.com/nxfaq.html If you do not have access to the newsgroups at all but do have internet access you can use Deja News to post. Go to: http://www.dejanews.com Then do a search for newsgroups with the topic "prostatitis" (use the second box). That should bring up sci.med/prostate.prostatitis. Click on it and you will get a list of some 5000 articles from the newsgroup sorted by newest first. Click on an article and you will then have a button at the top labeled "Post Article." Click on it and fill out the form. You can read any answers the same way though whole procedure is pretty slow. A better way might be to subscribe to the List Server. Then you get an email with all of the posts once a day and can reply to them. To SUBSCRIBE to the Prostatitis list: 1.Send electronic mail to this e-mail address: listserv@maelstrom.stjohns.edu 2.Subject is ignored, but put in a dash if your software requires something 3.Place the following message in the body of the mail: subscribe prostatitis Firstname Lastname 4.where Firstname and Lastname is your first and last name; you may also include a single letter middle initial. XXIII ARE THE NEWSGROUP POSTS ARCHIVED ANYWHERE? Yes. All posts of any value have been archived on the Prostatitis Foundation Website: http://www.prostatitis.org/textarchive.html Most are also available and searchable using Deja News. (See XXII) The Glossary This is a collection of terms and acronyms which you may run into on the newsgroup, on the website or in your doctor's office. Where a separate entry in the FAQ exists which explains a term in more detail this will be indicated by the entry number in parentheses. Trademark names are in all caps. For medical terms in languages other than English try: http://www-sci.lib.uci.edu/HSG/Phealth.html#DICTION Acidophilus:Any of several species of bacteria which thrive in an acid environment. Cultures of these bacteria are often used to replace those in the intestines killed off by antibiotic therapy. Available as pills or in Sweet Acidophilus milk. Acinus:One of the 20 to 50 fluid producing ducts found in the prostate. Plural is acini. During an ejaculation the fluid is pressed out of the ducts by contractions of the smooth muscle of the prostate. See http://www.prostatitis.org/tarf/p3.htm for drawing. (YY) Acronym:A word formed from the initials of a phrase. For net acronyms not found here see: http://www.uni-karlsruhe.de/~uplj/acronym.html Adjuvant.An additional treatment used to increase the effectiveness of the primary therapy. Radiation therapy and hormonal therapy are often used as adjuvant treatments following a radical prostatectomy. Aerobic:With air/oxygen. Said of bacteria which thrive in the presence of oxygen. AFAIK:Net shorthand for: As Far As I Know. Alanine: An amino acid. See Feinblatt/Gant Study. Allopurinol:A drug used to treat gout which has been found to be useful in relieving symptoms in some cases of prostatitis. More at: http://www.rxlist.com/cgi/generic/allopur.htm Alpha Blocker:Any of a number of drugs which interfere with the nerve stimulation of the muscle cells. Alpha-1 Blocker:An alpha blocker which interferes with signals to the muscles surrounding the urethra and the blood vessels without interfering with signals to the bladder, thus reducing urine back pressure and blood pressure at the same time. HYTRIN, CARDURA, and MINIPRESS are all alpha-1 blockers. Major side effects are those of low blood pressure (dizziness, fainting) plus some men experience problems with erections or ejaculation. Usually prescribed in gradually increasing doses. Recommendation is to stop increasing the dose when the first positive effects are noticed. This reduces the chance of side effects and leaves room to increase the dosage should the prostate continue to grow. More at: http://www.rxlist.com/cgi/generic/teraz.htm Amoxicillin: An antibiotic of the penicillin family. More at: http://www.rxlist.com/cgi/generic/amox.htm Ampullary vas:See Vas Deferens. Anaerobic:Without air/oxygen. Said of bacteria which thrive in the absence of oxygen. Anal Canal:The narrow passage between the anus and rectum. Androgen:A hormone that produces male characteristics. See Testosterone. Anesthetic:A drug that produces general or local loss of physical sensations, particularly pain. A "spinal" is the injection of a local anesthetic into the area surrounding the spinal cord. Antibody:A protein, produced by the body, that counteracts the toxic effects of a foreign substance, organism, or disease within the body. Antifungal:A drug used against fungal infections. Antigen:A substance which stimulates the production of an antibody. Antihistamine:Any of a variety of drugs commonly found in over-the-counter cold and allergy medicine. Most can cause a worsening of urine flow related problems and increased prostate pain in men with prostatitis or BPH. Anus:Often confused with rectum. This is the external opening of the anal canal which leads to the rectum. Apex:The narrow end of the prostate on the side going to the penis. Augmentin:A combination of Amoxicillin and Clavulanate potassium. It is added to Amoxicillin due to its ability to inactivate beta-lactamases. These are substances produced by bacterial defenses. More at: http://www.cdlr.tamu.edu/dentist/chemo4.html http://www.rxlist.com/cgi/generic/amoxclav.htm Auto-immune Disease:A disease caused by the body's protective mechanism becoming confused and attacking a part of the body which is not an invader. BACTRIM:Trademark name for sulfamethoxazole/trimethoprim. A combination of antibacterial drugs used for urinary and prostatic infections. Stay out of the sun while taking this drug. Also: SEPTRA, SMZ-TMP. More at: http://www.rxlist.com/cgi/generic/trisulf.htm Balloon Dilation:A procedure where a balloon like object is inserted in the urethra via the penis. When the device reaches the prostate the balloon part is inflated. This opens up the urethra and in some patients provides temporary relief of BPH related problems. Base:An alkaline substance. Opposite of acid. Biopsy:A procedure where a small hollow needle is inserted into a suspicious body part in order to obtain a specimen for laboratory analysis. Usually used to check for the presence of cancer. Bladder:Storage organ for urine. During urination the bladder contracts to force urine out. Bladder Neck:Outlet of the bladder. BPH: Short for Benign Prostatic Hypertrophy (or Hyperplasia). Noncancerous enlargement of the prostate. This enlargement often results in urinary flow problems in men. Also see the newsgroup at sci.med.prostate.bph. See: http://isis.nlm.nih.gov/ahcpr/bph/www/bphctxt.html for more details. These are the guidelines for BPH diagnosis and treatment recommended by a government panel and thus give a good idea of the mindset of the average uro. They also contain quite a bit of information on the various tests which you may run into. For an idea of the UK approach to BPH see: http://www.docnet.org.uk/germed/mar96/urology.html Brachytherapy:The insertion of a radioactive source into a patient. A therapy used to treat prostate cancer where radioactive beads are implanted in the prostate. See: http://www.grand-rounds.com/3no1ProsBrachy.html BTW:Net shorthand for: By The Way. Calcification:The body's attempt to render invading bacteria harmless by coating them with calcium. This can result in prostate stones which may cause problems of their own. Small stones may migrate out of the prostate into the urethra causing "sand" in the urine. Candida albicans:A fungal organism usually responsible for yeast infections in women. May be responsible for some cases of prostatitis. More at: http://alces.med.umn.edu/candida.html Candidiasis:A vaginal infection caused by Candida albicans. More at: http://www.netline.net/novus/crohn/aug95/research.html Carbenicillin:An antibiotic of the penicillin family. More at: http://www.gsm.com/clinphrm/docs/content/generics/G0101/G010101.html CARDURA:Tradename for Doxazosin. An alpha-1 blocker used to treat BPH symptoms. May also help against impotence! More at: http://www.pslgroup.com/dg/839a.htm CAT Scan:Short for Computerized Axial Tomography. A technique using X-rays and a computer to produce a three dimensional picture of a part of the body. Catheter:A tube inserted in the bladder (via the penis) to allow the bladder to drain. Chinese Herbs:Recently many readers have been trying Chinese herb pills; Kai Kit Wan and Sexoton. It appears they may open the acini and allow them to drain more easily. A web page dedicated to information on these herbs can be found at: http://www.prostatitis.org/chinesepills.html Chlamydia:A group of spherical-shaped non-bacterial organisms which can infect the urinary tract and the prostate. Considered a sexual transmitted disease. More widespread than gonorrhea. Often symptom-free though may cause orchitis or epididymitis in men. In women it causes pelvic inflammatory disease (PID) which can lead to infertility. If acquired during pregnancy can cause blindness in the baby. Symptoms in males: burning sensation during urination, discharge from the penis, testicular tenderness or pain, lower abdominal tenderness. Dr. Feliciano reports finding Chlamydia in 40% of his prostatitis patients. In females the symptoms may be: burning sensation during urination, vaginal discharge, symptoms of PID. More at: http://www.ppca.org/chlam.html CIPRO:Trademark name for ciprofloxacin. One of the family of quinolones. Can cause sore or broken tendons as a side effect. Do not take antiacids while taking this drug. More at: http://www.rxlist.com/cgi/generic/cipro.htm http://www.cdlr.tamu.edu/dentist/chemo6.html Ciprofloxacin:An antibiotic of the quinoline family. Used to treat urinary and prostatic infections. Can cause sore or broken tendons as a side effect. Do not take antiacids while taking this drug. Relatively new and expensive. More at: http://www.rxlist.com/cgi/generic/cipro.htm http://www.cdlr.tamu.edu/dentist/chemo6.html Circumcision:Surgical removal of the foreskin. CNBP:Short for Chronic Non-Bacterial Prostatitis. Coitus:The sex act. Colloidial Silver:A silver based preparation reported (but not proven) to have antibacterial properties. Generally considered a scam. Build up of silver can be irreversible. Not recommended. Computerized Axial Tomography:See CAT Scan. Corpura Amylacea:Small semi-solid bodies sometimes found in the prostate or the seminal fluid. Thought to be formed when seminal fluid remains too long in the prostate. Cryogenic Prostate Surgery:A technique using liquid nitrogen to freeze (and kill) the surrounding tissue in hopes of removing the obstruction or cancerous cells. Crystal Clear Wand:A commercial device which can be used to self-drain the prostate. Cost is about $50. Open Enterprises in San Francisco (800-289-8423). More at: http://www.prostatitis.org/wand.html Culture:A sample of a bodily fluid is placed into a nutritive medium and allowed to sit for 24 hours or longer. At the end of the time period the sample is inspected for any bacteria which may have grown. The technician can then count and identify the bacteria which were present in the bodily fluid. A culture can also be used to determine which antibiotic is most effective on the bacteria. This is then called sensitivity testing. Cyst:A pocket of fluid. Cystitis:Inflammation of the bladder. More at: http://203.17.138.60/websex/adult/problems/Cystitis.HTMl http://homearts.com/rb/health/05infeb2.htm Cystoscopy:An examination of the bladder and urethra using a tube inserted in the urethra. (XVII) Decongestant:Any of a variety of drugs commonly found in over-the-counter cold and allergy medicines. Most can cause a worsening of urine flow related problems and increased prostate pain in men with prostatitis or BPH. DHEA:Short for dehydroepiandrosterone. The most common steroid hormone found in circulation in the human body. Currently being touted as a "fountain of youth" supplement which gives you energy, builds muscles, takes off fat, and cures whatever is wrong with you. Not recommended for men with prostate problems. May increase the likelihood of prostate cancer or speed up the growth of already existing cancer. Diazepam:Generic name for the tranquilizer VALIUM. More at: http://www.mentalhealth.com/drug/p30-v01.html DIFLUCAN:Trade name for fluconazole, an antifungal. More at: http://www.rxlist.com/cgi/generic/flucon.htm http://www.biostat.wisc.edu/cgi-clinsci/amc.pl?drug=Fluconazole Digital Rectal Exam:See DRE. (XIII) DIY:Short for Do-It-Yourself. Usually refers to do-it-yourself prostate drainage. More at: http://www.prostatitis.org/doityourself.faq Doxazosin: Generic form of Cardura. See alpha-1 blocker. Doxycycline:An antibiotic of the tetracycline family. More at: http://www.rxlist.com/cgi/generic/doxycyc.htm Dr. F:Short for Dr. A. E. Feliciano, the doctor in the Philippines who has been able to cure several members of the newsgroup when no one else could. Dr. Fuzzy: Short for Dr. Fugazzotto. A doctor who has been able to cultivate bacteria in cultures when the standard procedures failed. DRE:Short for Digital Rectal Exam. You bend over and the doctor inserts his gloved finger (covered with lots of K-Y jelly) into your rectum via the anus so that he can feel the size, shape, and condition of the prostate. (XIII) DS:Short for Double Strength. Often used as part of the trademark name for a drug to indicate a stronger than usual dosage. Example: BACTRIM DS. Dynamic Obstruction:Blockage of the urethra due to the tightening of the smooth muscle tissue in the prostate. Dysuria:Burning feeling during urination. Ejaculation:Forceful expulsion of semen during an orgasm. Ejaculatory Duct:Term for the duct between the junction of the seminal vesicle & vas deferens and the urethra. Epididymis:This is the duct which brings the sperm from the top of the testicle to the vas deferens. There are two. Plural is Epididymides. It is coiled for extra length and plays a role in the maturation of sperm. It can also become infected and then you have epididymitis. Epididymitis:An infection of the epididymis. See Epididymis. More at: http://www.duj.com/epididymitis.html EPS:Short for Expressed Prostatic Secretion. The fluid pressed out of the prostate during a DRE or prostate drainage. Note that "Expressed" is used here with the meaning of "pressed out" not "overnight delivery." Erythromycin:An antibiotic. More at: http://www.rxlist.com/cgi/generic/erythro.htm FAQ:Short for Frequently Asked Questions. A list of common questions with answers. Always read the FAQ before posting a question in a newsgroup. Feinblatt/Gant Study:A study published in March of 1958 in the Journal of the Maine Medical Association Volume 49 Number 3 which reported that patients given a combination of three amino acids (glycine, alanine, and glutamic acid) resulted in considerable improvement in BPH symptoms in most patients. Feliciano, Dr A. E.:A doctor in the Philippines who has been able to successfully treat several members of the newsgroup when no one else could. Feliciano, Dr. A. N.:The father of Dr. A. E. Feliciano. He is estranged from his son but also advocates regular prostate drainage though he differs from his son in preferring the use of multiple antibiotics simultaneously. Finasteride:Generic name for PROSCAR. See Testosterone. More at: http://www.rxlist.com/cgi/generic/finas.htm http://www.mediconsult.com/noframes/prostate/conference/051796/brown.html FLAGYL:Trade name for metronidazole. An antibiotic used against anaerobic bacterial infections. More at: http://www.searlehealthnet.com/pi/flagyl375.html http://www.rxlist.com/cgi/generic/metronid.htm Fluconazole:Generic name for DIFLUCAN, an antifungal. More at: http://www.rxlist.com/cgi/generic/flucon.htm FLOXIN:One of the quinolone family of antibiotics. More at: http://www.rxlist.com/cgi/generic/oflox.htm Foley:A catheter which is held in place by a small balloon inside the bladder. Foreskin:The loose fold of skin which covers the glans in uncircumcised men. GEOCILLIN:Trade name for carbenicillin, an antibiotic of the penicillin family. More at: http://www.gsm.com/clinphrm/docs/content/generics/G0101/G010101.html Glans:The tip of the penis. Gleason Score:A measurement of the potential aggressiveness of prostate cancer. The Gleason scale is from 2 to 10 with 10 being the worst. 2 is the lowest score because the scale is made up of the results of two estimates (rated on a scale of 1 to 5), one of the more immature malignant scales and then the rest. Gram's method:A staining technique in which the bacteria are stained with crystal violet, treated with iodine, decolorized with alcohol, and counterstained with safranine (a dye). Results of this procedure are used to characterize bacteria as either Gram-positive or Gram-negative. This information is useful in classifying the bacteria and in determining which type of antibiotic might be effective. Gram-negative:A term used to describe bacteria which do not retain the violet stain used in Gram's method. Gram-positive:A term used to describe bacteria which retain the violet stain used in Gram's method. Glutamic Acid:An amino acid. See Feinblatt/Gant Study. Glycine:An amino acid. See Feinblatt/Gant Study. Hematospermia:Blood in the seminal fluid. Hematuria:Blood in the urine. Hemospermia:Blood in the seminal fluid. Hesitancy:Slowness to start urination. HTH:Net Shorthand for: Hope This Helps. Hydrocele:An accumulation of fluid in a body cavity, esp. in the scrotum. More at: http://www.duj.com/hernia.html HYTRIN:Tradename for terazosin. An alpha blocker used to treat the symptoms of BPH. More at: http://www.rxlist.com/cgi/generic/teraz.htm IC:Short for Interstitial Cystitis IMHO:Net shorthand for "In My Humble Opinion" Immunofluorescence:The use of fluorescein-stained or labeled antibodies to locate antigen in tissues. The antibodies combine with their specific antigen. The combination gives off a visible glow under the proper light (Ultra-violet?). Used as a test for certain infective agents. More at: http://www.ami-med.com/std/top/003521.htm IMO:Net shorthand for "In My Opinion" Impotence:The loss of ability to produce and/or sustain an erection. Incontinence:A loss of urinary control. There are various kinds and degrees of incontinence. Overflow, stress, and total incontinence are listed separately. Indoramin:An alpha-1 antagonist used to treat BPH in the UK. Presumably similar in effect to HYTRIN. Generic form of DORALESE. http://www.docnet.org.uk/germed/mar96/urology.html Infarction:Death of tissue due to a lack of blood supply. Common in BPH. Inflammation:Redness or swelling caused by injury or infection. INPO:Net shorthand for: In No Particular Order. Intermittency:Starting and stopping during urination. Interstitial:Located in the spaces between organs. Interstitial Cystitis:An inflammation of the bladder wall which results in symptoms similar to BPH. See: http://www.sonic.net/~jill/icnet/icnet.html IOW:Net shorthand for: In Other Words. IRL:Net shorthand for: In Real Life. K-Y Jelly:A slippery substance similar to VASELINE but preferred in medical procedures because it washes off easily with water. Kai Kit Wan:Chinese herb pills which have been reported to assist in draining the acini. See http://www.prostatitis.org/chinesepills.html Leukocyte:White blood cell. Libido:Sexual desire. Lobe:A subsection of the prostate. There are two lateral (side) lobes, a median (center) lobe, an anterior (front) lobe and a posterior(rear) lobe. LOL:Net shorthand for: Laughing Out Loud. Lomefloxacin:An antibiotic of the quinolone family. More at: http://www.searlehealthnet.com/pi/maxaquin.html MACROBID:Trade name for nitrofurantoin, an antibiotic. More at: http://www.rxlist.com/cgi/generic/nitro25m.htm MACRODANTIN:Trade name for nitrofurantoin, an antibiotic. More at: http://www.rxlist.com/cgi/generic/nitro25m.htm Meares-Stamey:A test where cultures of the urine are taken before and after a DRE. Currently the standard test used by some urologists to determine whether the prostatitis is bacterial or not. Medscape:A website which acts as a medical newsletter. Currently a free service but you must register and use a password to access full text of articles. See http://www.medscape.com Metronidazole:Generic name for FLAGYL. An antibiotic used against anaerobic bacterial infections. More at: http://www.searlehealthnet.com/pi/flagyl375.html MINIPRESS:A drug used to treat BPH. Similar in effect to HYTRIN. MINOCIN:Trade name for minocycline. More at: http://www.housecall.com/databases/ami/convert/001723.html Minocycline:An antibiotic of the tetracycline family. More at: http://www.housecall.com/databases/ami/convert/001723.html Morbidity.1)The number of cases of a disease 2)Unhealthy consequences and complications resulting from treatment. MOTAS:Net shorthand for: Member Of The Appropriate Sex. Replaces MOTOS (where the second O stood for opposite). See SO. MRI:Magnetic Resonance Imaging. An expensive high tech device for viewing soft tissue inside the body. Can be used to detect cancer, blood flow problems, cysts, and dead cells. NBCP:Short for Non-Bacterial Chronic Prostatitis. Nephritis:Chronic or acute infection of the kidney(s). Net:Short for the internet or world wide web. Newbie:A newcomer to the net. Nitrofurantoin:An antibiotic. More at: http://www.rxlist.com/cgi/generic/nitro25m.htm Nocturia:Waking up in the middle of the night to urinate. Norfloxacin:An antibiotic of the quinolone family. More at: http://www.cheshire-med.com/services/pharm/meds/quinolones.html Nosocomial:Hospital caused. Disease or problem acquired at a hospital or as a result of medical treatment. NTK:Net shorthand for: Nice To Know. NYSTATIN:Trade name for Mycostatin. An antifungal. More at: http://www.aidsnyc.org/network/access/drugs/nyst.html ONNAor ONNTA: Net shorthand for: Oh, No, Not (This) Again. Orchiectomy:Removal of one or both testicles. Orchitis:An inflammation of one or both of the testicles. Orofloxacin:Antibiotic of the quinolone family. More at: http://www.cheshire-med.com/services/pharm/meds/quinolones.html OTOH:Net shorthand for: On The Other Hand. Overflow Incontinence:A condition in which the bladder retains too much urine after voiding. As a consequence, the bladder remains full most of the time, resulting in involuntary seepage of urine from the bladder. Palliative Treatment:Medical care which aims to reduce the symptoms without curing the patient. Pca:Short for Prostate Cancer. Pelvic Inflammatory Disease:See PID Perineal:Having to do with the perineum. Perineum:The area between your legs from the anus to the scrotum. PID:Short for Pelvic Inflammatory Disease. A general term referring to infection involving the lining of the uterus, the Fallopian tubes, or the ovaries. pH:A measurement of the alkalinity or acidity of a solution. Neutral is 7.0. Lower numbers are acidic, higher alkaline. Placebo:A non working imitation of the real drug or procedure. Used during effectiveness testing as a control to eliminate psychological effects of taking medicine. (Some people will get better just because they think the medicine they are taking will help them.) Prazosin:A drug used to treat BPH symptoms. Similar to HYTRIN. Prednisone:A synthetic hormone used as an anti-inflammatory. More at: http://www.rxlist.com/cgi/generic/pred.htm Priapism:A painful erection that does not go away. Prognosis:A forecast of the course of a disease, and future prospects of the patient. Proloprim:Trade name for trimethoprim, an antibacterial drug. More at: http://www.ami-med.com/mhc/scr/003956sc.htm PROSCAR:Tradename for Finasteride. A drug used to shrink the prostate. See Testosterone. More at: http://www.rxlist.com/cgi/generic/finas.htm Prostate:A small organ wrapped around the urethra which provides some of the seminal fluid. During ejaculation the fluid is squeezed out of the prostate by contractions of the smooth muscles in the prostate. (III) See http://www.prostatitis.org/tarf/p3.htm for drawing. Prostate Cancer:A malignant tumor growing in/on the prostate. See sci.med.prostate.cancer newsgroup or http://www.prostate.com http://cancer.med.upenn.edu/disease/prostate/prostate_lit1.html http://medhlp.netusa.net/general/cancer2/600066.TXT http://rattler.cameron.edu/prostate/prostate.html http://www.comed.com/Prostate/index.html http://rattler.cameron.edu:80/strum/ Prostate Drainage:A technique perfected by Dr. Feliciano which uses maximum finger pressure on the prostate during a DRE in order to squeeze as much of the trapped prostatic fluid as possible. (XIII, XIX) Prostate Massage:An old remedy which was once the only treatment for prostatitis. During a DRE, the doctor gently strokes and pushes on the prostate. This helps to drain some of the trapped fluid. Prostate-Specific Antigen:See PSA. Prostate Stone:A small rock-like formation sometimes found in the prostate. Believed by some to be the result of calcification. Prostatectomy:A surgical operation where some or all of the prostate is removed. More at: http://www2.ari.net/icare/radprost.html http://oncolink.upenn.edu/specialty/surg_onc/ahcpr_radpc.html http://www.surg.med.umich.edu/urology/urology.profiles.5.html Prostatitis:An inflammation of the prostate. (YY) Prostatodynia:A word which means simply "prostate pain." Used as a diagnosis for patients when there is no sign of inflammation, even though there is pain in the prostate. Prostatosis:General term for any disease of the prostate. PROSTATRON:A device used to treat BPH symptoms using microwaves. (YY) PSA:Short for Prostate-Specific Antigen. This term is usually used when talking about a blood test which measures gamma-seminoprotein activity. Gamma-seminoprotein is a protein which is a key component in the liquification of semen. PSA is usually found in high levels in the prostate but low levels in the blood. When something such as cancer or an infection or injury breaks down prostate tissue, PSA is released into the blood stream. It has been found that high PSA test levels may indicate the presence of prostate cancer up to four years before it can be detected otherwise. There are several ways to interpret the PSA levels. One system uses 4.0 as the dividing line. Lower is OK higher is suspect. Another system uses a sliding number based on age: 49 and below = 2.5, 50-59 = 3.5, 60-69 = 4.5, 70+ = 6.5. Non-whites should subtract 10 years from each scale. A third system does not worry too much about the absolute value but instead concentrates on the rate of increase over time. A recent article in Urology (Dec 96 or Jan 97) reported that there are actually two types of PSA. One is termed "free" and the other "bound to ACT." ACT is a protein of some sort. The ratio of "free" to "bound" was found to detect cancer up to 10 years in advance of other detection methods and is claimed to be so accurate that biopsies would no longer be required. Unfortunately the PSA ratio test is not yet in use. The level of PSA can be influenced by: An ejaculation within 72 hours of the test, prostatitis, allopurinol, and PROSCAR. All but PROSCAR can raise the PSA level. Also recent studies (New England Journal of Medicine July 96. Oesterling) indicate that there is a significant difference in the way the PSA results should be interpreted for non-whites. A recent study also shows that HYTRIN also lowers PSA. See: http://www.mediconsult.com/noframes/prostate/conference/051796/brown.html The level of PSA may or may not be influenced by Saw Palmetto or a DRE prior to the test. Some recent studies have claimed there were no or only minor effects (0 for Saw Palmetto, +.1 for a DRE) but these are controversial. No information is available on the effect of a Dr. Feliciano style prostate drainage but chances are it could raise the PSA level. More on PSA at: http://www.tms.tribune.com/rjt_health/proanti.htm http://www.hslib.washington.edu/hsl/grand_rounds/95-96/17aug95.html http://medhlp.netusa.net/general/cancer2/600066.TXT http.//rattler.cameron.edu/prostate/strum/latepc.html Pubis:The area of the body just above the base of the penis. Pyuria:Pus in the urine. Quinolone:Any of a family of synthetic antibiotics. CIPRO, FLOXIN are the two most commonly prescribed. More at: http://www.cheshire-med.com/services/pharm/meds/quinolones.html Radical Prostatectomy:An operation to remove the entire prostate gland and seminal vesicles. RBC:Short for Red Blood Cells. Sometimes found in the EPS or urine. May indicate an infection. Rectum:The terminal portion of the large intestines. Reflux:Flowing back. Usually refers to the entry of urine into the prostate. Reiter's Syndrome:An inflammatory disease effecting several body systems in more-or-less random order: urinary tract, eyes, joints, and skin. Not all persons have the complete set of symptoms, in which case it is called incomplete Reiter's. Men are effected more than women. The urinary tract symptoms are typical of URI's -- burning, urgency, etc -- prostatitis can occur as well. The eye symptoms can be either conjunctivitis or iritis. The joint problems are primarily confined to the spine and pelvic region with some peripheral joints involved. Reiter's effects the tendons, ligaments, etc more than the joint itself. Tendonitis, particularly of the Achilles tendon is typical. So is fascitis of the foot. Permanent damage to joints is rare. The skin problems include rashes and painless sores in the mouth. The disease is typically episodic with flare-ups and remissions. Reiter's is thought to be an auto-immune disease which like rheumatic fever follows an infection somewhere else in the body. Susceptible persons usually (about 70%) have an antigen called HLA B27 which can be identified from a blood test. The infections that trigger Reiter's can be either urinary tract related or GI related. Multiple organisms have been implicated. Remission:Complete or partial disappearance of the signs and symptoms of the disease. Residual Urine:The amount of urine remaining in the bladder after urination. Retrograde Ejaculation:A condition where the semen is sent to the bladder instead of the penis. Common after a TURP. Retropubic Prosectomy:Similar to the suprapubic prosectomy except the bladder is not opened. More at: http://www.surg.med.umich.edu/urology/urology.profiles.html ROFL or ROTFL:Net shorthand for: Rolling On (The) Floor Laughing. Used as a response to joke or funny statement. ROTO-ROOTER:Trademark of a drain cleaning service in the USA which uses a rotating device on a flexible hose. Often used jokingly as a synonym for a TURP. Safranine:A dye used in Gram's method. Saw Palmetto:A member of the palm family which grows wild in Florida and the southeastern United States. Technically known as Serenoa repens. Often used as a treatment to relieve symptoms of enlarged prostate or BPH. See http://www.cruzio.com/~mendosa/sawpalm.html for more information. (YY) Scrotum:The pouch which contains the testicles. Selenium:An element. Thought to be required by the human body and often in short supply. Supplements of 200 mg per day have been recommended as a possible cancer prevention measure. More at: http://www.solgar.com/nutrition_library/healthy_living/selenium.html Semen:The fluid produced by an ejaculation. Seminal Vesicles:Two glands which provides about two-thirds of the fluid which makes up the semen. These are located to the left and right of the prostate. Output of the seminal vesicle mixes with the sperm from the vas deferens and flows through a duct which then passes the fluid through the prostate to the urethra. This duct can also be blocked by a swollen prostate and/or a spreading of the infection. Sensitivity Testing:A method of determining which antibiotic works best against a particular bacteria. SEPTRA:Trade name for sulfamethoxazole/trimethoprim. A combination of antibacterial drugs used for urinary and prostate infections. Stay out of the sun while taking this drug. Also: SMZ-TMP, BACTRIM. More at: http://www.rxlist.com/cgi/generic/trisulf.htm Sexoton.A type of Chinese herb pills. It appears they may open the acini and allow them to drain more easily. A web page dedicated to information on Chinese herbs can be found at: http://www.prostatitis.org/chinesepills.html Sitz Bath:A fancy term for sitting in a tub of hot water. May bring temporary relief of some prostatitis symptoms. SMZ-TMP:Trade name for sulfamethoxazole/trimethoprim. A combination of antibacterial drugs used for urinary and prostate infections. Stay out of the sun while taking this drug. Also: SEPTRA, BACTRIM. More at: http://www.rxlist.com/cgi/generic/trisulf.htm SO:Short for Significant Other. (Sexual partner). Sperm or spermatozoa: The little tadpole like organisms which actually fertilize the egg. Sphincter:A ringlike muscle that constricts a bodily passage or opening to control the flow through the passage or opening. Sphincters to control the flow of urine in men are found at the bladder neck and on the penis side of the prostate. Sphincter, Urinary:A ring-like muscle which contracts to cut off urine flow. Located on around the urethra at the exit from the prostate. Staph:Short for Staphylococcus. A spherical gram-positive bacterium. Static Obstruction:Blockage of the urethra due to the pressure of the swollen prostate. Stent:A hollow tube placed in the urethra to keep it open. Still experimental. Stricture:The narrowing of a passageway. Strep:Short for Streptococcus. An ovoid gram-positive bacterium which causes Scarlet Fever and Strep throat. Stress Incontinence:The involuntary discharge of urine when there is increased pressure upon the bladder, as in coughing or straining to lift heavy objects. Sulfamethoxazole/trimethoprim:An antibacterial. BACTRIM, SEPTRA. Stay out of the sun while taking this drug. More at: http://www.rxlist.com/cgi/generic/trisulf.htm Superior Pole:When used in reference to the prostate refers to the upper end of the prostate. The end farthest from the anus. Suprapubic Prosectomy: A prosectomy where the incision is made between the navel and the penis. The bladder is cut open during this procedure. Terazosin:Generic name for HYTRIN. More at: http://www.rxlist.com/cgi/generic/teraz.htm Testes: Another name for testicles. Testosterone:The male sex hormone. This hormone is produced mostly by the testes but the adrenal gland also produces a small amount. You need a supply to maintain your prostate's current size. Castration cuts off the major source of supply and results in shrinkage of the prostate so this is sometimes used to shrink or slow the growth of prostate cancer. Testosterone can not be used directly by the prostate however but must first be converted to Dihydrotestosterone by the action of a prostate enzyme called 5-alpha reductase. PROSCAR (used to shrink the prostate in some BPH cases) works by interfering with this conversion. Tetracycline:An antibiotic. More at: http://vet.purdue.edu/depts/bms/courses/chmrx/tetra.htm TIA:Net shorthand for "Thanks In Advance." TLIP:Transurethral Longitudinal Incision of the Prostate. Surgery which makes longitudinal cuts in the urethra in order to relieve some of the obstruction. Not as effective as a TURP but may be easier on the patient's sex life. (YY) Tobramycin:An antibiotic. More at: http://www.ami-med.com/mhc/scr/001732sc.htm Total Incontinence:The loss of control over the sphincters of the bladder neck and urethra, resulting in total loss of retentive ability. Trabeculation:Irregular configuration of the bladder caused by an obstruction. Trimethoprim-sulfa:An antibacterial compound. Appears to be a version of sulfamethoxazole/trimethoprim. TRUS:Short for TransRectal UltraSound. A device which uses ultrasound to check the prostate for tumors and cysts. Also gives an idea of the size and shape of the prostate. Most have the capability to do a biopsy. TULIP:Transurethral Ultrasound-guided Laser Incision of the Prostate. A high tech version of the TUIP. TUNA:A relatively new method for treating BPH. There was a good article in the Dec. '96 Newsweek (the one with the red Dilbert on the cover). TURP:Short for TransUrethral Resection of the Prostate. Surgical removal of the prostate's innermost core by an approach through the urethra, with no external skin incision; the most common treatment for symptomatic BPH. Urethra:the tube that carries urine from the bladder and semen from the prostate and other sex glands out through the tip of the penis See http://www.prostatitis.org/tarf/p3.htm for drawing. Urinalysis:examination of the urine for abnormalities. Uro:Short for urologist. Urologist:A doctor who specializes in diseases of the urinary tract and the male reproductive system. UTI:Short for Urinary Tract Infection. Utricle:The remnant of the tissue which would in a woman have developed into the uterus. Located in the uretha between the two ejaculatory duct openings. In some men this can form a cyst which can mimic prostatitis. See http://www.prostatitis.org/tarf/p3.htm for drawing. Vas Deferens:This is one of the tubes which they cut when you have a vasectomy. There is one for each testicle. Plural is vasa deferens. The lower end actually attaches to the epididymis. The upper end is slightly swollen and serves as a storage area for mature sperm. This end is sometimes called the ampullary vas. See http://www.prostatitis.org/tarf/p3.htm for drawing. Note that it is labeled Deferent Duct in the drawing. Verumontanum:Sometimes shortened to veru. A small protuberance (3-4 mm)on the urethra where the ejaculatory ducts enter. See http://www.prostatitis.org/tarf/p3.htm for drawing. VLAT:Visually directed Laser Ablation of the Prostate. A high tech version of the TURP. Void:To urinate. Watchful Waiting:A strategy of management in which the patient is monitored but receives no active treatment. WBC:Short for White Blood Cells. Examination of the EPS or urine sometimes reveals the presence of white blood cells. This is usually considered a sign of infection. Website:Usually refers to the website of the Prostatitis Foundation; http://www.prostatitis.org. Note that http://www.prostate.com is the website for Prostate Cancer. WT:Net shorthand for: Without Thinking. WTR:Net shorthand for: With Respect To. WTTM: Net shorthand for: Without Thinking Too Much. Xatral:A French alpha-1 blocker used to treat BPH symptoms. YMMV:Net shorthand for: Your Mileage May Vary. Used to indicate that something may work differently for someone else. Yohimbine:A bark extract used as a treatment for impotence. Warning: Some over-the-counter versions may contain added methyltestosterone which can increase the growth of prostate tumors. Yohimbine HCL:The purified prescription form of yohimbine. Zap:To kill or to heat up something in the microwave.

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