Prostatitis

Study guide:

Defnition:

  • Prostatitis is an infection or inflammation of the prostate gland.

  • Gram-negative organisms are the most common to cause prostatitis: E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, and Serratia spp.  

Types and Pathophysiology:

  • Bacterial prostatitis:

    • Acute bacterial prostatitis.       

    • Chronic bacterial prostatitis.

    • Spreads by:

      • Ascending (from the urethra) → chlamydia and gonorrhea.

      • Descending (usually following UTI) → E.coli.

      • Hematogenous spread (rare)→ uncommon, TB.

  • Nonbacterial chronic prostatitis (chronic pelvic pain), +90% of the cases.

  • Asymptomatic inflammatory prostatitis.

Clinical Presentation:

  • Acute bacterial: 

    • Common in middle aged men, causing fever, pain, dysuria, retention.

    • More serious than chronic prostatitis.

  • Chronic bacterial: 

    • Recurrent urinary tract infections, low back pain, dysuria, and perineal and suprapubic discomfort.

  • Chronic nonbacterial:

    • Pelvic pain, obstructive urinary tract symptoms, ejaculatory pain, erectile dysfunction.

Diagnosis:

  • Digital rectal examination (DRE): 

    • Acute bacterial:

      • Tender, boggy prostate (relative contraindication due to pain).

    • Chronic bacterial:

      • Tender, nodular, or normal gland (depends on active infection).

    • Chronic nonbacterial:

      • Mildly tender or normal prostate and tight anal sphincter.

Urinalysis (four bottle test; initial urine, midstream urine, post massage expressed prostatic secretion, post massage urine): 

  • Acute bacterial: WBC and bacteria.

  • Chronic bacterial: WBC and bacteria.

  • Chronic nonbacterial: WBC post massage.

  • Asymptomatic inflammatory prostatitis: WBC post massage.

  • CBC: indicated in acute toxic patient to check for sepsis.

Management:

  • Acute and Chronic bacterial: 

    • Lifestyle: Warm bath and frequent ejaculation, and avoid causes (stones, constipation).

    • Alpha-blockers.

    • Antibiotic (TMX/SMX or fluoroquinolone+Doxycyclin) → has to be taken for prolonged period due to the alkaline nature of the prostate (4 weeks for acute and 6 for chronic).

    • Analgesia (when needed).

  • Chronic nonbacterial: 

    • Anxiolytics (e.g., SSRIs, benzodiazepines), sacral nerve stimulation, biofeedback, prostatic massage, and microwave thermotherapy.

 

 

Complications: 

  • Sepsis: a complication of acute bacterial infection, treated with board spectrum IV antibiotics (ampicillin or gentamicin) and suprapubic catheter.

  • Abscess: treated with transurethral drainage.

  • Retention and hydronephrosis.

  • Infertility due to scarring of the urethra or ejaculatory ducts.

  • Recurrent cystitis.

  • Pyelonephritis.

  • Renal damage (Post-renal failure).

Avoid DRE & Prostate massage in acute prostatitis  because it may incduce bacterima 

References: 

 

Written by:      Lama Al Luhidan                                           


Reviewed by:  Bassam AlGhamdi
                         Roaa Amer ​

Format editor:  Adel Yasky

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