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.  

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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.

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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.

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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.

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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.