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:
-
Agabegi S, Agabegi E, Ring A. Step-up to medicine. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2013.
-
Kumar P, Clark M. Kumar & Clark's clinical medicine.
-
Walker B, Colledge N, Ralston S, Penman I. Davidson's principles and practice of medicine.
-
Le T, Bhushan V, Singh Bagga H. First aid for the USMLE step 2 CK. New York: McGraw-Hill Medical; 2010.
-
Merck Manuals Professional Edition. Prostatitis - Genitourinary Disorders [Internet]. 2016 [cited 19 February 2016]. Available from: http://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/prostatitis
-
Uptodate.com. Acute bacterial prostatitis [Internet]. 2016 [cited 19 February 2016]. Available from: http://www.uptodate.com/contents/acute-bacterial-prostatitis
-
Uptodate.com. Chronic bacterial prostatitis [Internet]. 2016 [cited 19 February 2016]. Available from: http://www.uptodate.com/contents/chronic-bacterial-prostatitis
-
Fischer C. Master the boards.
Written by: Lama Al Luhidan
Reviewed by: Bassam AlGhamdi
Roaa Amer
Format editor: Adel Yasky