Prostatitis

Acute Bacterial Prostatitis and Prostatic Abscess

Serratia species, chronic bacterial prostatitis, prostatic abscess, prostatitis, prostate disease, bladder outlet obstruction secondary to benign prostatic hyperplasia,abacterial prostatitis, prostatodynia, urinary tract infection in men,Enterobacter species, Pseudomonas aeruginosa,acute infection of the prostate, recurrent urinary tract infection, chronic infection of the prostate, chronic abacterial prostatitis, intraprostatic urinary refluxchronic pelvic pain syndrome, asymptomatic inflammatory prostatitis, ABP, acute prostatitis, nonbacterial prostatitis, Escherichia coli, Proteus mirabilis, Klebsiella species, inflammatory chronic pelvic pain syndrome, noninflammatory chronic pelvic pain syndrome,acute bacterial prostatitis,

Etiology

The most common infections are usually one strain of bacteria, somtimes, 2 or 3 strains of bacteria may be present. The organisms primarily responsible for ABP are also those responsible for most urinary tract infections. The most common causal organisms for ABP are Escherichia coli, Proteus mirabilis, Klebsiella species, Enterobacter species, Pseudomonas aeruginosa, and Serratia species.

Staphylococcus aureus infection due to prolonged catheterization may occur in the hospital. Other occasional causes include Neisseria gonorrhea, Mycobacterium tuberculosis, Salmonella species, Clostridium species, and parasitic or mycotic organisms.

The following are risk factors for ABP (all allow bacterial colonization):

• Altered prostatic secretions
• Intraprostatic ductal reflux
• Urinary tract infections  
• Acute epididymitis
• Unprotected anal intercourse
• Specific blood groups
• Indwelling Foley catheter and condom catheter
• Transurethral surgery
• Phimosis and redundant foreskin

Clinical

Symptoms for ABP are fever, chills, low back and perineal pain, urinary frequency and urgency, dysuria, nocturia, and generalized malaise.

Rectal exam shows an enlarged, exquisitely tender, swollen prostate gland, which is firm, warm, and, occasionally, irregular to the touch. Care must be taken to avoid vigorous prostatic massage in a patient with suspected ABP.
Rectal palpation usually reveals.

Symptoms of sexual dysfunction is a symptom. Pain associated with ejaculation (which translates to impaired overall quality of life) contributes to or causes erectile dysfunction.


Indications

Prostatic abscess is a potential indication for surgery. Prostatic abscess is an uncommon but well-described complication of ABP. Medical management is often not successful.

Transrectal or perineal aspiration of the abscess is preferred and is often effective, especially if symptoms do not improve after 1 week of medical therapy. Transurethral resection of the prostate and drainage of the cavity is another approach. However, this approach is less desirable because of the potential hematogenic spread of bacteria.