Prostatitis

Overview of Prostatitis

Related keywords: CPPS, asymptomatic inflammatory prostatitis, prostatic inflammation prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, prostatodynia, bacterial prostatitis, chronic pelvic pain syndrome, acute bacterial prostatitis, prostate gland,

Background

Prostatitis is an infection of the prostate gland.

The National Institutes of Health (NIH) has defined a classification system for prostatitis in 1999.

I . Acute bacterial prostatitis
II . Chronic bacterial prostatitis
III. Chronic prostatitis and chronic pelvic pain syndrome (CPPS), Inflammatory, Noninflammatory
IV. Asymptomatic inflammatory prostatitis.

Chronic pelvic pain syndrome is defined by pain, such as presence of urethritis, urinary tract infection, urethral stricture. It is divided into inflammatory and noninflammatory.

Acute and chronic bacterial prostatitis are defined by bacterial infections of the prostate glands.

presence of prostatitis are the presence of inflammatory cells in the prostateepithelium , with chronic inflammatory cells in the tissue . However, degree of physical genital symptoms and the presence of inflammatory cells in the urine or prostatic secretions does not correlate with each other.

Asymptomatic prostatitis is the prostatic inflammation without any genital symptoms. These patients are diagnosed for infertility or elevated prostate-specific antigen (PSA) level.

Chronic pelvic pain syndrome is diagnosed based on pain and negative culture results of prostatic secretion.

In bacterial prostatitis, sexual transmission of bacteria is very common.

Granulomatous and viral and prostatitis may be another cause of culture-negative disease. cytomegalovirus (CMV), common viral pathogen of prostatitis . Mycobacteria, tuberculosis, and fungi, Candida albicans, have also been connected with culture-negative disease.

 

International

The incidence of bacterial prostatitis, with disseminated disease, is increased in many countries. Areas have a higher incidence of acute bacterial prostatitis also have widespread sexually transmitted disease (STD) rates and prostitution

Frequency

United States

Acute bacterial prostatitis and chronic bacterial prostatitis each make up another 5% of cases. The most common of the 4 categories of prostatitis, chronic prostatitis/chronic pelvic pain syndrome, accounting for 90% of cases of prostatitis.

The diagnosis of prostatitis is made in approximately 35% of male patients presenting with genitourinary symptoms. Prostatitis is the most common urology diseases in the United States,chronic bacterial prostatitis and chronic pelvic pain syndrome being most frequently diagnosed, accounting for nearly 3 million patient visits per year.

History

• Acute bacterial prostatitis
• • Malaise
  • Chills
  • Fever
  • Low back pain
    
  • Myalgias
  • Dysuria
  • Perineal prostatic pain
  • urinary tract symptoms, including dysuria, frequency, urgency, nocturia, hesitancy, and incomplete voiding, weak stream
  • Arthralgias
  • Lower abdominal pain
  • urethral discharge
    
    
• Chronic bacterial prostatitis
• • Intermittent obstructive urinary tract symptoms
    
  • Intermittent dysuria
  • Absent Systemic symptoms
    
    
• Chronic prostatitis and chronic pelvic pain syndrome
• • Pelvic pain including testicular/scrotal pain, urethral, perineal, rectal
  • Obstructive urinary tract symptoms, incomplete voiding, dysuria, frequency
  • Erectile dysfunction
  • Ejaculatory pain
    |
    
• lack of symptoms, asymptomatic inflammatory prostatitis

Age

the most common variant of the syndrome is acute bacterial prostatitis is in patients younger than 35 years,

Mortality

diabetes mellitus, patients on dialysis for chronic renal failure.

In the United States, compliant patients, the prognosis is good for the first occurrence of acute bacterial prostatitis with antibiotic therapy.

Physical

Acute bacterial prostatitis

• • Tender, hot, boggy, nodular,prostate glands on digital rectal examination
  • urinary retention due to enlarged tender bladder
    
    
• Chronic bacterial prostatitis
• • Normal examination findings between acute episodes
  • on digital rectal examination normal gland,tender, nodular
    
• chronic pelvic pain syndrome and Chronic prostatitis
• • normal prostate or light tender on digital rectal examination
• Normal or calcified prostate on digital rectal examination is symptoms of asymptomatic inflammatory prostatitis

Causes

• Chronic bacterial prostatitis
• • E coli is responsible for chronic bacterial prostatitis cases. Enterococci and gram-negative aerobes such as Pseudomonas are usually isolated.
  • Cytomegalovirus
  • Trichomonas vaginalis, C trachomatis, Ureaplasma species,
  • sarcoidosis
  • U M tuberculosis and Coccidioides, Histoplasma, and Candida

Consider Chlamydia trachomatis, Neisseria gonorrhoeae infection in any male with urinary tract symptoms.

• Acute bacterial prostatitis may be caused by
  
  
  • gram-negative organisms, Pseudomonas, Serratia, Enterococcus, Escherichia coli, Enterobacter,and Proteus species. Mixed bacterial infections are rare. Staphylococcus aureus was documented in a diabetic patient.
    
  • Refluxing urine into prostate ducts
  • ymphatic spread from the rectum
  • infection through the urethra
    
    
  • Chronic prostatitis and chronic pelvic pain syndrome
  • • bacterial pathogen isolated from their urine or prostatic fluid.
    • primary vesical neck obstruction, pseudodyssynergia
    • obstruction of Ejaculatory duct
    • 
      

Lab

• Prostate-specific antigen determination: PSA determination may help in diagnosis of acute bacterial prostatitis.
• Complete blood count: A complete blood count (CBC) with cultures acutely toxic patients.
• Urine culture to identify the causative organisms.
• Chemistry: in patients with urinary retention or obstruction.
• Urinalysis: Obtain quantitative values of oval fat bodies, and lipid-laden macrophages for thebacterial count and white blood count.

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Imaging

• CT studies of the pelvis in evaluation of prostatic abscess.
  In acute prostatitis, on color Doppler ultrasonography, a increase in color around the ejaculatory ducts, in the prostatic urethral, and close to the seminal vesicles.
• Transrectal ultrasound
• • prostatic calculi,capsular thickening.
  • enlargement and thickening of the seminal vesiclles
  • diagnosis requires digital rectal examination and clinical correlation.

Consultations

Consultation with a urologist, check if STD is cultured. Consult a psychiatrist with your case.

Medication

various medical therapies are used for  different NIH prostatitic.

treatment of acute bacterial prostatitis is antibiotic therapy. If the patient have systemic symptoms, hydration, and analgesia, intravenous antibiotics is warranted,. If the patient shows signs of obstruction, urinary retention, catheter treatment is needed.

Type and duration of antibiotics used as well as adjunctive medications are used for chronic bacterial prostatitis therapy. Treatment of prostate-penetrating antibiotics, such a fluoroquinolone or trimethoprim-sulfamethoxazole, typically lasts 4-8 weeks.

alpha-blocking agents or diazepam with sitz baths are treated for chronic prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis.

Antibiotics

N gonorrhoeae and C trachomatis are the primary suspected pathogens, Empiric antibiotics treating gram-negative pathogens.

treatment guidelines for gonococcal infection. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States.

 
consider trimethoprim/sulfamethoxazole (Bactrim) or fluoroquinolones for 28 days or more as empiric agents, for the treatment of chronic bacterial prostatitis with Enterobacteriaceae, enterococci, and P aeruginosa.

doxycycline or erythromycin should be instituted for nonbacterial prostatitis caused by Chlamydia and Ureaplasma species.

Alpha-adrenergic antagonists

These agents are used in the treatment of BPH, benign prostatic hypertrophy. Alpha-blockers improve bladder outlet obstruction and voiding dysfunction. Studies suggest that combiningantibiotics with alpha-blockers may reduce the risk of recurrence of chronic prostatitis.

Alpha-blockers may also improve symptoms in chronic pelvic pain syndrome.

Further Outpatient Care

• patients found to have elevated PSA levels should be followed up by their  urologists, primary care-physicians, or both, although no clear connection between elevated PSA level in prostatitis and cancer.
• acute bacterial prostatitis managed with outpatient care with4 week course of oral antibiotics.
• as aggressive treatment of acute prostatitis reduce the chance of developing chronic prostatitis. After primary management, patient care is transferred to a urologist.
• long-term antimicrobial suppression, intraprostatic injection, transurethral resection of the prostate (TURP) are the management strategies for category II prostatitis, chronic bacterial prostatitis.
• thermal therapy, bio feedback, anti-inflammatory, phyto therapy, and pelvic floor exercises are studied for category III prostatitis

Prevention

• Recognition of psychosomatic in chronic cases and appropriate psychiatric treatment lessens the recurrence rate. Psychological stress are associated with symptoms of chronic prostatitis.
• acute bacterial prostatitis, chronic prostatitis, and causes of nonbacterial prostatitis is associated with protection against STDs also provides protection against many organisms.

Complications

• Abscess - immunocompromised patients
• urinary retention/Bladder outlet obstruction
• Chronic prostatitis - one third of patients with chronic bacterial prostatitis experience recurrence following initial treatment.
• scarring of the urethra and Infertility
• Renal damage
• Recurrent cystitis
• Sepsis
• Pyelonephritis

Prognosis

• aggressive antibiotic therapy and good patient compliance could have goood prognosis of the first occurrence of acute bacterial prostatitis.
• causative factors must be determined to affect outcome in cases of recurrent chronic prostatitis acute exacerbations,

Special Concerns

• Chronic prostatitis and asymptomatic inflammatory prostatitis have not been scientifically linked to prostate cancer.
• Nursing home patients with indwelling urethral catheters may be at increased risk.
• Patients referred to their primary care doctors or a urologist for PSA recheck, follow-up if with an elevated PSA value.

Medical Pitfalls

• Performing prostatic massage in acute bacterial prostatitis patients
• Fail to recognize acute urinary retention
• Failure to consider diagnosis in sexually active men