Prostatitis Disease

DESCRIPTION

One of several inflammatory and/or painful conditions affecting the prostate gland

Acute bacterial prostatitis - generally associated with urinary tract infection, has characteristically abrupt onset
Chronic bacterial prostatitis - major cause of recurrent bacteriuria, less fulminant
Nonbacterial prostatitis/prostadodynia - findings similar to chronic bacterial, but bacterial cultures negative
System(s) affected: Reproductive, Renal/Urologic
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Common
Predominant age:
- Mostly ages 30-50, sexually active
- Chronic more common in ages over 50
Predominant sex: Male only

SIGNS AND SYMPTOMS

Acute bacterial
- Fever; chills
- Tense, boggy, very tender and warm prostate
- Low back pain
- Perineal pain
- Frequency
- Urgency
- Dysuria
- Nocturia
- Bladder outlet obstruction
Chronic bacterial
- Symptoms often absent
- Perineal pain
- Dysuria
- Irritative voiding
- Lower abdominal pain
- Low back pain
- Scrotal pain
- Penile pain
- Pain on ejaculation
- Hematospermia
Nonbacterial
- Similar to chronic prostatitis

CAUSES

Acute and chronic bacterial
- Ascending infection through urethra
- Refluxing urine into prostate ducts
- Direct extension or lymphatic spread from rectum
- Hematogenous spread
- Calculi serving as nidus for infection
- Aerobic gram negative bacteria (Escherichia coli, Pseudomonas, Klebsiella, Proteus), N. gonorrhea, Enterobacteriaceae
- Miscellaneous - Chlamydia trachomatis
- Gram positive bacteria (Streptococcus faecalis, Staphylococcus aureus)
- Organisms suspected, but unproven (Staphylococcus epidermidis, Micrococci, non-group D streptococcus, Diphtheroids)
- Uncommon: Mycobacterium tuberculosis, parasitic, Mycoses (blastomycosis, coccidioidomycosis, cryptococcus, histoplasmosis, paracoccidiomycosis, candidiasis)
Nonbacterial
- Nonrelaxation (spasm) of the internal urinary sphincter and pelvic floor striated muscles leading to increased prostatic urethral pressure and intraprostatic urinary reflux leading theory
- Ureaplasma, trichomonas vaginalis, and Chlamydia postulated, but not proven

RISK FACTORS

Male sex
Age over 50
Prostatic calculi
Urinary tract infection

LABORATORY

Fractional urine examination (initial 10 mL from urethra for voided bladder 1 (VB1) test, next 200 mL discarded, then midstream from bladder for VB2 test, then expressed prostate secretion (EPS), lastly urine after prostate massage for VB3 test. Some feel vigorous massage may lead to bacteremia.
Urinalysis, culture, sensitivities on all samples
Over 10-15 white cells per high powered field or positive culture in EPS or VB3 but not VB1 or VB2 diagnostic of bacterial prostatitis
Bacteria count generally less in chronic than acute
Macrophages containing fat (oval bodies) in bacterial prostatitis
Antigen-specific IgA and IgG levels in prostatic fluid helpful for diagnostic confirmation and determining response to therapy
Alkaline pH of prostatic fluid in chronic bacterial prostatitis
Nonbacterial will show white blood cells with a negative culture
No abnormal findings with prostatodynia

Drugs that may alter lab results: Antibiotics
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Inflammatory changes (except prostatodynia)

SPECIAL TESTS

N/A

IMAGING

CT or ultrasound, if malignancy or abscess suspected
Transrectal ultrasound (if prostatic calculi or abscess suspected)

DIAGNOSTIC PROCEDURES

Needle biopsy or aspiration for culture
Urodynamic testing (prostatodynia)
Cystoscopy (in persistent nonbacterial prostatitis to rule out bladder cancer, interstitial cystitis)

APPROPRIATE HEALTH CARE

Inpatient (proven or suspected abscess, urosepsis, immunocompromised)
Outpatient, if nontoxic

GENERAL MEASURES

Analgesics
Antipyretics
Stool softeners
Hydration
Sitz baths to relieve pain and spasm
Suprapubic catheter for severe urinary retention

SURGICAL MEASURES

Surgical resection for intractable chronic disease, or to drain an abscess; transurethral microwave thermotherapy for chronic nonbacterial prostatitis

ACTIVITY

Bedrest in severe cases

DIET

Nonbacterial and prostatodynia - avoid spicy foods, excess caffeine and alcohol
Acute and chronic bacterial - no special diet

PATIENT EDUCATION

Printed patient information available from:
National Kidney & Urologic Diseases Information Clearinghouse, Box NKUDIC, Bethesda, MD 20893, (301)468-6345

PREVENTION/AVOIDANCE

Suppression therapy may benefit patient with chronic bacterial prostatitis

POSSIBLE COMPLICATIONS

Abscess
Sepsis
Urinary retention

EXPECTED COURSE AND PROGNOSIS

Often prolonged and difficult to cure. Studies with 55-97% cure rate depending on population and drug used.

ASSOCIATED CONDITIONS

Prostatic hypertrophy
Cystitis
Urethritis

AGE-RELATED FACTORS

Pediatric: None
Geriatric: Consider prostatic hypertrophy and urinary retention more seriously
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Prostatodynia: pain in the area of prostate. Sometimes inaccurately designated as a diagnosis.

ABBREVIATIONS

VB = voided bladder
EPS = expressed prostate secretion

Clinical Investigations

ROLE OF HOMOEOPATHY

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