Chronic Prostatitis Flashcards
Chronic …. is characterised by > 3 months of urogenital pain, often associated with LUTS or sexual dysfunction.
Chronic prostatitis is characterised by > 3 months of urogenital pain, often associated with LUTS or sexual dysfunction.
Chronic prostatitis may be categorised as:
Chronic prostatitis/chronic pelvic pain syndrome: clinical features of chronic prostatitis in the absence of an identifiable bacterial infection.
Chronic bacterial prostatitis: relatively uncommon, accounting for around 10% of patients with chronic prostatitis.
The aetiology of non-bacterial associated chronic prostatitis is … …..
The aetiology of non-bacterial associated chronic prostatitis is poorly understood.
Chronic prostatitis/chronic pelvic pain syndrome
The aetiology remains poorly understood. Infective and inflammatory triggers may be implicated. There are suggestions that some may have a neuropathic component.
Chronic bacterial prostatitis may develop when?
This may develop following an episode of acute bacterial prostatitis or present more insidiously. The urinary tract is frequently implicated as the source of infection but it may also arise lymphogenous spread from the rectum or as part of the systemic spread of an infection from a distant location.
Those with underlying urinary tract abnormalities are at greater risk. Men with HIV are at risk of a greater breadth of infective aetiologies. Less commonly STI’s are the infective agent.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) classification may be used to categorise p….
Categorise prostatitis
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for prostatitis - The two glass test, just involving EPS and VB3 is commonly used.
I: Acute bacterial prostatitis (ABP)
II: Chronic bacterial prostatitis (CBP)
III: Chronic pelvic pain syndrome (CPPS)
IIIA: Inflammatory CPPS (leucocytes in semen/EPS/VB3)
IIIB: Non-inflammatory CPPS (no leucocytes in semen/EPS/VB3)
IV: Asymptomatic inflammatory prostatitis (histological prostatitis)
Urogential pain in prostatitis
Pain is often diffuse and poorly localised. Many patients will describe pain in the perineum but it can also be in the external genitalia, back, lower abdomen or rectum.
Urinary symptoms in prostatitis (3)
Hesitancy
Dysuria
Frequency
Sexual dysfunction in prostatitis (3)
Pain on ejaculation
Erectile dysfunction
Premature ejaculation
Investigations for chronic bacterial prostatitis:
The majority of investigations are aimed at identifying any underlying bacterial infection.
Urine dipstick and MSU
Expressed prostatic secretions
Consider semen MC+S
STI screen (including blood borne viruses)
Consider PSA (may be elevated in prostatitis or malignancy)
Chronic bacterial prostatitis management:
Patients should be referred for urology review. An antibiotic course is given dependent on the suspected organism. Courses of fluoroquinolone (e.g. ciprofloxacin) or doxycycline may be used. Length of antibiotics courses vary, discussion with microbiology can help guide management. Analgesia and stool softeners can be prescribed and offer symptomatic relief.
In rare and select cases surgical intervention may be indicated, typically in the form of a transurethral resection of the prostate (TURP) to remove an infective nidus.
Chronic prostatitis/chronic pelvic pain syndrome management:
Analgesia, beginning with paracetamol should be offered. NSAIDs may be given taking into consideration co-morbidities and age as well as the need for PPI cover. Again stool softeners may offer some relief. Alpha-blockers (e.g. Tamsulosin) should be trialled if significant lower urinary tract symptoms are present.
A course of antibiotics is often given as infection can be difficult to conclusively exclude. Where concern exists, symptoms are severe or persistent, or the diagnosis is uncertain refer to urology.
Referral to Pain Team specialists is often needed, particularly if neuropathic pain is considered.
