Chronic prostatitis/pelvic pain syndrome Flashcards
What proportion of men are affected by prostatitis at some point in life?
35-50%
What are the 4 classifications of prostatitis?
I Acute bacterial prostatitis
II chronic bacterial prostatitis
III chronic prostatitis/chronic pelvic pai syndrome
IV asymptomatic inflammatory prostatitis
There are 2 subclasses of chronic prostatitis/CPPS - what are they? Describe them.
IIIa inflammtory CPPS - WBC in semen
IIIb non-inflammatory CPPS - NO WBC
Describe the difference between chronic prostatitis/CPPS and chronic bacterial prostatitis
No demonstrated infection in CPPS, can be inflammatory though
What areas can be affected by pain in prostatitis?
Perineum Suprapuic Testicles Penis inc tip Lower abdomen/back Inguinal region Rectum
Which site is pain most often reported in prostatitis?
PErineum 63%
In what situations may a person experience pain caused by prostatitis?
Micturition
Ejaculation
What voiding or storage symptoms may present in prostatitis?
weak stream straining hesitancy urgency increased urinary frequency nocturia dysuria
What other lower urinary tract symptoms may occur in prostatitis (other than void or storage)?
urethral burning with or without micturition
Haematospermia
Recurrent UTI
What sexual dysfunction symptoms may be present in prostatitis?
erectile OR ejaculatory dysfunction
decreased libido
Describe EARLY stage CBP or CP/CPPS
less than 6 months
antibiotic naive
Describe LATE stage CBP or CP/CPPS
more than 6 months
refractory to initial pharmacotherapy
What physical examination should take place for prostatitis?
Abdominal
Genital exam
DRE
What samples are taken for microscopy and culture to establish if bacterial cause for prostatitis
voided bladder 1, 2 and 3 samples
expressed prostatic secretions after massage
In addition to MSSU, which other tests should be performed as part of initial work up for prostatitis?
PSA
STI testing
Indications for PSA testing?
Abnormal prostate on DRE
symptoms suggestive of bladder outlet obstruction
patient concern about prostate cancer
What are the 3 components of the NIH-CPSI questionnaire for assessing prostatitis?
Pain
Voiding
Impact on QoL
When should alpha-adrenergic antagonists be used for prostatitis?
those with voiding symptoms
Why should uroselective alpha-adrenergic antagonists be used for prostatitis?
less systemic side effects
What impact do alpha-adrenergic antagonists have for people with prostatitis?
reduce urinary symptoms and pain
improved QoL
When should antibiotics be used in prostatitis?
Early stage
Bacterial cause found
How long should antibiotics be given for in CBP or CP/CPPS?
4-6 weeks
Repeat if partial response and bacterial cause identified
What antibiotic class should be considered first line for prostatitis?
Quinolones - ciprofloxacin
When should NSAIDs be used for prostatitis?
early stage
inflammatory flares
What is the limit on NSAID used for prostatitis?
4-6 weeks if no improvement of symptoms
What treatments can be considered for prostatitis with neuropathic origin?
gabapentinoid
TCA
SSRI
SNRI
Are 5-alpha reductase inhibitors useful in prostatitis?
Lack of evidence
May be given if benign prostatic enlargement a factor
What specific enquiry should take place for patients with refractory symptoms in CBP or CP/CPPS?
history of past trauma
- physical, emotional or sexual
Who might be part of an MDT for chronic prostatitis?
urologist pain specialist nurse specialist physiotherapist GPs psychologist sexual health specialist
What therapies may be offered by physiotherapy?
relaxation/coordination/reeducation pelvic floor muscles
myofascial trigger point release
TENS
acupuncture
When should surgical intervention be offered for CBP or CP/CPPS?
Only if clinical trial
no evidence to support use as current treatment
