Prostatitis Flashcards
What is prostatitis?
Prostatitis is inflammation of the prostate gland.
What are the different types of prostatitis?
Prostatitis is comprised of acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia.
Briefly describe acute bacterial prostatitis and its causes
Most cases of acute bacterial prostatitis are caused by ascending urethral infection, although occasionally direct or lymphatic spread from the rectum or hematogenous spread via bacterial sepsis can be the cause.
Causative organisms include E. Coli (most common), Enterobacter, Serratia, Pseudomonas and Proteus species. Sexually transmitted infections, such as Chlamydia or Gonorrhoea, are a rare cause.
Briefly describe chronic bacterial prostatitis
Chronic bacterial prostatitis is chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be the sequelae of inadequately treated acute prostatitis.
What are the risk factors for acute bacterial prostatitis?
For acute bacterial prostatitis:
- Indwelling catheters
- Phimosis or urethral stricture
- Recent surgery, including cystoscopy or transrectal prostate biopsy
- Immunocompromised
What are the risk factors for chronic bacterial prostatitis?
In addition, for chronic prostatitis:
- Intraprostatic ductal reflux
- Neuroendocrine dysfunction
- Dysfunctional bladder
What are the clinical features of acute bacterial prostatitis?
Acute bacterial prostatitis can present with lower urinary tract symptoms (LUTS), features of systemic infection (including pyrexia), perineal or suprapubic pain or urethral discharge.
On rectal examination, there is often a very tender and boggy prostate. Associated inguinal lymphadenopathy may also be present.
What are the clinical features of chronic bacterial prostatitis?
Chronic prostatitis should be suspected in men who complain of pelvic pain or discomfort for at least 3 months (Prostatodynia), alongside LUTS; the perineum is the most common site for pain, however pain can occur in the suprapubic region, lower back or rectum.
What investigations should be ordered for prostatitis?
Urine culture are the first line investigations in the acute setting for suspected cases. Antibiotic therapy can be guided from any sensitivities obtained.
Other investigations to consider include an STI screen and routine bloods, including FBC, CRP, and U&Es (prostate specific antigen (PSA) will often be elevated in cases, therefore is not routinely performed).
Further investigations are only preformed in the secondary care setting and are usually indicated when initial therapy has failed or to investigate for potential underlying causes.
In patients who failed to respond to antibiotic therapy, other pathologies such as prostate abscess need to be ruled out using transrectal prostatic ultrasound (TRUS) or CT imaging.
Briefly describe the management of acute bacterial prostatitis
The mainstay of the management of acute bacterial prostatitis is via prolonged antibiotic treatment, typically a quinolone due to their good penetration into the prostate. Ensure suitable analgesia (typically paracetamol and NSAIDs) is also provided.
For patients that are considered to be severely ill or are unable to tolerate oral antibiotics, then admission to hospital may be necessary. Specialist input may be required those patients with diabetes mellitus, long-term catheter, immunocompromised, or suspected prostatic abscess.
Those with pre-existing urological condition (e.g. BPH) may warrant referral to urology following the treatment of the acute infection for further management.
Briefly describe the management of chronic bacterial prostatitis
When managing chronic prostatitis, it should be explained to the patient that the cause is not always understood and therefore can be difficult to treat. Management is primarily focused on symptom control (oral analgesia with stool softeners if any painful defecation).
Significant LUTS can be managed well with a 4-6-week trial of an alpha blocker (e.g. doxazosin, terazosin, tamsulosin). A 6-week course of antibiotics may also be warranted if symptoms have been present for less than 6 months.
If symptoms persist after urological treatment and management, consider referral to a chronic pain specialist. For CPPS, psychological therapies are an additional therapeutic option.
Who is involved in the MDT of chronic prostatitis?
An MDT approach (urologists, pain specialists, specialist physiotherapists, GPs, cognitive behavioural therapists, sexual health specialists) is recommended for optimal outcome.
