Prostatitis Flashcards
What is Prostatitis
The term prostatitis has been used clinically to describe various complaints referable to the lower urogenital tract and perineum in men
It has been estimated that 50% of men experience symptoms of prostatitis at some time in their life
Critical to distinguish patients with lower urinary tract complaints associated with bacteriuria from the larger number of patients without bacteriuria.
Classification of Prostatitis
Prostatitis syndromes may be classified into 4 major groups:
Acute bacterial prostatitis
Chronic bacterial prostatitis
CP/CPPS, (Chronic prostatitis and chronic pelvic pain prostatitis syndrome
Asymptomatic inflammatory prostatitis
Pathogenesis of Bacterial Prostatitis
Organisms that ascend through the urethra cause most infections of the UT, urogenital ducts and accessory sex organs including the prostate
Virulence factors of uropathogens e.g. haemolysin,
cytotoxic necrotizing factor etc.
Urologic procedures also predisposes to infection
Host mechanical factors, such as the flushing action of
micturition and ejaculation are protective
A zinc-containing polypeptide: prostatic antibacterial factor = important antimicrobial substance secreted by the prostate
Bacterial Causes of Prostatitis
Gram negative bacilli especially Eschericia coli = commonest cause, predominates >60% cases
Enterococci species estimation = 15% of cases
Staphylococcus species including Staph epidemidis, Staph aureus,(Look for remote/ endovascular primary source of infection e.g. bacteremia/ infective endocarditis)
Other pathogens: Trichomonas vaginalis, Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae – STI pathogens esp in younger males
Clinical Presentation of Prostatitis
Spectrum:
-Acute (may complicate into: abscess, infarct, chronic)
- Chronic / recurrent infection by the same organism
- Asymptomatic
- Abscess
Urological emergency if acute and severe
Signs and symptoms of UTI (Intense suprapubic pain, FOM, BOM)
Lower back pain
Fever and Chills
Urinary retention e.g. dt prostate oedema
N.B. Largely a clinical diagnosis.
N.B. rectal examination may precipitate frank sepsis or bacteraemia (If abscess is suspected imaging to be done)
Laboratory Diagnosis:
Specimens
Routine urine for microscopy and culture (acute)
Sequential urine cultures: pre and post prostate
massage urine (chronic)
Semen
Prostate secretions
Prostate tissue biopsy to exclude malignancy in
chronic prostatitis
Laboratory Diagnosis:
Routine Urine for Microscopy and Culture
Lower Urinary Tract Localization Using Sequential Urine Cultures = Gold standard
Voided bladder 1 : Initial 5-10 mL of urinary
stream
Voided bladder 2 : Midstream specimen
Expressed prostatic secretions expressed from
prostate by digital massage
Voided bladder 3: First 5-10 mL of urinary
stream immediately after prostatic massage
Pyuria and bacteriuria in routine urine
Colony count in voided bladder 3 urine sample should
exceed that of voided bladder 1 urine sample (by up to
10 fold)
Prostatic secretions: neutrophils, bacteria, fatty bodies
(semen culture better)
Treatment: General
Prostatitis – Empiric treatment with antibiotics= directed at suspected organisms
IV Beta-lactam + aminoglycoside or fluoroquinolone
(Ciprofloxacin)= DOC
Switch to oral once patient is stable and organisms
susceptible to the drug
Treatment duration is long = 4-6 weeks especially if chronic
Treatment: Prostatic Abscess
HIV, diabetics are at risk
Requires IV antibiotics and prompt drainage
Post per-rectal prostatic biopsy also a risk factor
NB: HIV(+) prostate might be reservoir of C.neoformans
Treatment: Urinary Retention
Best managed with a suprapubic cystostomy, rather
than a transurethral catheter, to avoid obstructing
drainage of infected prostatic secretions into the
urethra.
General measures, including hydration, analgesics,
and bed rest, also are indicated
