• Clinical science

Prostatitis

Abstract

Prostatitis is an inflammation of the prostate gland that may be of infectious (acute and chronic bacterial prostatitis) or noninfectious origin (chronic pelvic pain syndrome, or CPPS). Acute and chronic bacterial prostatitis are most often caused by Escherichia coli, while in CPPS no causative organism can be identified. Patients with acute bacterial prostatitis typically present with spiking fevers, chills, perineal pain, and symptoms of bladder irritation. The presentation of chronic bacterial prostatitis and CPPS is more subtle, including symptoms of chronic or recurrent urinary tract infections and genitourinary pain. Findings on examination include a tender, boggy prostate in acute bacterial prostatitis, and mildly tender or normal prostate in chronic bacterial prostatitis and CPPS. Diagnostics aim to identify a potential causative organism via urine culture or fractional urine examination. Empirical antibiotic treatment is the primary therapeutic approach for acute and chronic bacterial prostatitis, whereas treatment for CPPS is multimodal, including pharmacological treatment, psychological support, and physiotherapy. Acute bacterial prostatitis can lead to complications (e.g., acute urinary retention, prostatic abscess formation, sepsis) that may require additional treatment, such as suprapubic catheterization or ultrasound-guided abscess drainage.

Epidemiology

  • Very common urologic diagnosis in men < 50 years of age
  • 25% of men are diagnosed with prostatitis in their lifetime
  • Bacterial prostatitis (2–5% of cases): primarily affects men ∼ 20–50 years of age
  • Chronic pelvic pain syndrome (90–95% of cases): primarily affects men 40–60 years of age

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Pathogenesis

Risk factors for bacterial prostatitis

References:[2][4][5][6][7]

Clinical features

Acute bacterial prostatitis Chronic bacterial prostatitis Chronic pelvic pain syndrome

Constitutional symptoms

  • Spiking fevers, chills, malaise
  • Commonly absent
  • Low-grade fever in some patients
  • Commonly absent

Genitourinary tract symptoms

  • Acute dysuria , frequency, urgency, cloudy urine

Genitourinary pain

  • Severe (perineal, pelvic, with defecation)
  • Moderate, diffuse (lower abdomen, perineum, scrotum, or penis)

Prostate

  • Tender, boggy, swollen
  • Often normal
  • May be enlarged and tender
  • Usually normal
  • May be slightly tender

References:[2][8][9][10][11][12][13]

Diagnostics

Clinically suspected bacterial prostatitis is confirmed by detection of bacteria in urinalysis and culture. Chronic pelvic pain syndrome is a diagnosis of exclusion.

Laboratory tests

Further diagnostics

References:[3][9][14][15][16][13][17][18]

Treatment

Bacterial prostatitis

Chronic pelvic pain syndrome

References:[3][8][9][14][13][19]

Complications

References:[13]

We list the most important complications. The selection is not exhaustive.

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last updated 09/28/2018
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