- Clinical science
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.
- Very common urologic diagnosis in men < 50 years of age
- In men, there is an ∼ 8% lifetime risk of developing prostatitis.
- 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
Epidemiological data refers to the US, unless otherwise specified.
- Bacterial prostatitis:
- Chronic pelvic pain syndrome (CPPS): no detectable causative organism (the exact etiology remains unknown)
Risk factors for bacterial prostatitis
- Other genitourinary tract infections (e.g., urethritis, cystitis, epididymitis)
- Genitourinary tract interventions (e.g., indwelling catheter, transurethral surgery, prostate biopsy)
- Voiding dysfunction and bladder outlet obstruction
|Acute bacterial prostatitis||Chronic bacterial prostatitis||Chronic pelvic pain syndrome|
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Genitourinary tract symptoms
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- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Urethral swab and culture
- Uroflowmetry or cystoscopy
- First-line treatment: fluoroquinolones (e.g., ciprofloxacin) or trimethoprim-sulfamethoxazole; PO for 6 weeks 
- Suprapubic catheterization in cases of acute urinary retention and persistent fever
- Medical therapy
- Psychological support and treatment
- Prostatic abscess
- Acute urinary retention
- Pyelonephritis and sepsis
We list the most important complications. The selection is not exhaustive.