Prostatitis

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Clinical-manifestations 6 Laboratory 7 Differential-diagnosis 8 Management 9 More General Terms 10 Additional Terms 11 References

Introduction

• Inflammation/infection of the prostate gland. A common cause of urinary tract infection ( UTI) in men.

Etiology

• mechanisms

• ascending urethral infection
• reflux of infected urine
• contiguous spread from rectum
• hematogenous spread

• etiologic agents

• gram-negative bacilli ( Escherichia coli)
• Enterococci
• Chlamydia
• Ureaplasma

• idiopathic (chronic prostatitis/pelvic pain syndrome) [4]

Epidemiology

• acute prostatitis is uncommon
• chronic prostatitis is more common

Pathology

• repeated urinary tract infections caused by the same pathogen
• antimicrobial agents diffuse poorly into the prostate
• pain does not correlated with histological inflammation [5]
• some evidence for neuropathic pain [7]

Clinical-manifestations

• constitutional:

• fever/ chills, malaise, myalgias (acute)
• low-grade fever (chronic)

• urogenital:

• oliguria, dysuria, nocturia, hesitancy, dribbling
• prostate tenderness, enlargement, bogginess on rectal exam
• bladder distention ( suprapubic pressure)
• peritoneal & back pain (acute)
• rectal pressure
• sexual dysfunction

Laboratory

• urinalysis
• expressed prostatic secretions

• microscopy
• culture

• urine culture
• blood culture
• prostate-specific antigen (PSA) may be elevated
• cystoscopy
• prostate biopsy

Differential-diagnosis

• benign prostatic hypertrophy
• prostatic carcinoma
• urethral stricture
• bladder cancer
• neurogenic bladder
• interstitial cystitis

Management

• antibiotic therapy

• IV therapy, hospitalized patients with acute prostatitis

• ampicillin plus aminoglycoside
• cephalosporin plus aminoglycoside

• oral therapy for 3-4 weeks [1] (4 weeks [2])

• Bactrim DS BID
• ampicillin 500 mg QID
• tetracycline 500 mg QID
• doxycycline 100 mg BID
• carbenicillin 1 g QID
• ciprofloxacin 500 mg BID

• treat benign prostatic hyperplasia [6]
• patient education

• discontinue over-the-counter decongestants
• sitz baths may help difficulty voiding

• diet

• avoid spicy foods if they cause exacerbation of symptoms
• avoid caffeine

• activity: no restrictions
• follow-up

• acute prostatitis: re-evaluation 48-72 hours
• chronic prostatitis:

• within 2-3 weeks & 1 month after completion of antibiotics
• pharmacotherapy not helpful [4]

• referral to urologist if indicated

More General Terms

• prostatic disease
• infection (infectious disease)

Additional Terms

• prostadynia (prostatosis)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 554-55
2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
3. Roberts & Leiber 49:809, 1997
4. Journal Watch 24(23):173, 2004 Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP, Pontari MA, McNaughton-Collins M, Shoskes DA, Comiter CV, Datta NS, Fowler JE Jr, Nadler RB, Zeitlin SI, Knauss JS, Wang Y, Kusek JW, Nyberg LM Jr, Litwin MS; Chronic Prostatitis Collaborative Research Network. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med. 2004 Oct 19;141(8):581-9. PMID: [1]
5. Nickel JC et al, Examination of the relationship between symptoms of prostatitis and histological inflammation: Basline data from the REDUCE chemoprevention trial. J Urol 2007, 178:896 PMID: [2]
6. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
7. Pontari MA et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: A randomized controlled trial. Arch Intern Med 2010 Sep 27; 170:1586. PMID: &dopt=Abstract
8. Prostatitis: Disorders of the Prostate [3]
   - Chronic Prostatitis Workshop [4]
9. National Guideline Clearinghouse United Kingdom national guideline for the management of prostatitis British Association for Sexual Health and HIV ngc-guideline: [5]
   - Prostatitis and chronic pelvic pain syndrome. In: Guidelines on the management of urinary and male genital tract infections. European Association of Urology ngc-guideline: [6]

prostatitis