Prostatitis

Alok Anand MD

The Common Vein Copyright 2010

Definition

Prostatitis is a common condition, characterized by inflammation and infection of the prostate gland.

 There are 4 groupings:

    1. Acute Bacterial

   2. Chronic Bacterial

   3. Chronic non-bacterial also called male chronic pelvic pain syndrome.

   4. Leukocytic prostatitis

 Functionally, this is often a result of obstruction and stasis of prostatic secretions or urine.

Clincally, protatitis manifests with swelling and edema.  Further progression ot abscess results in encapsulated complex purulent collections, often with septations.  The most common symptoms of prostatitis are pain or irritation with urination, often with fever and chills.  Pain may also extend to the back and perineum.  Diagnosis can be made from urine culture.  Often, cultures are performed on expressed prostatic secretions, or voided specimen after prostatic massage.  Biospy should not be performed due to a risk of sepsis.

 Structurally there is increased blood flow (hyperemia) and capillary permeability that results in swelling of the gland.  Evaluation is usually by digital rectal examination.  The prostate will be boggy and tender.

Functionally, the main result is pain, although in the setting of sever inflammation and edema, obstructive and dysuric symptoms may occur.

Imaging is not routinely used for diagnosis, although ultrasound and MR may demonstate early changes.  Late changes associated with infectious prostatitis may also manifest on contrast-enhanced multidetector CT.

Treatment varies depending upon etiology, although most infections are treated with antibiotics, along with non-steroidal anti-inflammatory agents (NSAIDs).

The most common causative organisms involved are E. coli (80%), Pseudomonas, Serratia, Klebsiella, or enterococci.  Neisseria Gonococci, a common cause in the pre-antibiotic era is now less common.  Non-bacterial prostatitis is poorly understood with any number of possible causes.

 Chronic non-bacterial prostatitis comprises about 95% of prostatitis diagnoses.  Many treatments have been attempted, including alpha blockers, phytotherapy, physical therapy, psychotherapy, antihistamines, anxiolytics, nerve modulators, surgery , and more.