Prostatitis

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Introduction

An inflammation of the prostate or pain in the prostate, similar to that caused by an inflammation.

Classified into:

  • Acute bacterial prostatitis
  • Chronic bacterial prostatitis
  • Chronic non-bacterial prostatitis
  • Prostatodynia

Risk factors:

  • Ductile reflux
  • Urinary tract infection
  • Indwelling urethral catheterization
  • Penetrating anal sex
  • Sexually transmitted infections

Classification

Acute bacterial prostatitis

  • Results from direct spread of ascending urethral infection or reflux of infected urine into the prostatic ducts. E. coli is the main causative organism. Others are Klebsiella, Pseudomonas, Streptococcus faecalis and Staph aureus

Chronic bacterial prostatitis

  • Caused by E. coli, Klebsiella, Mycoplasma and Chlamydia

Non-bacterial prostatitis

  • An inflammation of indeterminate cause

Clinical features

Acute prostatitis

Systemic features:

  • Fever
  • Chills
  • Malaise
  • Nausea

Local features:

  • Dysuria
  • Frequency
  • Haematuria
  • Urethral discharge

Rectal examination:

  • Hot boggy, swollen and very tender prostate

Chronic prostatitis

  • Voiding symptoms: dysuria, frequency, urgency, haematuria
  • Poor stream
  • Urethral discharge
  • Low back pain
  • Perineal pain
  • Haemospermia
  • Painful ejaculation
  • Rectal examination: enlarged, tender, firm prostate

Differential diagnoses

  • Benign prostatic hypertrophy
  • Cystitis
  • Urethral stricture
  • Prostate cancer

Complications

  • Prostatic abscess
  • Prostatic calculi
  • Infertility
  • Septicaemia

Investigations

  • FBC and ESR
  • Urinalysis
  • Urine microscopy, culture and sensitivity
  • Prostatic massage: microscopy, culture and sensitivity (chronic prostatitis only)
  • Trans-rectal ultrasound
  • Biopsy: culture and histology
  • Urethrocystoscopy (chronic prostatitis only)

Treatment goals

  • To eradicate causative organisms
  • Control pain

Drug treatment

Antibiotics (based on local sensitivity)

Ciprofloxacin 500 mg orally every 12 hours for 28 days

Or:

Cotrimoxazole 960 mg orally every 12 hours for 28 days

Anti-inflammatory drugs

Non-steroidal e.g. diclofenac, ibuprofen etc

Steroids e.g. prednisolone, dexamethasone

Alpha blockers e.g. prazosin,

Hormonal therapy e.g. finasteride,

Non-drug treatment

  • Prostatic massage (chronic prostatitis only)
  • Physiotherapy
  • Sitz baths