Prostate : Prostatitis
- Acute bacterial prostatitis,
- Chronic bacterial prostatitis,
- Nonbacterial prostatitis,
- Acute Bacterial Prostatis (ABP):
- Characterized by; Fever, chills, low back and perineal pain, Myalgia and varying degree of irritative and bladder outlet obstruction features.
- Rectal examination reveals hot and tender prostate.
- Caused by E. Coli (commonest), Proteus, Klebsiella, Enterobactor, Pseudomonas, Serratia and other less common gr.-ve organism. (Most inf. Is caused by single pathogen)
- Treatment: Antibiotics and symptomatic (analgesics) treatment.Septran (TMP-SMX): Should be given for 30 days to prevent CBP, Ciprofloxacin, Norfloxacin, Ofloxacin or ampicillin with gentamicin (IV). Urethral instrumentation should be avoided in acute phase. Q
- PROSTATIC ABSCESS: Coliform (mainly E. coli) is the main causative organism (>70%). Presentation is like acute prostatitis, which fails to respond to antibiotics, (commonest presenting symptom is acute urinary retention and fever > 35%). On PR examination prostate is tender with an area of fluctuation. Main diagnostic tools are TRUS and CT scan. Treatment is: drainage under antibiotic cover. Drainage is done by transurethral route, percutaneous aspiration, or perineal incision.
- Chronic Bacterial Prostatitis (CBP):
- It may evolve from ABP, but many men with CPB have no prior history of ABP. It mainly presents with irritative voiding symptoms. Post ejaculatory pain or hemospermia may be found.
- Hallmark of CBP is recurrent UTI, caused by same pathogen. Prostatic exprassates show excessive WBC and fat laden macrophages and fewer bacteria.
- Treatment is mainly medical: Antibiotic therapy, Septran (for 4 to 16 weeks), Carbenicillin, erythromycin, minocyclin, Doxycyclin and cephalexin.
- Fluoroqunolone: ciprofloxacin, norfloxacin and ofloxacin are also effective. Those who do not respond to medical therapy are candidate for surgical therapy (TURP).
- Nonbacterial Prostatitis
(Abacterial prostatitis, Prostatosis):
- It is an inflammatory condition of unknown cause. Usually presents with irritative voiding symptom and pain / discomfort in pelvis, suprapubic region genitals, perineal or postejaculatory.
- In NBP culture is negative despite the presence of excessive leukocytes and macrophages.
- Exact causative organism is not known but Staphylococcus epidermidis, Ureaplasma urealyticum, Mycoplasma and Chlamydia tracomatis are probable pathigen.
- As the causative organism is not known, when culture is negative an empirical trial of tetracycline, erythromycin, minocyclin or doxycyclin is given.
- Prostatodynia (PD):
- Patient with PD has symptoms of prostatitis but, no H/O UTI, culture is negative and typically normal Prostatic secretion.
- A typical patient of prostatodynia is young or middle aged with variable sign and symptom of urinary flow, irritative voiding and pain.
- It is diagnosed by normal urine findings, normal EPS, sterile culture but abnormal urodynamic study (Decreased UFR, decreased relaxation of the sphincter, increased urethral pressure).
- Treatment includes: Sitz bath, alpha-1 blockers, sedative and analgesics.
|Syndrome||H/O UTI||PR: prost abnormal||EPS: WBC excessive||EPS: +ve culture||Common causative agent||Antibiotic response||Urinary flow rate|