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Prostate :  Prostatitis

  1. Acute bacterial prostatitis,                            
  2. Chronic bacterial prostatitis,                                                                          
  3. Nonbacterial prostatitis,                                                
  4. Prostatodynia
  1. Acute Bacterial Prostatis (ABP):
    1. Characterized by; Fever, chills, low back and perineal pain, Myalgia and varying degree of irritative and bladder outlet obstruction features.
    2. Rectal examination reveals hot and tender prostate.
    3. Caused by E. Coli (commonest), Proteus, Klebsiella, Enterobactor, Pseudomonas, Serratia and other less common gr.-ve organism. (Most inf. Is caused by single pathogen)
    4. 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
    5. 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.  
  2. Chronic Bacterial Prostatitis (CBP):
    1. 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.
    2.  Hallmark of CBP is recurrent UTI, caused by same pathogen. Prostatic exprassates show excessive WBC and fat laden macrophages and fewer bacteria.
    3. Treatment is mainly medical: Antibiotic therapy, Septran (for 4 to 16 weeks), Carbenicillin, erythromycin, minocyclin, Doxycyclin and cephalexin.
    4. Fluoroqunolone: ciprofloxacin, norfloxacin and ofloxacin are also effective. Those who do not respond to medical therapy are candidate for surgical therapy (TURP).
  3. Nonbacterial Prostatitis
    (Abacterial prostatitis, Prostatosis):
    1. 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.
    2. In NBP culture is negative despite the presence of excessive leukocytes and macrophages.
    3. Exact causative organism is not known but Staphylococcus epidermidis, Ureaplasma urealyticum, Mycoplasma and Chlamydia tracomatis are probable pathigen.
    4. As the causative organism is not known, when culture is negative an empirical trial of tetracycline, erythromycin, minocyclin or doxycyclin is given.
  4. Prostatodynia (PD):
    1. Patient with PD has symptoms of prostatitis but, no H/O UTI, culture is negative and typically normal Prostatic secretion.
    2. A typical patient of prostatodynia is young or middle aged with variable sign and symptom of urinary flow, irritative voiding and pain. 
    3. 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).
    4. 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
ABP + + + + Coliform + +
CBP + + + + Coliform + +
NBP - + + - None
+ +
Prostatodynia - - - - None - +

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