Prostatitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
Overview
Prostatitis is an inflammation of the prostate. Because women do not have a prostate gland, it is a condition found only in men, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate, and may cause symptoms. The term prostatitis refers, in its strictest sense, to histological (microscopic) inflammation of the tissue of the prostate gland. Like all forms of inflammation, it can be associated with an appropriate response of the body to an infection, but it also occurs in the absence of an infection.
Classification
According to the International Prostatitis Collaboration Network, prostatitis may be classified into 5 subtypes based on the duration of symptoms and evidence of bacterial infection / inflammation into either acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory chronic prostatitis/chronic pelvic pain syndrome, non-inflammatory chronic prostatitis/chronic pelvic pain syndrome, or asymptomatic inflammatory prostatitis.[1]
Pathophysiology
The exact pathogenesis of bacterial prostatitis is not yet fully understood. Two possible theories include ascending urethral infection and the reflux of urine via the ejaculatory and prostatic ducts.[2][3] The pathogenesis of chronic prostatitis/chronic pelvic pain syndrome includes stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone (endocrine) abnormalities, neurogenic inflammation, and myofascial pain syndrome.[4] On microscopic histopathologic analysis, prostatitis may be characterized by either neutrophils or lymphocytes within the glands, between the epithelial cells or within the stroma.[5][6]
Causes
Prostatitis may be caused by bacteria. Aerobic gram-negative bacilli are the most common cause of bacterial prostatitis, with Escherichia coli accounting for 50-80% of cases.[7] The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown.[8]
Differential Diagnosis
Prostatitis must be differentiated from acute cystitis, benign prostatic hyperplasia, prostatic abscess, bladder cancer, urinary tract stones, and a foreign body within the urinary tract.[3]
Epidemiology and demographics
Risk Factors
Common risk factors in the development of prostatitis include recurrent urinary tract infections, benign prostatic hyperplasia, urethral strictures, bladder neck hypertrophy, prostatic carcinoma, and previous instrumentation or catheterization.
Natural History, Complications, and Prognosis
f left untreated, patients with acute bacterial prostatitis may progress to develop prostatic abscess, septicemia, urosepsis, and urinary retention.[9][10] Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, infertility, urinary frequency and urgency, and recurrent urinary tract infections.[10][11] Full recovery without sequelae is usual among patients with acute prostatitis.[12] Patients with chronic prostatitis have a gradual recovery and relapse is common.[13]
Diagnosis
History and Symptoms
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include previous history of sexually transmitted diseases, any new sexual partners, urogenital disorders, and recent catheterization or other genitourinary instrumentation.[7][14] Common symptoms of acute and chronic bacterial prostatitis include urinary frequency, urinary urgency, burning during urination, nocturia, urinary retention and pain in the genital area, groin, lower abdomen, or lower back. Symptoms of acute prostatitis also include fever, nausea, and vomiting.[8]
Physical Examination
Patients with chronic prostatitis are usually well-appearing. Patients with acute prostatitis may appear ill and have systemic symptoms such as fever, chills, and nausea.[3][8] In acute prostatitis, palpation of the prostate reveals a tender and enlarged prostate.[2][3] In chronic prostatitis, palpation of the prostate reveals a tender and soft (boggy) prostate gland.[3] A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis.[15]
Laboratory Findings
Treatment
Medical Therapy
Antimicrobial therapy is indicated for acute and chronic prostatitis. Patients are generally treated in an outpatient setting unless severe disease (e.g. bacteremia) is suspected. Empirical therapy for both acute and chronic prostatitis includes monotherapy with either ciprofloxacin, levofloxacin, or TMP-SMX for at least 6 weeks. When culture results are obtained, antimicrobial therapy may be narrowed down to cover the causative pathogen more adequately. Addition of alpha blocker may be considered for the symptomatic management of bacterial prostatitis. Inflammatory prostatitis may be treated with NSAIDs, allopurinol, or cernilton.
References
- ↑ Krieger JN, Nyberg L, Nickel JC (1999). "NIH consensus definition and classification of prostatitis". JAMA. 282 (3): 236–7. PMID 10422990.
- ↑ 2.0 2.1 Stevermer JJ, Easley SK (2000). "Treatment of prostatitis". Am Fam Physician. 61 (10): 3015–22, 3025–6. PMID 10839552.
- ↑ 3.0 3.1 3.2 3.3 3.4 Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
- ↑ Chronic prostatitis/chronic pelvic pain syndrome. Wikipedia 2016. https://en.wikipedia.org/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome. Accessed on March 2, 2016
- ↑ Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Acute_inflammation_of_the_prostate_gland. Accessed on March 2, 2016
- ↑ Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Chronic_inflammation_not_otherwise_specified. Accessed on March 2, 2016
- ↑ 7.0 7.1 Lipsky BA, Byren I, Hoey CT (2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
- ↑ 8.0 8.1 8.2 Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostatitis-disorders-of-the-prostate/Pages/facts.aspx#sec3. Accessed on February 25, 2016
- ↑ Nickel JC (2011). "Prostatitis". Can Urol Assoc J. 5 (5): 306–15. doi:10.5489/cuaj.11211. PMC 3202001. PMID 22031609.
- ↑ 10.0 10.1 Naber KG, Weidner W (2000). "Chronic prostatitis-an infectious disease?". J Antimicrob Chemother. 46 (2): 157–61. PMID 10933636.
- ↑ Schaeffer AJ (2006). "Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome". N Engl J Med. 355 (16): 1690–8. doi:10.1056/NEJMcp060423. PMID 17050893.
- ↑ Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis#Prognosis. Accessed on March 1, 2016
- ↑ Prostatitis. NHS 2016.http://www.nhs.uk/Conditions/Prostatitis/Pages/Introduction.aspx. Accessed on March 1, 2016
- ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
- ↑ Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis. Accessed on March 4, 2016