Prostatitis Category II: Chronic bacterial prostatitis

Jump to navigation Jump to search
Urinary Tract Infections Main Page

Prostatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Prostatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

CT scan

Echocardiography and Ultrasound

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Prostatitis Category II: Chronic bacterial prostatitis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Prostatitis Category II: Chronic bacterial prostatitis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Prostatitis Category II: Chronic bacterial prostatitis

CDC on Prostatitis Category II: Chronic bacterial prostatitis

Prostatitis Category II: Chronic bacterial prostatitis in the news

Blogs on Prostatitis Category II: Chronic bacterial prostatitis

Directions to Hospitals Treating Prostatitis

Risk calculators and risk factors for Prostatitis Category II: Chronic bacterial prostatitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Category II: Chronic Bacterial Prostatitis

Signs and Symptoms

Chronic bacterial prostatitis is a relatively rare condition (<5% of patients with prostate-related non-BPH LUTS) that usually presents with an intermittent UTI-type picture and that is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Dr. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were E-coli."[1] Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.[2]

Main symptoms of chronic prostitis:

Diagnosis

In chronic bacterial prostatitis there are bacteria in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. Prostate specific antigen levels may be elevated, although there is no malignancy.

Treatment

Chronic Prostatitis
Preferred Regimen
Ciprofloxacin 500 mg po bid x 4 weeks
OR
Levofloxacin 750 mg po q24h x 4 weeks
Alternative Regimen
TMP-SMX DS 1 tab PO bid x 1–3 months

Treatment requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well (β-lactams and nitrofurantoin are ineffective). These include quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may be helped in 80% of patients by the use of alpha blockers (tamsulosin (Flomax), alfuzosin), or long term low dose antibiotic therapy.[3] Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.

The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial.[4][5] It is though not without some risk,[6][7] and in more recent trials, was not shown to improve outcome compared to antibiotics alone.[8]

Prognosis

Over time, the relapse rate is high, exceeding 50%. A 2007 study showed that repeated courses of combination antibiotics may eradicate infection in 83.9% of patents with clinical remission extending throughout a follow-up period of 30 months for 94% of these patients.[9]

References

  1. Schneider, H., Ludwig, M., Hossain, H. M., Diemer, T. & Weidner, W. (2003). "The 2001 Giessen Cohort Study on patients with prostatitis syndrome – an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis". Andrologia. 35 (5): 258-262.
  2. Habermacher GM, Chason JT, Schaeffer AJ. (2006). "Prostatitis/chronic pelvic pain syndrome". Annu Rev Med. 57: 195-206.
  3. Shoskes D, Hakim L, Ghoniem G, Jackson C (2003). "Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome". J Urol. 169 (4): 1406–10. PMID 12629373.
  4. Nickel J, Downey J, Feliciano A, Hennenfent B (1999). "Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience". Tech Urol. 5 (3): 146–51. PMID 10527258.
  5. "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer Prostatic Dis. 2 (3): 159–162. 1999. PMID 12496826.
  6. Buse S, Warzinek T, Hobi C, Ackerman D. (2003). "Prostate massage with unwanted consequences. Case report". Urologe A. 42 (1): 78-79.
  7. Sengoku A, Yamashita M, Umezu K (1990). "[A case of Fournier's gangrene: was it triggered by prostatic massage?]". Hinyokika Kiyo. 36 (9): 1097–100. PMID 2239620.
  8. Ateya A, Fayez A, Hani R, Zohdy W, Gabbar M, Shamloul R (2006). "Evaluation of prostatic massage in treatment of chronic prostatitis". Urology. 67 (4): 674–8. PMID 16566972.
  9. Magri V; et al. (2007 May). &dopt=citation "Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis" Check |url= value (help). Int J Antimicrob Agents. 29 (5): 549-556. Check date values in: |year= (help)

Template:WH Template:WS