Prostatitis overview: Difference between revisions
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==Overview== | ==Overview== | ||
Prostatitis is an [[inflammation]] of the [[prostate]] gland. Because women do not have a prostate gland, this condition occurs in males only. 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.<ref name="pmid10422990">{{cite journal| author=Krieger JN, Nyberg L, Nickel JC| title=NIH consensus definition and classification of prostatitis. | journal=JAMA | year= 1999 | volume= 282 | issue= 3 | pages= 236-7 | pmid=10422990 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10422990 }} </ref> On microscopic histopathologic analysis, prostatitis may be characterized by either [[neutrophils]] or [[lymphocytes]] within the glands, between the epithelial cells or within the stroma.<ref name=lll>Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Acute_inflammation_of_the_prostate_gland. Accessed on March 2, 2016</ref><ref name=lbl>Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Chronic_inflammation_not_otherwise_specified. Accessed on March 2, 2016</ref> Aerobic gram-negative bacilli are the most common cause of bacterial prostatitis, with ''[[Escherichia coli]]'' accounting for 50-80% of cases.<ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref> The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown.<ref name=nid>Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/ | Prostatitis is an [[inflammation]] of the [[prostate]] gland. Because women do not have a prostate gland, this condition occurs in males only. 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.<ref name="pmid10422990">{{cite journal| author=Krieger JN, Nyberg L, Nickel JC| title=NIH consensus definition and classification of prostatitis. | journal=JAMA | year= 1999 | volume= 282 | issue= 3 | pages= 236-7 | pmid=10422990 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10422990 }} </ref> On microscopic histopathologic analysis, prostatitis may be characterized by either [[neutrophils]] or [[lymphocytes]] within the glands, between the epithelial cells or within the stroma.<ref name=lll>Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Acute_inflammation_of_the_prostate_gland. Accessed on March 2, 2016</ref><ref name=lbl>Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Chronic_inflammation_not_otherwise_specified. Accessed on March 2, 2016</ref> Aerobic gram-negative bacilli are the most common cause of bacterial prostatitis, with ''[[Escherichia coli]]'' accounting for 50-80% of cases.<ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref> The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown.<ref name=nid>Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostate-problems/Pages/facts.aspx. Accessed on February 25, 2016</ref> 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]].<ref name="pmid20704171">{{cite journal| author=Sharp VJ, Takacs EB, Powell CR| title=Prostatitis: diagnosis and treatment. | journal=Am Fam Physician | year= 2010 | volume= 82 | issue= 4 | pages= 397-406 | pmid=20704171 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20704171 }} </ref> Common risk factors in the development of prostatitis include recurrent [[urinary tract infection]]s, benign prostatic hyperplasia, [[urethral stricture]]s, bladder neck hypertrophy, [[prostatic carcinoma]], and previous instrumentation or catheterization. If left untreated, patients with acute bacterial prostatitis may progress to develop prostatic abscess, [[septicemia]], urosepsis, and urinary retention.<ref name="pmid22031609">{{cite journal| author=Nickel JC| title=Prostatitis. | journal=Can Urol Assoc J | year= 2011 | volume= 5 | issue= 5 | pages= 306-15 | pmid=22031609 | doi=10.5489/cuaj.11211 | pmc=PMC3202001 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22031609 }} </ref><ref name="pmid10933636">{{cite journal| author=Naber KG, Weidner W| title=Chronic prostatitis-an infectious disease? | journal=J Antimicrob Chemother | year= 2000 | volume= 46 | issue= 2 | pages= 157-61 | pmid=10933636 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10933636 }} </ref> Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, [[infertility]], urinary frequency and urgency, and recurrent [[urinary tract infection]]s.<ref name="pmid10933636">{{cite journal| author=Naber KG, Weidner W| title=Chronic prostatitis-an infectious disease? | journal=J Antimicrob Chemother | year= 2000 | volume= 46 | issue= 2 | pages= 157-61 | pmid=10933636 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10933636 }} </ref><ref name="pmid17050893">{{cite journal| author=Schaeffer AJ| title=Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 16 | pages= 1690-8 | pmid=17050893 | doi=10.1056/NEJMcp060423 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17050893 }} </ref> Full recovery without sequelae is usual among patients with acute prostatitis.<ref name=abc>Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis. Accessed on March 1, 2016</ref> Patients with chronic prostatitis have a gradual recovery and relapse is common.<ref name=nnn>Prostatitis. NHS 2016.http://www.nhs.uk/Conditions/Prostatitis/Pages/Introduction.aspx. Accessed on March 1, 2016</ref> 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]].<ref name=nid>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. Accessed on March 2, 2016</ref> Laboratory findings consistent with the diagnosis of acute prostatitis include increased [[leukocytes]] on CBC, bacteria seen on [[urine culture]], elevated [[C-reactive protein]], and transiently elevated [[PSA]] (prostate specific antigen) levels.<ref name=www> Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis. Accessed on March 7, 2016</ref> Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include negative pre-massage [[urine culture]] results, more than 10 to 20 [[leukocytes]] per high-power field in both the pre- and the postmassage urine specimen, [[bacteriuria]] in the postmassage urine specimen, and lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions.<ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref><ref name="pmid10839552">{{cite journal| author=Stevermer JJ, Easley SK| title=Treatment of prostatitis. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 10 | pages= 3015-22, 3025-6 | pmid=10839552 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10839552 }} </ref> The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.<ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref> | ||
Antimicrobial therapy is indicated for acute and chronic prostatitis. | Antimicrobial therapy is indicated for acute and chronic prostatitis. | ||
Revision as of 20:39, 7 March 2016
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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 gland. Because women do not have a prostate gland, this condition occurs in males only. 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] On microscopic histopathologic analysis, prostatitis may be characterized by either neutrophils or lymphocytes within the glands, between the epithelial cells or within the stroma.[2][3] Aerobic gram-negative bacilli are the most common cause of bacterial prostatitis, with Escherichia coli accounting for 50-80% of cases.[4] The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown.[5] 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.[6] 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. If left untreated, patients with acute bacterial prostatitis may progress to develop prostatic abscess, septicemia, urosepsis, and urinary retention.[7][8] Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, infertility, urinary frequency and urgency, and recurrent urinary tract infections.[8][9] Full recovery without sequelae is usual among patients with acute prostatitis.[10] Patients with chronic prostatitis have a gradual recovery and relapse is common.[11] 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.[5] Laboratory findings consistent with the diagnosis of acute prostatitis include increased leukocytes on CBC, bacteria seen on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels.[12] Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include negative pre-massage urine culture results, more than 10 to 20 leukocytes per high-power field in both the pre- and the postmassage urine specimen, bacteriuria in the postmassage urine specimen, and lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions.[4][13] The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.[4] Antimicrobial therapy is indicated for acute and chronic prostatitis.
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.[13][6] 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.[12] On microscopic histopathologic analysis, prostatitis may be characterized by either neutrophils or lymphocytes within the glands, between the epithelial cells or within the stroma.[2][3]
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.[4] The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown.[5]
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.[6]
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
If left untreated, patients with acute bacterial prostatitis may progress to develop prostatic abscess, septicemia, urosepsis, and urinary retention.[7][8] Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, infertility, urinary frequency and urgency, and recurrent urinary tract infections.[8][9] Full recovery without sequelae is usual among patients with acute prostatitis.[10] Patients with chronic prostatitis have a gradual recovery and relapse is common.[11]
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.[4][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.[5]
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.[6][5] In acute prostatitis, palpation of the prostate reveals a tender and enlarged prostate.[13][6] In chronic prostatitis, palpation of the prostate reveals a tender and soft (boggy) prostate gland.[6] A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis.[10]
Laboratory Findings
Laboratory tests used in the diagnosis of prostatitis may include a CBC, urinalysis, serum PSA (prostate-specific antigen) level, urine culture, postvoid residual volume levels, 2-glass pre- and post-prostatic massage test, Stamey-Meares four-glass test, and a semen analysis.[5][6][4] Laboratory findings consistent with the diagnosis of acute prostatitis include increased leukocytes on CBC, bacteria seen on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels.[12] Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include negative pre-massage urine culture results, more than 10 to 20 leukocytes per high-power field in both the pre- and the postmassage urine specimen, bacteriuria in the postmassage urine specimen, and lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions.[4][13] The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.[4]
Imaging Findings
Findings of prostatitis on CT include a diffusely enlarged, edematous gland with predilection for peripheral zone involvement. When an abscess is present it is seen as a rim-enhancing, unilocular or multilocular, hypodensity in the peripheral zone. On ultrasound, prostatitis is characterized by a focal hypoechoic region in the peripheral zone of the gland. Discrete fluid collection suggests abscess formation. Colour Doppler ultrasound demonstrates increase flow in the periphery of the abscess. On MRI, the prostate will be diffusely enlarged, often with associated inflammatory changes of periprostatic fat and of the seminal vesicles.[15]
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
- ↑ 1.0 1.1 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 Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Acute_inflammation_of_the_prostate_gland. Accessed on March 2, 2016
- ↑ 3.0 3.1 Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Chronic_inflammation_not_otherwise_specified. Accessed on March 2, 2016
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Lipsky BA, Byren I, Hoey CT (2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostate-problems/Pages/facts.aspx. Accessed on February 25, 2016
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
- ↑ 7.0 7.1 Nickel JC (2011). "Prostatitis". Can Urol Assoc J. 5 (5): 306–15. doi:10.5489/cuaj.11211. PMC 3202001. PMID 22031609.
- ↑ 8.0 8.1 8.2 8.3 Naber KG, Weidner W (2000). "Chronic prostatitis-an infectious disease?". J Antimicrob Chemother. 46 (2): 157–61. PMID 10933636.
- ↑ 9.0 9.1 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.
- ↑ 10.0 10.1 10.2 Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis. Accessed on March 1, 2016
- ↑ 11.0 11.1 Prostatitis. NHS 2016.http://www.nhs.uk/Conditions/Prostatitis/Pages/Introduction.aspx. Accessed on March 1, 2016
- ↑ 12.0 12.1 12.2 Acute Prostatitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Acute_prostatitis. Accessed on March 7, 2016
- ↑ 13.0 13.1 13.2 13.3 Stevermer JJ, Easley SK (2000). "Treatment of prostatitis". Am Fam Physician. 61 (10): 3015–22, 3025–6. PMID 10839552.
- ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
- ↑ Prostatitis. Radiopaedia 2016. http://radiopaedia.org/articles/prostatitis. Accessed on March 7, 2016