Prostatitis overview: Difference between revisions
Jump to navigation
Jump to search
Usama Talib (talk | contribs) No edit summary |
m (Bot: Removing from Primary care) |
||
| (46 intermediate revisions by 6 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Prostatitis}} | {{Prostatitis}} | ||
{{CMG}} {{AE}} {{Maliha}} | |||
{{CMG}} {{AE}} {{Maliha}}, {{USAMA}} | |||
==Overview== | ==Overview== | ||
Prostatitis is an [[inflammation]] of the [[prostate]] gland. | Prostatitis is an [[inflammation]] of the [[prostate]] gland. Prostatitis has been classified by International Prostatitis Collaboration Network, into 5 subtypes. This classification is on the basis of timing of the symptoms and the presence of bacterial pathogens and other markers of infection and inflammation. The categories include acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory chronic prostatitis/chronic pelvic pain syndrome, non-inflammatory chronic prostatitis/chronic pelvic pain syndrome, and 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> By the help of microscopic histopathological studies, [[neutrophils]] or [[lymphocytes]] can be seen inside the glands, between the cells of epithelium or inside the stromal component.<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> The most common bacteria causing prostatitis are aerobic gram-negative bacilli, ''[[Escherichia coli]]'' is responsible for 50-80% incidents of bacterial 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> Though a single definitive cause has not been established, different theories exist about chronic prostatitis/chronic pelvic pain syndrome pathogenesis including chemical damage owing to [[reflux]] or [[autoimmune]] process.<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 various causes of dysuria including [[pyelonephritis]], [[cystitis]], [[urethritis]], [[benign prostatic hyperplasia]], prostatic [[abscess]], [[bladder cancer]], [[Urinary stones|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> Recurrent [[urinary tract infection]]s, [[benign prostatic hyperplasia]], [[urethral stricture]]s, bladder neck [[hypertrophy]], [[prostatic carcinoma]], and [[catheterization]] are risk factors for prostatitis. Acute prostatitis usually results in complete recovery without sequelae. If left untreated, patients with acute bacterial prostatitis may progress to develop chronic prostatitis, [[epididymitis]], prostatic [[abscess]], [[septicemia]], [[urosepsis]], [[urinary retention]] and metastasis of infection to [[spinal cord]] or [[sacroiliac joint]].<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><ref>{{Cite journal | ||
| author = [[M. B. Siroky]], [[R. Moylan]], [[G. Jr Austen]] & [[C. A. Olsson]] | | author = [[M. B. Siroky]], [[R. Moylan]], [[G. Jr Austen]] & [[C. A. Olsson]] | ||
| title = Metastatic infection secondary to genitourinary tract sepsis | | title = Metastatic infection secondary to genitourinary tract sepsis | ||
| Line 14: | Line 15: | ||
| month = September | | month = September | ||
| pmid = 986763 | | pmid = 986763 | ||
}}</ref> Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, [[infertility]] 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> | }}</ref> Patients with untreated chronic prostatitis may develop [[chronic pelvic pain]], [[sexual dysfunction]], [[infertility]] 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> [[Frequency]], [[urgency]], [[dysuria|burning during urination]], [[nocturia]], [[urinary retention]] and pain in the genital area, groin, lower abdomen, or lower back may be the presenting features. Other features include [[fever]], [[nausea]], and [[vomiting]] in acute infection.<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 show an increase in the number of [[leukocytes]] on [[CBC]], bacteria on [[urine culture]], elevated [[C-reactive protein]], and transiently elevated [[PSA]] (prostate specific antigen) levels in case of bacterial prostatitis. While in chronic bacterial prostatitis negative pre-massage [[urine culture]] results, more than 10 to 20 [[leukocytes]] per high-power field in both the pre and the post massage 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 are seen.<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. | ||
==Historical Perspective== | ==Historical Perspective== | ||
In 350 BC, the anatomical positioning and existence of the prostate gland was explained by Herophilus. | In 350 BC, the anatomical positioning and existence of the prostate gland was explained by [[Herophilus]]. Prostatic incitement was recognised as a cause of prostatitis in 1800. In 1978 Drach et al. gave the basis of the current classification of prostatitis.<ref name="Textbook of Prostatitis">{{cite book |last=Nickel |first=J Curtis |date=1999 |title=Textbook of Prostatitis |location= Harvard Medical School |publisher=Isis Medical Media |page=3 |isbn=1901865045}}</ref> | ||
==Classification== | ==Classification== | ||
Prostatitis has been classified by International Prostatitis Collaboration Network, into 5 subtypes. This classification is done on the basis of timing of the symptoms and the presence of bacterial pathogens and other markets of infection and inflammation. The categories include:<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> | |||
*Acute bacterial prostatitis | *Acute bacterial prostatitis | ||
| Line 31: | Line 32: | ||
==Pathophysiology== | ==Pathophysiology== | ||
The | The pathogenesis of prostatitis is not completely understood. An infection ascending from the [[urethra]], chemical damage caused by the [[reflux]] of urine through the [[ejaculatory ducts]] and [[prostatic ducts]] and [[autoimmune]] involvement are a few possible theories related to the pathogenesis of various types of prostatitis.<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><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> Chronic prostatitis/chronic pelvic pain syndrome is thought to be caused by an abnormality in the hypothalamic-pituitary-adrenal axis and hormonal derangements involving the adrenocortical hormone. These changes can stem from variable response to [[stress]], neurogenic [[inflammation]], and myofascial pain syndrome. On microscopic examination, [[neutrophils]] or [[lymphocytes]] can be seen inside the [[prostatic gland]], among the cells of the [[epithelium]] or inside the stromal component of the gland.<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> | ||
==Causes== | ==Causes== | ||
The most common [[bacteria]] causing prostatitis are aerobic gram-negative bacilli, ''[[Escherichia coli]]'' is responsible for 50-80% incidents of bacterial 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>Though a single definitive cause has not been established, different theories exist about chronic prostatitis/chronic pelvic pain syndrome pathogenesis including chemical damage owing to [[reflux]] or [[autoimmune]] process.<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> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Prostatitis must be differentiated from various entities that include [[ | Prostatitis must be differentiated from various entities on the basis of [[dysuria]] that include [[cystitis]], [[pyelonephritis]], [[benign prostatic hyperplasia]], prostatic [[abscess]], [[bladder cancer]], [[Urinary stones|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> | ||
==Epidemiology and demographics== | ==Epidemiology and demographics== | ||
In men who are younger than 50 years of age, prostatitis is the most common problem related to the [[urinary tact]]. Prostatitis is the 3rd most common urinary diagnosis made in men aged more than 50 years. There are almost 2 million health care visits yearly, associated with prostatitis. Chronic prostatitis is the most commonly seen type of prostatitis.<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#sec3. Accessed on February 27, 2016</ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of prostatitis include recurrent [[urinary tract infection]]s | Common risk factors in the development of prostatitis include recurrent [[urinary tract infection]]s, [[urethral stricture]]s, hypertrophy of the neck of the bladder, [[prostatic carcinoma]], [[benign prostatic hyperplasia]],use of alcohol, [[smoking]] and history of [[foley catheterization]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
If left untreated, patients with acute bacterial prostatitis may progress to develop chronic prostatitis, prostatic abscess, [[septicemia]], urosepsis, urinary retention and metastasis of infection to spinal cord or sacroiliac joint.<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]], severe 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> | If left untreated, patients with acute bacterial prostatitis may progress to develop [[chronic prostatitis]], prostatic [[abscess]], [[septicemia]], urosepsis, [[urinary retention]] and [[metastasis]] of infection to [[spinal cord]] or [[sacroiliac joint]].<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]], severe 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> Complete recovery without sequelae is usual among patients with acute prostatitis. 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> | ||
== Screening == | |||
[[USPSTF|United States preventive task force]] ([[USPSTF]]) has no guidelines till date for the screening of prostatitis in men. | |||
==Diagnosis== | ==Diagnosis== | ||
=== Diagnostic Study of Choice === | |||
There is no [[Gold standard (test)|gold standard]] for the [[diagnosis]] and evaluation of patients presenting with prostatitis. The evaluation of a patient with acute and chronic bacterial prostatitis consists of [[History and Physical examination|history and physical examination]] and [[urine culture]] for lower urinary tract localization cultures, respectively. The evaluation of chronic pelvic pain syndrome includes tests which can be broadly divided into mandatory, recommended and optional. | |||
===History and Symptoms=== | ===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 disease]]s, any new sexual partners, urogenital disorders, and recent [[catheterization]] or other genitourinary instrumentation.<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=nlm>Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref> Common symptoms of acute and chronic bacterial prostatitis include [[urinary frequency]], [[urinary urgency]], [[Dysuria|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/prostate-problems/Pages/facts.aspx. Accessed on March 2, 2016</ref> | 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 disease]]s, any new sexual partners, known urogenital disorders, and recent [[catheterization]] or other genitourinary instrumentation.<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="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref> Common symptoms of acute and chronic bacterial prostatitis include [[urinary frequency]], [[urinary urgency]], [[Dysuria|burning during urination]], [[nocturia]], [[urinary retention]] and pain in the genital area, groin, lower abdomen, or lower back. Symptoms of acute prostatitis may 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/prostate-problems/Pages/facts.aspx. Accessed on March 2, 2016</ref> | ||
===Physical Examination=== | ===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]].<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><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 4, 2016</ref> In acute prostatitis, palpation of the prostate reveals a tender and enlarged [[prostate]].<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><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> | 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]].<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><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 4, 2016</ref> In acute prostatitis, palpation of the prostate reveals a tender and enlarged [[prostate]].<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><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> | ||
In chronic prostatitis, palpation of the prostate reveals a tender and soft (boggy) [[prostate gland]].<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> A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce [[sepsis]]. | In chronic prostatitis, palpation of the [[prostate]] reveals a tender and soft (boggy) [[prostate gland]].<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> A [[prostate massage]] should never be done in a patient with suspected acute prostatitis, since it may induce [[sepsis]]. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
The laboratory tests used in the diagnosis of prostatitis are [[CBC]], [[urinalysis]], serum [[PSA]] (prostate-specific antigen) levels, [[urine culture]], postvoid residual volume levels, 2-glass pre and post-prostatic massage test, Stamey-Meares four-glass test, and a [[semen analysis]].<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="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><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> Laboratory findings consistent with the diagnosis of acute prostatitis include increased [[leukocytes]] on [[complete blood picture]], [[bacteria]] seen on [[urine culture]], elevated [[C-reactive protein]], and transiently elevated [[PSA]] (prostate specific antigen) levels. 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 post massage 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> | |||
===Imaging Findings=== | ===Imaging Findings=== | ||
[[CT scan]] in a patient with prostatitis shows edema of the [[prostate gland]] with diffuse enlargement, mostly in the peripheral zone. An [[abscess]] may be seen as a rim enhancing hypodensity which can either have single or multiple loci. [[Ultrasound]] can be used to diagnose prostatitis. On [[ultrasonography]], focal hypoechoic area in the periphery of the [[prostate]] represents prostatitis. Fluid collection can show [[abscess]] formation. Colour [[doppler ultrasound]] may also prove to be very effective. [[MRI]] can also be used to diagnose prostatitis. Though it is not used commonly, its utilisation when suspecting alternate diagnosis like [[prostatic carcinoma]] etc is very important. [[MRI]] in case of a patient wit prostatitis depicts diffuse enlargement of the gland.<ref name="rrr">Prostatitis. Radiopaedia 2016. http://radiopaedia.org/articles/prostatitis. Accessed on Feb 09, 2017</ref><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><ref>{{Cite journal | |||
| author = [[Choon-Young Kim]], [[Sang-Woo Lee]], [[Seock Hwan Choi]], [[Seung Hyun Son]], [[Ji-Hoon Jung]], [[Chang-Hee Lee]], [[Shin Young Jeong]], [[Byeong-Cheol Ahn]] & [[Jaetae Lee]] | |||
| title = Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guerin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer | |||
| journal = [[Nuclear medicine and molecular imaging]] | |||
| volume = 50 | |||
| issue = 1 | |||
| pages = 31–37 | |||
| year = 2016 | |||
| month = March | |||
| doi = 10.1007/s13139-015-0364-y | |||
| pmid = 26941857 | |||
}}</ref> | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===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 [[NSAID]]s, [[allopurinol]], or cernilton. | 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 [[NSAID]]s, [[allopurinol]], or [[cernilton]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Andrology]] | [[Category:Andrology]] | ||
[[Category:Disease]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 23:51, 29 July 2020
|
Prostatitis Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Prostatitis overview On the Web |
|
American Roentgen Ray Society Images of Prostatitis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]
Overview
Prostatitis is an inflammation of the prostate gland. Prostatitis has been classified by International Prostatitis Collaboration Network, into 5 subtypes. This classification is on the basis of timing of the symptoms and the presence of bacterial pathogens and other markers of infection and inflammation. The categories include acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory chronic prostatitis/chronic pelvic pain syndrome, non-inflammatory chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis.[1] By the help of microscopic histopathological studies, neutrophils or lymphocytes can be seen inside the glands, between the cells of epithelium or inside the stromal component.[2][3] The most common bacteria causing prostatitis are aerobic gram-negative bacilli, Escherichia coli is responsible for 50-80% incidents of bacterial prostatitis.[4] Though a single definitive cause has not been established, different theories exist about chronic prostatitis/chronic pelvic pain syndrome pathogenesis including chemical damage owing to reflux or autoimmune process.[5] Prostatitis must be differentiated from various causes of dysuria including pyelonephritis, cystitis, urethritis, benign prostatic hyperplasia, prostatic abscess, bladder cancer, urinary tract stones, and a foreign body within the urinary tract.[6] Recurrent urinary tract infections, benign prostatic hyperplasia, urethral strictures, bladder neck hypertrophy, prostatic carcinoma, and catheterization are risk factors for prostatitis. Acute prostatitis usually results in complete recovery without sequelae. If left untreated, patients with acute bacterial prostatitis may progress to develop chronic prostatitis, epididymitis, prostatic abscess, septicemia, urosepsis, urinary retention and metastasis of infection to spinal cord or sacroiliac joint.[7][8][9] Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, infertility and recurrent urinary tract infections.[8][10] Frequency, urgency, burning during urination, nocturia, urinary retention and pain in the genital area, groin, lower abdomen, or lower back may be the presenting features. Other features include fever, nausea, and vomiting in acute infection.[5] Laboratory findings show an increase in the number of leukocytes on CBC, bacteria on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels in case of bacterial prostatitis. While in chronic bacterial prostatitis negative pre-massage urine culture results, more than 10 to 20 leukocytes per high-power field in both the pre and the post massage 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 are seen.[4][11] The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.[4] Antimicrobial therapy is indicated for acute and chronic prostatitis.
Historical Perspective
In 350 BC, the anatomical positioning and existence of the prostate gland was explained by Herophilus. Prostatic incitement was recognised as a cause of prostatitis in 1800. In 1978 Drach et al. gave the basis of the current classification of prostatitis.[12]
Classification
Prostatitis has been classified by International Prostatitis Collaboration Network, into 5 subtypes. This classification is done on the basis of timing of the symptoms and the presence of bacterial pathogens and other markets of infection and inflammation. The categories include:[1]
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory chronic prostatitis/chronic pelvic pain syndrome
- Non-inflammatory chronic prostatitis/chronic pelvic pain syndrome
- Asymptomatic inflammatory prostatitis.
Pathophysiology
The pathogenesis of prostatitis is not completely understood. An infection ascending from the urethra, chemical damage caused by the reflux of urine through the ejaculatory ducts and prostatic ducts and autoimmune involvement are a few possible theories related to the pathogenesis of various types of prostatitis.[6][11] Chronic prostatitis/chronic pelvic pain syndrome is thought to be caused by an abnormality in the hypothalamic-pituitary-adrenal axis and hormonal derangements involving the adrenocortical hormone. These changes can stem from variable response to stress, neurogenic inflammation, and myofascial pain syndrome. On microscopic examination, neutrophils or lymphocytes can be seen inside the prostatic gland, among the cells of the epithelium or inside the stromal component of the gland.[2][3]
Causes
The most common bacteria causing prostatitis are aerobic gram-negative bacilli, Escherichia coli is responsible for 50-80% incidents of bacterial prostatitis.[4]Though a single definitive cause has not been established, different theories exist about chronic prostatitis/chronic pelvic pain syndrome pathogenesis including chemical damage owing to reflux or autoimmune process.[5]
Differential Diagnosis
Prostatitis must be differentiated from various entities on the basis of dysuria that include cystitis, pyelonephritis, benign prostatic hyperplasia, prostatic abscess, bladder cancer, urinary tract stones, and a foreign body within the urinary tract.[6]
Epidemiology and demographics
In men who are younger than 50 years of age, prostatitis is the most common problem related to the urinary tact. Prostatitis is the 3rd most common urinary diagnosis made in men aged more than 50 years. There are almost 2 million health care visits yearly, associated with prostatitis. Chronic prostatitis is the most commonly seen type of prostatitis.[5]
Risk Factors
Common risk factors in the development of prostatitis include recurrent urinary tract infections, urethral strictures, hypertrophy of the neck of the bladder, prostatic carcinoma, benign prostatic hyperplasia,use of alcohol, smoking and history of foley catheterization.
Natural History, Complications, and Prognosis
If left untreated, patients with acute bacterial prostatitis may progress to develop chronic prostatitis, prostatic abscess, septicemia, urosepsis, urinary retention and metastasis of infection to spinal cord or sacroiliac joint.[7][8] Patients with untreated chronic prostatitis may develop chronic pelvic pain, sexual dysfunction, infertility, severe urinary frequency and urgency, and recurrent urinary tract infections.[8][10] Complete recovery without sequelae is usual among patients with acute prostatitis. Patients with chronic prostatitis have a gradual recovery and relapse is common.[13]
Screening
United States preventive task force (USPSTF) has no guidelines till date for the screening of prostatitis in men.
Diagnosis
Diagnostic Study of Choice
There is no gold standard for the diagnosis and evaluation of patients presenting with prostatitis. The evaluation of a patient with acute and chronic bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The evaluation of chronic pelvic pain syndrome includes tests which can be broadly divided into mandatory, recommended and optional.
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, known 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 may 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.[11][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.
Laboratory Findings
The laboratory tests used in the diagnosis of prostatitis are CBC, urinalysis, serum PSA (prostate-specific antigen) levels, urine culture, postvoid residual volume levels, 2-glass pre and post-prostatic massage test, Stamey-Meares four-glass test, and a semen analysis.[4][5][6] Laboratory findings consistent with the diagnosis of acute prostatitis include increased leukocytes on complete blood picture, bacteria seen on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels. 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 post massage 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][11] The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.[4]
Imaging Findings
CT scan in a patient with prostatitis shows edema of the prostate gland with diffuse enlargement, mostly in the peripheral zone. An abscess may be seen as a rim enhancing hypodensity which can either have single or multiple loci. Ultrasound can be used to diagnose prostatitis. On ultrasonography, focal hypoechoic area in the periphery of the prostate represents prostatitis. Fluid collection can show abscess formation. Colour doppler ultrasound may also prove to be very effective. MRI can also be used to diagnose prostatitis. Though it is not used commonly, its utilisation when suspecting alternate diagnosis like prostatic carcinoma etc is very important. MRI in case of a patient wit prostatitis depicts diffuse enlargement of the gland.[15][6][16]
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 5.6 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 6.7 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.
- ↑ M. B. Siroky, R. Moylan, G. Jr Austen & C. A. Olsson (1976). "Metastatic infection secondary to genitourinary tract sepsis". The American journal of medicine. 61 (3): 351–360. PMID 986763. Unknown parameter
|month=ignored (help) - ↑ 10.0 10.1 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.
- ↑ 11.0 11.1 11.2 11.3 Stevermer JJ, Easley SK (2000). "Treatment of prostatitis". Am Fam Physician. 61 (10): 3015–22, 3025–6. PMID 10839552.
- ↑ Nickel, J Curtis (1999). Textbook of Prostatitis. Harvard Medical School: Isis Medical Media. p. 3. ISBN 1901865045.
- ↑ 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
- ↑ Prostatitis. Radiopaedia 2016. http://radiopaedia.org/articles/prostatitis. Accessed on Feb 09, 2017
- ↑ Choon-Young Kim, Sang-Woo Lee, Seock Hwan Choi, Seung Hyun Son, Ji-Hoon Jung, Chang-Hee Lee, Shin Young Jeong, Byeong-Cheol Ahn & Jaetae Lee (2016). "Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guerin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer". Nuclear medicine and molecular imaging. 50 (1): 31–37. doi:10.1007/s13139-015-0364-y. PMID 26941857. Unknown parameter
|month=ignored (help)