PROSTATITIS - Disease Management

Prostatitis is an infection or inflammation of the pro-state gland that presents as several syndromes with varying clinical features. The four most common syndromes of prostatitis acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. Individuals with acute and chronic bacterial prostatitis have documented bacterial infections of the prostate.

Causes

• Neisseria gonorrhoea and Chlamydia trachomatis
• Acute bacterial prostatitis
• Ascending infection through the urethra
• Refluxing urine into prostate ducts
• Direct extension or lymphatic spread from the rectum
• Aerobic Gram-negative organisms-Escherichia coli, Enterobacter, Serratia, Pseudomonas, Enterococcus, and Proteus

Signs and Symptoms

• Fever, chills, malaise
• Arthralgias
• Obstructive urinary tract symptoms, including frequency, urgency, dysuria, nocturia, hesitancy, and incomplete voiding
• Low back pain
• Perineal and rectal pain
• Orchalgia
• Urethralgia
• Suprapubic, scrotal and penile pain
• Pain on ejaculation
• Spontaneous urethral discharge
• Acute bacterial prostatitis

         -Nodular, boggy, or normal-feeling gland
         -Maybe tender to palpation and hot to touch

• Chronic bacterial and nonbacterial prostatitis

         -Normal-feeling gland/calcifications

         -Perineal pain

         -Dysuria

         -Low abdominal pain

         -Low back pain

         -Scrotal and penile pain

         -Pain on ejaculation

         -Hematospermia

Risk Factors

• Bladder outlet obstruction (e.g., stone, tumour, BPH)
• Diabetes mellitus
• Suppressed immune system
• Urethral catheterization
• Sexually transmitted diseases

DIAGNOSIS

Differential Diagnosis

• Anal fistulas and fissures
• Foreign Bodies
• Cystitis
• Urethritis
• Pyelonephritis
• Malignancy
• Obstructive calculus
• Acute urinary retention

Investigations

• Fractionated urine specimens
• Complete blood count (CBC) with differential and blood cultures Urine analysis - white blood count and bacterial count, presence of oval fat bodies and lipid-laden macrophages
• Urine culture
• Prostatic localization studies
• Prostate-specific antigen
• Transrectal ultrasound
• Color Doppler ultrasound
• Computed Tomography (CT) Scan
• Cystoscopy
• Intravenous urography or voiding cystourethrogram
• Needle biopsy

TREATMENT

Non-Pharmacological Treatment

• Hydration
• Sitz baths

Pharmacological Treatment

Antibiotics

• Chronic bacterial prostatitis: fluoroquinolones, co-trimoxazole

Acute

• <35yrs: Ofloxacin or Ceftriaxone and doxycycline
• 35yrs: ciprofloxacin, ofloxacin, co-trimoxazole chronic
• Ciprofloxacin, ofloxacin, co-trimoxazole

PATIENT EDUCATION

• Avoid using heavy machinery, driving, or operating machinery.
• Drink plenty of water to flush the bladder
• Eat a balanced diet.

Complications

• Chronic prostatitis
• Bladder outlet obstruction/urinary retention
• Abscess
• Infertility due to scarring of the urethra
• Recurrent cystitis
• .Pyelonephritis
• Renal damage
• Sepsis

Prognosis

• The prognosis of the first occurrence of acute bacterial prostatitis is good with aggressive antibiotic therapy and good patient compliance.
• In cases of recurrent chronic prostatitis that may present with acute exacerbations, the causative underlying factors must be determined to affect the outcome