Prostatitis Specialists  David Leff, MD Allan Pantuck, MD, MS, FACS Ongoing Clinical Trials Chronic Prostatitis - Clinical trial for men with chronic prostatitis Related Research Projects No Current Research Projects...

General Information

Prostatitis is a term used to describe inflammatory conditions of the prostate gland. It is thought that most cases of prostatitis result from nonbacterial causes. An infected or inflamed prostate can cause painful urination and ejaculation.

Incidence and Prevalence
Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. Prostatitis is the most common urological disorder in men over the age of 50 and the third most common disorder in men younger than 50.

According to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.

Nonbacterial prostatitis and prostatodynia, which is also called chronic pelvic pain syndrome (CPPS), are the most common diagnoses. Bacterial prostatitis (acute and chronic) accounts for less than 5-10% of cases. Acute bacterial prostatitis occurs most often in men under age 35, and chronic bacterial prostatitis primarily affects men between the ages of 40 and 70.

Anatomy
The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It secretes seminal fluid, a milky substance that combines with sperm to form semen. During sexual climax, muscles in the prostate propel the semen through the urethra and out through the penis.

Types
There are four types of prostatitis: acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia.

Acute bacterial prostatitis (ABP) is inflammation of the prostate gland caused by bacteria such as Escherichia coli and Klebsiella. Severe complications may develop if not promptly treated. ABP can be fatal if the bacterial infection is untreated and travels to the bloodstream (sepsis).

Chronic bacterial prostatitis (CBP) is a recurrent infection and inflammation of the prostate and urinary tract. Symptoms are less severe than those associated with acute bacterial prostatitis.

Nonbacterial prostatitis is an inflamed prostate without bacterial infection.

Prostatodynia, sometimes called chronic pelvic pain syndrome (CPPS), is the occurrence of prostatitis symptoms, without inflammation or bacterial infection.

Risk Factors

Risk factors include bladder outlet obstruction (e.g., stone, tumor, BPH), diabetes mellitus, a suppressed immune system, and urethral catheterization (i.e., small tube inserted into the bladder through the urethra to drain urine). Some sexually transmitted diseases (STDs; e.g., nongonnococcal urethritis, gonorrhea) increase the risk for developing bacterial prostatatis. Unprotected anal and vaginal intercourse can allow bacteria to enter the urethra and travel to the prostate.

Causes

Bacterial prostatitis is caused by the growth of bacteria that are normally found in prostatic fluid, such as Escherichia coli and Klebsiella. Urine that flows back into the urethra (urine reflux) that enters the prostate can also cause the condition. There is no known cause for nonbacterial prostatitis or prostatodynia, but atypical organisms (e.g., viruses, chlamydial organisms) have recently been suggested.

Signs and Symptoms

Symptoms of acute bacterial prostatitis (ABP) are usually sudden and include the following:

• Chills
• Fever
• Frequent urination
• Incomplete emptying of bladder
• Joint pain (arthralgia)
• Lower back pain
• Muscle pain (myalgia)
• Pain in penis, testicles, and area between the scrotum and the rectum (perineum)
• Painful ejaculation
• Painful urination (dysuria)
• Sensation of having to urinate immediately, often accompanied by bladder pain or spasm (urgency)
• Tender, swollen prostate

Symptoms of chronic bacterial prostatitis (CBP) and nonbacterial prostatitis are generally less severe than those of ABP and include the following:

• Blood in semen (hematospermia)
• Discomfort in genital area and perineum
• Dysuria
• Fever
• Lower back pain
• Pain in lower abdomen
• Painful ejaculation
• Recurring urinary tract infection (UTI)

Patients with prostatodynia have symptoms of prostatitis but there is no evidence of infection or inflammation.

Complications
Complications of acute bacterial prostatitis (ABP) include the following:

• Collection of pus (abscess)
• Acute urinary retention
• Chronic bacterial prostatitis
• Infection in bloodstream (sepsis)

Diagnosis

A digital rectal exam (DRE) is used to determine if the prostate gland is tender or swollen. To perform a DRE, the physician inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall and assess its size, shape, and consistency.

A three-part urinalysis is the standard diagnostic tool. Two urine specimens are collected and analyzed, followed by prostate massage and a third urine sample that contains prostatic fluid.

During prostate massage, the physician inserts a lubricated, gloved finger into the rectum to massage the surface of each lobe of the prostate gland, resulting in the release of prostate fluids. Prostate massage should not be used if ABP is suspected because massage may encourage the spread of bacteria.

Urinalysis determines the presence of white blood cells (leukocytes) in the urine. Leukocytes help the body to fight infection; a high number indicates a bacterial infection. A urine culture is performed to identify bacteria.

Nonbacterial prostatitis is diagnosed when tests reveal no bacteria in the urine or prostatic secretions. There is no test to diagnose prostatodynia; it is diagnosed after eliminating other probable causes (e.g., kidney stones, interstitial cystitis, urethral cancer).

Treatment

Medication
Acute bacterial prostatitis is treated with antibiotics such as flouroquinolones (e.g., Avelox®, Levaquin®) and trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®) administered intravenously, followed by a course of oral antibiotics. Side effects include the following:

• Diarrhea
• Dizziness
• Headache
• Nausea
• Stomach pain
• Vomiting

Surgery
In cases of chronic bacterial prostatitis or prostatodynia, surgery to remove part of the prostate is a treatment option. It is recommended for patients who experience chronic pain and serious complications, such as the following:

• Damage to the kidneys caused by urine backing up
• Frequent urinary tract infections
• Inability to urinate
• Stones in the bladder

Patients usually stay in the hospital for about 3 days, during which time a catheter is used to drain urine. Most men are able to return to work within a month. During the recovery period, patients are advised to

• avoid heavy lifting, driving, or operating machinery;
• drink plenty of water to flush the bladder;
• eat a balanced diet;
• use a laxative if necessary to prevent constipation and straining during bowel movements.

Complications

Blood in the urine (hematuria) is common after TURP surgery and usually resolves by the time the patient is discharged. Bleeding also may result from straining or activity. Postsurgical bleeding should be reported to the urologist immediately.

Some patients have initial discomfort, a sense of urgency to urinate, or short-term difficulty controlling urination. These conditions improve as recovery progresses, but the longer the urinary problems existed before surgery, the longer it takes to regain full and normal bladder function after surgery.

Up to 30% of men who undergo TURP experience problems with sexual function. Complete recovery of sexual function may take up to 1 year. The most common, long-term side effect of prostate surgery is dry climax (retrograde ejaculation), which results when the muscle that closes the bladder neck during ejaculation is removed along with the prostate tissue. Semen enters the wider opening to the bladder instead of being expelled through the penis, causing sterility but not affecting the man's ability to experience sexual pleasure.

Prostatectomy Surgical removal of the prostate (prostatectomy) is very rarely indicated for treatment of prostatitis. Severe symptoms that do not improve after all other methods of treatment have been tried may be treated using this procedure.

Prevention

Avoiding unprotected sex can help prevent acute bacterial prostatitis.

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