Prostatitis
An inflammation of the prostate gland, prostatitis occurs in several forms. Acute prostatitis most commonly results from gram-negative bacteria and is easily recognized and treated. Chronic prostatitis, which affects up to 35% of males older
than age 50 and is the most common cause of recurrent urinary tract infection (UTI) in males, is harder to recognize. Other classifications include granulomatous prostatitis (also called tuberculous prostatitis), nonbacterial prostatitis, and prostatodynia (painful prostate).
than age 50 and is the most common cause of recurrent urinary tract infection (UTI) in males, is harder to recognize. Other classifications include granulomatous prostatitis (also called tuberculous prostatitis), nonbacterial prostatitis, and prostatodynia (painful prostate).
Causes
About 80% of bacterial prostatitis cases result from infection by Escherichia coli. The rest result from infection by Klebsiella, Enterobacter, Proteus, Pseudomonas, Serratia, Streptococcus, Staphylococcus, and diphtheroids, which are contaminants from the anterior urethra’s normal flora.
Infection probably spreads to the prostate gland by the hematogenous route or from ascending urethral infection, invasion of rectal bacteria by way of the lymphatic vessels, or reflux of infected bladder urine into prostate ducts. Less commonly, infection may result from urethral procedures performed with instruments, such as cystoscopy and catheterization.
Chronic prostatitis usually results from bacterial invasion from the urethra. Granulomatous prostatitis occurs secondary to a miliary spread of Mycobacterium tuberculosis. Nonbacterial prostatitis is probably caused by Mycoplasma, Ureaplasma, Chlamydia, Trichomonas vaginalis, or some viruses. The cause of prostatodynia is unknown.
Complications
UTI is the most common complication of prostatitis. An untreated infection can progress to prostatic abscess, acute urine retention from prostatic edema, pyelonephritis, and epididymitis.
Assessment
The patient with acute prostatitis may report sudden fever, chills, lower back pain, myalgia, perineal fullness, arthralgia, frequent urination, urinary urgency, dysuria, and nocturia. Some degree of urinary obstruction may also occur, and the urine may appear cloudy. The bladder may feel distended when palpated. When palpated rectally, the prostate is markedly tender and boggy or soft.
Clinical features of chronic bacterial prostatitis vary. Although some patients are asymptomatic, this condition usually elicits the same urinary symptoms as the acute form but to a lesser degree. Other possible signs and symptoms include hemospermia, persistent urethral discharge, and painful ejaculation that’s responsible for some sexual dysfunction. The prostate is usually normal.
Digital examination in granulomatous prostatitis may reveal a stony, hard induration of the prostate (mimicking cancer or a calculus). This finding may suggest prostatitis if the patient has a history of pulmonary or GI tuberculosis or has been receiving intravesical therapy for superficial bladder cancer.
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