Prostatitis
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Example Management | References
Definition
Prostatitis is an inflammation of the prostate gland, which can cause a variety of symptoms and affect men of all ages. It is classified into four main types: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic inflammatory prostatitis.
Aetiology
Prostatitis can result from various causes, including:
- Bacterial infections: Commonly caused by bacteria such as Escherichia coli and other Gram-negative bacteria.
- Non-bacterial causes: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) often has no identifiable infectious cause.
- Autoimmune responses: In some cases, an autoimmune response may contribute to the inflammation.
- Trauma: Injury to the pelvic area can lead to inflammation of the prostate.
- Urinary reflux: Backward flow of urine into the prostate ducts.
Pathophysiology
The pathophysiology of prostatitis varies with its type:
- Acute bacterial prostatitis: Results from an acute bacterial infection, causing inflammation and swelling of the prostate.
- Chronic bacterial prostatitis: Persistent or recurrent bacterial infection of the prostate.
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): Involves chronic pain and urinary symptoms without a clear bacterial infection, possibly due to a combination of factors including inflammation, immune response, and nerve involvement.
- Asymptomatic inflammatory prostatitis: Inflammation of the prostate without symptoms, often found incidentally.
Risk Factors
- Age: More common in men aged 30-50 years.
- Urinary tract infections: Previous or recurrent UTIs can increase the risk.
- Prostate manipulation: Procedures such as biopsy or catheterisation.
- Dehydration: Can contribute to urinary stasis and infection.
- Unprotected sex: Increased risk of sexually transmitted infections (STIs).
- Pelvic trauma: Injury to the pelvic area.
Signs and Symptoms
- Acute bacterial prostatitis: Fever, chills, dysuria, pelvic or perineal pain, and urinary retention.
- Chronic bacterial prostatitis: Recurrent UTIs, pelvic pain, dysuria, and ejaculation pain.
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): Chronic pelvic pain, urinary symptoms, sexual dysfunction, and psychological distress.
- Asymptomatic inflammatory prostatitis: No symptoms, but inflammation is found on examination or biopsy.
Investigations
- Clinical history and physical examination, including digital rectal examination (DRE).
- Urinalysis and urine culture: To detect bacterial infection.
- Prostate-specific antigen (PSA) test: Elevated levels can indicate inflammation or infection.
- Expressed prostatic secretion (EPS) analysis: Microscopic examination of prostatic fluid.
- Imaging: Ultrasound or MRI to evaluate the prostate and surrounding structures.
- Urodynamic studies: To assess bladder function if urinary symptoms are significant.
Management
Primary Care Management
- Antibiotic therapy: For bacterial prostatitis, antibiotics such as ciprofloxacin or Levofloxacin are commonly prescribed for 14 days.
- Analgesia: NSAIDs like ibuprofen to manage pain and inflammation.
- Alpha-blockers: Medications like tamsulosin to relieve urinary symptoms by relaxing the prostate and bladder neck muscles.
- Hydration: Encourage adequate fluid intake to help flush the urinary system.
- Patient education: Inform about the condition, treatment adherence, and lifestyle modifications.
- Referral to a specialist: If symptoms persist or if there are complications such as abscess formation or severe urinary retention.
Specialist Management
- Further diagnostic evaluation: Including EPS analysis, imaging, and urodynamic studies if necessary.
- Advanced treatments: Antibiotics tailored to culture results, anti-inflammatory medications, and alpha-blockers.
- Physiotherapy: Pelvic floor physiotherapy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
- Pain management: Chronic pain management strategies, including medications, nerve blocks, or acupuncture.
- Minimally invasive procedures: Transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA) for severe cases.
- Management of complications: Addressing abscesses, severe urinary retention, or other complications.
Example Management for Prostatitis
A patient presenting with symptoms of acute bacterial prostatitis, such as fever, chills, pelvic pain, and dysuria, should be treated with antibiotics like ciprofloxacin 500 mg twice daily for 2 weeks. Pain can be managed with NSAIDs such as ibuprofen. Alpha-blockers like tamsulosin may be prescribed to alleviate urinary symptoms. Adequate hydration should be encouraged. If symptoms persist or if there are complications, referral to a urologist is recommended for further evaluation and management. For chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), a multidisciplinary approach including antibiotics, alpha-blockers, anti-inflammatory medications, and physiotherapy may be necessary.
References
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