Prostatitis

Prostatitis is swelling and inflammation of the prostate gland.

Types

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis without infection
• Asymptomatic inflammatory prostatitis

Causes of Prostatitis

Acute bacterial prostatitis

• Ascending infection through the urethra
• Direct extension /lymphatic spread from the rectum
• Indwelling urethral catheters
• Refluxing urine into prostate ducts

Chronic bacterial prostatitis

• Primary voiding dysfunction

1. primary vesical neck obstruction
2. pseudodyssynergia
3. impaired detrusor contractility
4. contractile detrusor muscle

• E coli (most common), M tuberculosis, Coccidioides, Histoplasma, and Candida species
• Human immunodeficiency virus (HIV)
• Cytomegalovirus
• Inflammatory conditions (sarcoidosis)

Chronic prostatitis

Without infection( chronic pelvic pain syndrome)

• Ejaculatory duct obstruction
• Increased pelvic side wall tension
• Immune system disorders
• Nervous system dysfunctioning
• Infection with a virus or bacteria

Asymptomatic inflammatory prostatitis

Causes are similar to those of chronic inflammatory Prostatitis but without any symptoms.

Symptoms and signs

Acute Bacterial  Prostatitis  

• Arthralgias
• Chills
• Fever
• Malaise
• Myalgias
• Perineal prostatic pain
• Obstructive urinary tract symptoms
  1. Dysuria
  2. Frequency
  3. Hesitancy
  4. Incomplete voiding
  5. Nocturia
  6. Urgency
  7. Weak Stream
• Low back pain
• Spontaneous urethral discharge
• Gland feels tender, nodular, hot, boggy or normal
• Suprapubic abdominal tenderness
• Enlarged tender bladder due to urinary retention
• History of sclerotherapy for rectal prolapse

Chronic Bacterial  Prostatitis 

• Gland feels tender, nodular, or normal
• Intermittent obstructive urinary tract symptoms
• Recurrent urinary tract infections
• Suprapubic tenderness during acute episodes

Chronic Prostatitis and Chronic Pelvic Pain Syndrome

• Pelvic pain or discomfort( perineal, suprapubic, coccygeal, rectal, urethral, and testicular/scrotal pain)
• Obstructive urinary tract symptoms 
• Ejaculatory pain
• Erectile dysfunction
• Mildly tender or normal prostate
• Tight anal sphincter

Asymptomatic inflammatory prostatitis

Normal or calcified prostate.

Investigations

• Urinalysis
• Ultrasound
• X-ray
• Computerized tomography (CT)

Treatment

1. Acute bacterial prostatitis

• Drink plenty of fluids
• Medicines
• Rest

2. Chronic bacterial prostatitis

Long-term medicines

3. Chronic prostatitis without infection

• Physical therapy
• Relaxation techniques
• Medicines

4. Asymptomatic inflammatory prostatitis

Medicines

Complications

• Bladder outlet obstruction/urinary retention
• Abscess
• Infertility
• Recurrent cystitis
• Pyelonephritis
• Renal damage
• Sepsis