Prostatitis

 Voiding – elimination, excretion

 PSA – Prostatic Specific Antigen (elevation in patology of prostate)
 DRE – Digital rectal exam
 Perineum – space between the anus and scrotum in man
 Emesis – an act or instance of vomiting
 Dysuria – painful urination
 Polyuria – excessive urination
 Nocturia – excessive urination at night
 Hematospermia – blood in the semen
 Erectile dysfunction – the inability to develop or maintain an erection
Prostatitis

 Inflammation of the prostate gland

 The most common problem in men under 50 years old
 Result of an infection or other various causes
 Classified into four categories – each with its own
diagnostic and treatment approach:
 Prostate gland

 Tubuloalveolar exocrine gland of the male

reproductive system
 Size of a walnut
 Location: anterior to the rectum (digital
rectal examination - DRE)
posterior to the pubic symphysis
superior to the perineal membrane
inferior to the bladder
(urethra goes through the
prostate – symptoms of prostatitis)
Types of prostatitis
1. Acute bacterial prostatitis
 Acute bacterial infection of the prostate gland
 Etiology: E.coli (+ other gram – bacteria; N. gonorrhoeae and C. trachomatis)
 Clinical presentation: Systemic - high fever, chills, nausea, emesis
Local - dysuria, urinary frequency, urinary urgency,
incomplete voiding, weak stream, straining to urinate,
suprapubic, perineal or rectal pain
 Diagnosis: Medical history + DRE (tender, enlarged) + urine and blood cultures
 Complications: prostatic abscess (prolonged fever and resistant to AB) –
transrectal ultrasonography, CT, MRI
 Treatment: AB (initial – adjusted)
  Chronical reccurent bacterial infection of the
prostate gland
Types of prostatitis  Ascendent urinary infection or urine reflux
(chemical iritation)
2. Chronic  Etiology: E.coli (and other as acute)
bacterial prostatitis  Clinical presentation: low-back pain, pain in the
perineum, pain in the
testicles or penis; urgent,
frequent or painful urination,
nocturia, flu-like symptoms;
painful ejaculation,
hematospermia
 Diagnosis: culturing urin, prostate fluid and semen
+ PSA
search for cause of recurrence
 Treatment: AB (prolonged therapy) + alpha
blockers
long term low-dose th.
 Complications: infertility, semen abnormalities
and reduced quality of life
  Chronic pelvic pain syndrome; the most common
form
Types of prostatitis  Symptoms resemble those of chronic bacterial
prostatitis
3. Chronic
 Etiology: no bacteria
nonbacterial prostatitis cascade of interconnected events -
overactive pain syndrome
condition may affect the entire pelvic
floor
 Clinical presentation: pelvic or perineal pain
without evidence of urinary
tract infection, lasting longer
than 3 months; pain;
voiding problems; erectile
dysfunction
 Diagnostic: no definite diagnostic test
leukocytes in prostatic fluid
 Treatment: AB, pain relievers, alpha blockers –
depending on pattern of symptoms
Types of prostatitis
4. Asymptomatic inflammatory prostatitis

 Histological diagnosis with no symptoms

 Diagnosis based on biopsy obtained for elevated PSA (malignancy?) or for
testing for infertility
 Elevated PSA and white blood cells in the urine
 No known cause, no symptoms – no treatment