Prostatitis

Introduction to Prostatitis

Prostatitis is an inflammation of the prostate or pain in the prostate, similar to that caused by an inflammation.
It accounts for 2% of prostatic pathology.

Risk factors for Prostatitis

  • Ductile reflux
  • Urinary tract infection
  • Indwelling urethral catheterization
  • Penetrating anal sex
  • Sexually transmitted infections

Classification of Prostatitis

Prostatitis is classified into:

  1. Acute bacterial prostatitis
  2. Chronic bacterial prostatitis
  3. Chronic non-bacterial prostatitis (Prostatodynia)
  4. Asymptomatic inflammatory prostatitis

1. Acute bacterial prostatitis

  1. This results from direct spread of ascending urethral infection or reflux of infected urine into the prostatic ducts
  2. E. coli is the main causative organism. Others are Klebsiella, Pseudomonas, Streptococcus faecalis and Staph aureus

2. Chronic bacterial prostatitis

This is caused by E. coli, Klebsiella, Mycoplasmaa and C. hlamydia

3. Non-bacterial prostatitis

  • An inflammation of indeterminate cause this

Symptoms and clinical features of Prostatitis

1. Acute prostatitis

Systemic features 

  1. Fever
  2. Chills
  3. Malaise
  4. Nausea

Local features 

  1. Dysuria
  2. Frequency
  3. Haematuria
  4. Urethral discharge

Rectal examination:

  • Hot boggy, swollen and very tender prostate

2. Chronic prostatitis

  1. Voiding symptoms:
    • dysuria,
    • frequency,
    • urgency,
    • haematuria
  2. Poor stream
  3. Urethral discharge
  4. Low back pain
  5. Perineal pain
  6. Haemospermia
  7. Painful ejaculation

Rectal examination:

  • enlarged, tender, firm
    prostate

Differential diagnoses

  • Benign prostatic hypertrophy
  • Cystitis
  • Urethral stricture
  • Prostate cancer

Complications of Prostatitis

  1. Prostatic abscess
  2. Prostatic calculi
  3. Infertility
  4. Septicaemia

Investigations

  • Urinalysis
  • Urine microscopy, culture and sensitivity
  • Prostatic massage: microscopy, culture and sensitivity (chronic prostatitis only)
  • Trans-rectal ultrasound
  • Full Blood Count; ESR
  • Biopsy: culture and histology
  • Urethrocystoscopy (chronic prostatitis only)

Treatment for Prostatitis

Treatment objectives

  • To eradicate causative organisms
  • Control pain

Drug treatment

A. Mild to Moderate infections

1st Line Treatment
Evidence Rating: [B]
Ciprofloxacin, oral, 500 mg 12 hourly for 4-6 weeks

And

Doxycycline, oral, 100 mg 12 hourly for 4-6 weeks
2nd Line Treatment
Levofloxacin, oral, 500 mg daily for 4-6 weeks

And

Doxycycline, oral, 100 mg 12 hourly for 4-6 weeks

B. Severe infections

Ciprofloxacin, IV, 400 mg 8-12 hourly (to be administered over 60 minutes)

Or

Levofloxacin, IV, 500 mg 12 hourly

Or

Ceftriaxone, IV, 1-2g Daily

And

Gentamicin, IV, 80 mg 12 Hourly
Note

Initial therapy with parenteral antibiotics is indicated in severe cases.
Follow up should be for at least 4 months

C. For improvement of urinary flow

Tamsulosin, 400 micrograms daily (at night)

Or

Alfuzosin, 10 mg daily

Or

Terazosin, 2-5 mg daily (at night)

D. Adjunct treatment in severe presentations

Evidence Rating: [C]
Sodium chloride 0.9%, IV, as required in severe systemic infections.

And

Ibuprofen, oral, 400 mg 8 hourly when required

Or

Diclofenac, oral, 75 mg 12 hourly when required

And

Lactulose, oral, 10-15 ml 12 hourly and adjust dose accordingly

Non-drug treatment

  • Prostatic massage (chronic prostatitis only)
  • Physiotherapy
  • Sitz baths

Referral Criteria

Refer all cases of severe infections or chronic prostatitis for specialist
care.