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Prostatitis Prostatitis
Mai BanakharMai Banakhar
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Definition Definition
Infection &/ or inflammation of the prostateInfection &/ or inflammation of the prostate
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EpidemiologyEpidemiology
Overall prevalance in men is 5Overall prevalance in men is 5 higher risk age 20 – 50 & >70higher risk age 20 – 50 & >70
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Pathogenesis Pathogenesis
Tissue around prostatic Tissue around prostatic acini become infiltrated acini become infiltrated by inflamatory cells.by inflamatory cells.
Organisms:Organisms: G-ve (E.coli, G-ve (E.coli,
pseudomonas, klebsiella pseudomonas, klebsiella , serratia, Enterobacter , serratia, Enterobacter aerogenes.)aerogenes.)
1 &P pili virulence1 &P pili virulence
G+ve 5-10 %G+ve 5-10 % (staph aureus, (staph aureus,
saprophyticus, saprophyticus, streptococcus faecalis)streptococcus faecalis)
Aetiology ???Aetiology ???
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Risk factorsRisk factors
UTIUTI Acute epididymitis.Acute epididymitis. Urethral catheters.Urethral catheters. Transurethral surgeryTransurethral surgery Intraprostatic duct Intraprostatic duct
refluxreflux PhimosisPhimosis Prostatic stonesProstatic stones
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Segmented urine culturesSegmented urine cultures
Localize bacteria to specific part of the urinary Localize bacteria to specific part of the urinary tract.tract.
first voided 10ml ---------- urethritis & first voided 10ml ---------- urethritis & prostatitis VB1prostatitis VB1
Midstream urine -------------cystitis VB2Midstream urine -------------cystitis VB2 Prostatic massageProstatic massage 10 ml post massage---------- prostatitis VB310 ml post massage---------- prostatitis VB3 EPS ------------------------------ prostatitisEPS ------------------------------ prostatitis
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Classification Classification
Class 1: acute bacterial Class 1: acute bacterial prostatitisprostatitis
Class 2: chronic Class 2: chronic bacterial prostatitis.bacterial prostatitis.
Class 3: chronic pelvic Class 3: chronic pelvic pain syndromepain syndrome
3a inflammatory non- 3a inflammatory non- bacterial : wbc in EPS, bacterial : wbc in EPS, VB3 or semen.VB3 or semen.
3b non-inflammatory : 3b non-inflammatory : no wbc in Eps , vb3 or no wbc in Eps , vb3 or semen.semen.
Class 4: Asymptomatic Class 4: Asymptomatic inflammatory prostatitisinflammatory prostatitis
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Evaluation Evaluation
Class 1: acute bacterial prostatitisClass 1: acute bacterial prostatitis E.coli commonE.coli common Associated with LUT infection.Associated with LUT infection.
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Class 1 Class 1
Acute onset fever.Acute onset fever. ChillsChills Nausea &vomitingNausea &vomiting Perineal & sp painPerineal & sp pain Irritative urinary Irritative urinary
symptoms ( frequency, symptoms ( frequency, urgency, dysuria)urgency, dysuria)
Obstructive (hesitancy, Obstructive (hesitancy, strangury, UR, strangury, UR, intermittency)intermittency)
Sings: Sings: Systemic toxicitySystemic toxicity Sp tenderness.Sp tenderness. Palpable bladder with Palpable bladder with
URUR Tender DRETender DRE
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Class 1Class 1
Systemically wellSystemically well Oral quinolone Oral quinolone
ciprofloxacin 500 BIDciprofloxacin 500 BID 2-4 weeks2-4 weeks
Systemically unwellSystemically unwell I.V antibioticI.V antibiotic Aminoglycoside+3Aminoglycoside+3rdrd
generation generation cephalosporinscephalosporins
Pain reliefPain relief FC URFC UR
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Class 1Class 1
Prostatic abcessProstatic abcess Persistant symptoms:Persistant symptoms: Fever while on antibiotic.Fever while on antibiotic. TRUS ???? PAINTRUS ???? PAIN C.T C.T Transurethral management Transurethral management
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Class2 Class2
Hx:Hx: recurrent UTIrecurrent UTI Chronic episods of pain & voiding dysfunctionChronic episods of pain & voiding dysfunction DRE: tender, enlarged & boggy prostateDRE: tender, enlarged & boggy prostate
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Class 3Class 3
Chronic pelvic pain Chronic pelvic pain syndromesyndrome
Both types present with:Both types present with: >3 months localized >3 months localized
pain.pain.(perineal, suprapubic, (perineal, suprapubic,
penile , groin or ext. penile , groin or ext. genitalia)genitalia)
Pain with ejaculation.Pain with ejaculation.LUTSLUTS
EDED Symptoms can recur Symptoms can recur
over time over time Affect patient’s quality Affect patient’s quality
of lifeof life
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Class 4Class 4
Incidental histological Dx in prostate Incidental histological Dx in prostate specimens.specimens.
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Evaluation Evaluation
HxHx NIH- CPI questionnaire:NIH- CPI questionnaire: Pain ( location, severity, frequency)Pain ( location, severity, frequency) Voiding (obstructive , irritative symptoms)Voiding (obstructive , irritative symptoms) Impact on quality of life.Impact on quality of life.
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Evaluation Evaluation
Segmented urine culture & EPSSegmented urine culture & EPS Cultures –ve Cultures –ve high Leucocyte e >10/ HPF high Leucocyte e >10/ HPF Favor Dx inflammatory chronic pelvic pain Favor Dx inflammatory chronic pelvic pain
syndromsyndrom
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Treatment Treatment
Alpha- blockers: improve urinary flow,& Alpha- blockers: improve urinary flow,& reduce intraprostatic ductal refluxreduce intraprostatic ductal reflux
Anti inflammatory drugs NSAIDAnti inflammatory drugs NSAID 5 alph reductase inhibitors :improve 5 alph reductase inhibitors :improve
intraprostatic ductal reflux.intraprostatic ductal reflux. Microwave heat therapyMicrowave heat therapy
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Non- inflammatory chronic pelvic Non- inflammatory chronic pelvic pain syndromepain syndrome
Treatment:Treatment: Drugs: analgesia ( tricyclic antidepressent, Drugs: analgesia ( tricyclic antidepressent,
anti inflammatory, muscle relaxants, 5- alpha anti inflammatory, muscle relaxants, 5- alpha reductase inhibitorsreductase inhibitors
Biofeedback.Biofeedback. psychologicalpsychological