Prostatitis Prostatitis

Mai BanakharMai Banakhar

Definition Definition

Infection &/ or inflammation of the prostateInfection &/ or inflammation of the prostate

EpidemiologyEpidemiology

Overall prevalance in men is 5Overall prevalance in men is 5 higher risk age 20 – 50 & >70higher risk age 20 – 50 & >70

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 ???

Risk factorsRisk factors

UTIUTI Acute epididymitis.Acute epididymitis. Urethral catheters.Urethral catheters. Transurethral surgeryTransurethral surgery Intraprostatic duct Intraprostatic duct

refluxreflux PhimosisPhimosis Prostatic stonesProstatic stones

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

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

Evaluation Evaluation

Class 1: acute bacterial prostatitisClass 1: acute bacterial prostatitis E.coli commonE.coli common Associated with LUT infection.Associated with LUT infection.

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

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

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

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

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

Class 4Class 4

Incidental histological Dx in prostate Incidental histological Dx in prostate specimens.specimens.

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.

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

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

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