Atlas of pathophysiology, 2 Edition

Part II - Disorders

Genital Diseases

Prostatitis

Prostatitis, or inflammation of the prostate gland, may be acute or chronic. It's usually nonbacterial and idiopathic in origin (95% of cases). Acute prostatitis most often results from infection with gram-negative bacteria and is easy to recognize and treat. However, chronic prostatitis, the most common cause of recurrent urinary tract infections (UTIs) in men, is less easy to recognize. Granulomatous prostatitis (tuberculous prostatitis), nonbacterial prostatitis, and prostatodynia (painful prostate) are other classifications of the disease.

Age Alert

As many as 35% of men over age 50 have chronic prostatitis.

Causes

·   Nonbacterial prostatitis—unknown

·   Bacterial prostatitis—Escherichia coli (80% of cases); KlebsiellaEnterobacter, Proteus, Pseudomonas, streptococci, staphylococci

Probable routes of entry

·   Through the bloodstream

·   Invasion of rectal bacteria through lymphatics

·   Reflux of infected bladder urine into prostate ducts

·   Infrequent or excessive sexual intercourse

·   Procedures, such as cystoscopy or catheterization (less commonly)

·   From the urethra (chronic prostatitis)

Age Alert

Acute prostatitis is associated with benign prostatic hypertrophy in older men.

Pathophysiology

Spasms in the genitourinary tract or tension in the pelvic floor muscles may cause inflammation and nonbacterial prostatitis.

Bacterial prostatic infections can be the result of a previous or concurrent infection, which stimulates an inflammatory response in the prostate. Inflammation is usually limited to a few of the gland's excretory ducts.

Signs and symptoms

Early acute prostatitis

·   Fever

·   Chills

·   Low back pain, especially when standing

·   Perineal fullness, suprapubic tenderness

·   Frequent and urgent urination

·   Dysuria, nocturia, urinary obstruction

·   Cloudy urine

Chronic bacterial prostatitis

·   Same urinary symptoms as in acute form but to a lesser degree

·   Recurrent symptomatic cystitis

Other possible signs

·   Evidence of UTI, such as urinary frequency, burning, cloudy urine

·   Painful ejaculation

·   Bloody semen

·   Persistent urethral discharge

·   Erectile dysfunction

Diagnostic test results

·   Pelvic X-ray shows prostatic calculi.

·   Urine culture identifies the causative organism.

·   Comparison of urine cultures of specimens obtained by the Meares and Stamey technique diagnose disease.

Clinical Tip

The Meares and Stamey technique offers a firm diagnosis of prostatitis. The test requires four specimens, as follows:

·   when the patient starts voiding

·   midstream

·   after patient stops voiding and health care provider massages the prostate to produce secretions

·   final voided specimen.

Treatment

Supportive therapy

·   Bed rest, adequate hydration, analgesics, antipyretics, sitz baths, stool softeners as necessary

Acute prostatitis

·   Systemic antibiotic therapy is treatment of choice; may include:

·   oral antibiotic indicated by culture and sensitivity testing

§  I.V. co-trimoxazole or I.V. gentamicin plus ampicillin until sensitivity test results are known; parenteral therapy for 48 hours to 1 week; then oral agent for 30 more days (with favorable test results and clinical response)

Chronic prostatitis due to E. coli

·   Co-trimoxazole for at least 6 weeks

·   If drug therapy is unsuccessful:

§  transurethral resection removing all infected tissue

§  total prostatectomy

Symptomatic treatment of chronic prostatitis

·   Instruct patient to drink at least 8 glasses of water daily

·   Regular careful massage of the prostate to relieve discomfort (vigorous massage may cause secondary epididymitis or septicemia)

·   Regular ejaculation to help promote drainage of prostatic secretions

·   Anticholinergics and analgesics to help relieve nonbacterial prostatitis symptoms

·   Alpha-adrenergic blockers and muscle relaxants to relieve pain

·   Continuous low-dose anabolic steroid therapy (effective in some men)

P.335

PROSTATIC INFLAMMATION

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