Lecture notes for medical students

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2. Introduction

3. Introduction
• Prostatitis is an infection or inflammation of
the prostate gland that presents as several
syndromes with varying clinical features.
• The term prostatitis is defined as
microscopic inflammation of the tissue of
the prostate gland and is a diagnosis that
spans a broad range of clinical conditions.

4. Classification
•

5. Classification
• I - Acute bacterial prostatitis
• II - Chronic bacterial prostatitis
• III - Chronic prostatitis and chronic pelvic
pain syndrome (CPPS; further classified as
inflammatory or noninflammatory)
• IV - Asymptomatic inflammatory prostatitis

6. CPPS

7. CPPS
• CPPS is characterized primarily by
urological pain complaints in the absence of
urinary tract infection

8. Asymptomatic inflammatory
prostatitis

9. Asymptomatic inflammatory
prostatitis
• Asymptomatic inflammatory prostatitis is
characterized by the incidental discovery of
prostatic inflammation without genitourinary
complaints. This condition is diagnosed
during a workup for infertility or elevated
prostate-specific antigen (PSA) level

10. Clinical Features

11. Clinical Features
Acute Prostatitis
• Fever
• Chills
• Malaise
• Arthralgias
• Myalgias
• Perineal/prostatic pain
• Dysuria

12. Clinical Features
Acute Prostatitis
• Obstructive urinary tract symptoms,
including frequency, urgency, dysuria,
nocturia, hesitancy, weak stream, and
incomplete voiding
• Low back pain
• Low abdominal pain
• Spontaneous urethral discharge
• History of sclerotherapy for rectal prolapse

13. Clinical Features
Chronic Prostatitis
• Typically have no systemic symptoms.
Instead, these patients may present with the
following:
• Intermittent dysuria
• Intermittent obstructive urinary tract
symptoms
• Recurrent urinary tract infections [

14. Clinical Features
Chronic Prostatitis
• Pelvic pain or discomfort, including
perineal, suprapubic, coccygeal, rectal,
urethral, and testicular/scrotal pain for more
than 3 of the previous 6 months without
documented urinary tract infections from
uropathogens
• Obstructive urinary tract symptoms,
• Ejaculatory pain
• Erectile dysfunction

15. Clinical Features
Acute Prostatitis
• Tender, nodular, hot, boggy, or normal-
feeling gland on digital rectal examination
• Suprapubic abdominal tenderness
• Enlarged tender bladder due to urinary
retention

16. Clinical Features
Acute Prostatitis
• Bladder outlet obstruction/urinary retention
• Abscess - Typically in immunocompromised
patients
• Infertility due to scarring of the urethra or
ejaculatory ducts
• Recurrent cystitis
• Pyelonephritis
• Renal damage
• Sepsis

17. Pathophysiology
• Although various routes have been
postulated, none has been firmly
substantiated.
• Acutegram-negative organisms
(eg, Escherichia coli, Enterobacter,
Serratia, Pseudomonas,
Enterococcus, and Proteusspecies).
• Chronic -cytomegalovirus
(CMV). Mycobacteria, such
as Mycobacterium tuberculosis, and fungi,
such as Candida albicans,

18. Pathophysiology

19. Pathophysiology
• Neisseria gonorrhoeae and Chlamydia
trachomatis
• indwelling urethral catheters
• Sclerotherapy for rectal prolapse

20. Complications

21. Complications
• Prostatitis may lead to urosepsis with
significant associated mortality in patients
with diabetes mellitus, patients on dialysis
for chronic renal failure, patients who are
immunocompromised, and postsurgical
patients who have had urethral
instrumentation.

22. Investigations

23. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology

24. Diagnostic Studies

25. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

26. Diagnostic Studies
Lab
• Urinalysis and urine culture can confirm the
presence of infection and identify
pathogens.
• Fractional urine examination
• Cytology of expressed prostatic secretions
• Prostate inflammation can lead to elevation
of serum prostate-specific antigen (PSA).

27. Diagnostic Studies
Imaging Studies
• On transrectal ultrasonography-capsular
thickening and prostatic calculi.
• Computed tomography (CT)

28. Management

29. Management
• acutely ill/evidence of sepsis, or both
require hospital admission
• parental bactericidal agents such as broad-
spectrum penicillin derivatives, third-
generation cephalosporins with or without
aminoglycosides, or fluoroquinolones.
• Patients without a toxic appearance can be
treated on an outpatient basis with a 14- to
28-day course of oral antibiotics, usually a
fluoroquinolone or trimethoprim-
sulfamethoxazole

30. Management
• Suprapubic catheters
• Prostatic abscess, the fluctuant site may be
drained under local anesthesia either
transrectally or transperineally.
• A 4- to 6-week trial of antibiotic therapy is
indicated in chronic bacterial prostatitis and
chronic pelvic pain syndrome with
inflammation,

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