II. Epidemiology
- Prostatitis accounts for 25% genitourinary complaints in men
III. Types: NIH Consensus Classification of Prostatitis
-
Acute Bacterial Prostatitis
- Severe, acute prostate Bacterial Infection with an ill, toxic appearing patient
-
Chronic Bacterial Prostatitis
- Symptoms >3 months with culture demonstrating the same organism
- Chronic Nonbacterial Prostatitis (90% of Chronic Prostatitis)
- Symptoms >3 months with inconsistent culture results
- May be Inflammatory (White Blood Cells >10 per HPF) or Non-Inflammatory
- Causes Chronic Pelvic Pain in Men
- Asymptomatic Prostatitis
- White Blood Cells >10 per HPF despite lack of symptoms
IV. Types: Uncommon
- Gonococcal Prostatitis (NeisseriaGonorrheae)
- Tuberculous Prostatitis (Tuberculosis)
- Parasitic Prostatitis (e.g. Trichomonas vaginalis)
- Mycotic Prostatitis (Fungal organisms - Aspergillus, Candida, Cryptococcus, Histoplasma)
V. Symptoms
- Irritative urinary symptoms
- Dysuria
- Urinary Frequency
- Urinary urgency
- Ejaculatory pain
- Hematospermia
- Referred pain
- Low pack pain
- Perineal pain
- Lower Abdominal Pain
- Scrotal Pain
- Pain in penis
- Pain in inner thighs
- Systemic symptoms (e.g. fever)
- Suggests Acute Prostatitis, Prostate abscess or other significant acute infection
- Obstructive urinary symptoms (diminished urinary stream, hesitancy, straining)
VI. Exam
- Abdominal exam including Pelvis and flank
- Genitourinary exam (scrotal exam and penis exam)
-
Digital Rectal Exam
- Avoid Prostatic Massage in suspected Acute Bacterial Prostatitis
- Obtain Urinalysis and Urine Culture before and after Prostatic Massage
VII. Differential Diagnosis
VIII. Precautions
-
Cystoscopy (and urine cytology) Indications
- Hematuria and Bladder Cancer risk factors (Tobacco Abuse, age >40 years old)
IX. Management
- See Acute Bacterial Prostatitis
- See Chronic Bacterial Prostatitis
- See Chronic Nonbacterial Prostatitis
X. References
- Cooner (1994) Am Fam Physician, p. 9-15
- Coker (2016) Am Fam Physician 93(2): 114-20 [PubMed]
- Holt (2016) Am Fam Physician 93(4):290-6 [PubMed]
- Krieger (1999) JAMA 281(3): 236-7 [PubMed]