II. Epidemiology
- Young or middle aged patients (under age 50 years)
III. Pathophysiology
- Prostate inflammation without pathogenic organism
- Etiology not yet fully elucidated
- Pelvic Floor inflammation
- Perineal neuromuscular dysfunction
- Bladder neck spasm may increase Urethral pressure
- Intraprostatic urine reflux
- Chemical Prostatitis
IV. Symptoms (sudden onset)
-
Chronic Pain and discomfort in Pelvis
- Low pack pain
- Perineal pain
- Lower Abdominal Pain
- Scrotal Pain
- Pain in penis
- Pain in inner thighs
- Irritative urinary symptoms (Mild to Moderate)
- Urine hesitancy
- Urine interruption (voiding in pulses)
- Decreased urine stream and caliber
- Postvoid dribbling
- Associated symptoms
- Sexual Dysfunction
- Mood Disorder (e.g. emotional stress, Anxiety Disorder, Major Depression)
V. Signs
- General physical exam
-
Digital Rectal Exam
- Prostate minimally tender of normal on exam
VI. Labs
- Urinalysis and Urine Culture
- Urine Cytology
- Post-void residual
-
Expressed Prostatic Secretion
-
Leukocytosis
- White Blood Cells with excessive fat droplets
- Macrophages with excessive fat droplets
-
Urine Culture negative
- Segmented Urine Cultures normal in 75% of cases
-
Leukocytosis
VII. Diagnostics: Advanced testing to consider
- Prostate Specific Antigen
- Semen Analysis and culture
- Transrectal Ultrasonography-guided biopsy
- CT Abdomen and Pelvis
- Urine flow (urodynamics)
VIII. Differential Diagnosis
- See Prostatitis
- Chronic Bacterial Prostatitis
- Benign Prostatic Hyperplasia
- Voiding dysfunction
- Bladder Cancer
- Prostate Cancer
- Mullerian duct remnants
- Neuropathy
- Ejaculatory duct obstruction
-
Cystitis
- Interstitial Cystitis
- Radiation cystitis
- Eosinophilic cystitis
- Chronic proliferative cystitis
IX. Management
- See Chronic Prostatitis for urology Consultation
- Step 1: Consider causes above
- Step 2: Consider infectious cause
- Treat as Chronic Bacterial Prostatitis
- Step 3: Symptomatic Management
- See Prostatitis Management for general measures
- Obstructive Uropathy symptoms
- Pain symptoms predominate: Antiinflammatory agents
- Pentosan (Elmiron) 900 mg daily for 16 weeks
- Risk of Retinal damage (Pigmentary Maculopathy) with prolonged use (typically with years of use)
- Finasteride (Proscar) 5 mg daily for 6 weeks
- Quercetin (bioflavinoid supplement) 500 mg twice daily for 30 days
- Pentosan (Elmiron) 900 mg daily for 16 weeks
- Irritation symptoms: Anticholinergic Agents
- Neuropathic pain agents
- Step 4: Non-pharmacologic management
- Biofeedback
- Physical therapy
- Sacral neuromodulation
X. References
- Habermacher (2006) Annu Rev Med 57:195-206 [PubMed]
- Holt (2016) Am Fam Physician 93(4):290-6 [PubMed]
- Pontari (2008) Urol Clin North Am 35(1): 81-9 [PubMed]
- Pontari (2007) J Urol 177(6): 2050-7 [PubMed]
- Sharp (2010) Am Fam Physician 82(4): 397-406 [PubMed]
- Schaeffer (2006) N Engl J Med 355(16): 1690-8 [PubMed]