PROSTATE INFECTION 1.Acute Bacterial Prostatitis 2.Chronic Bacterial Prostatitis 3.Granulomatous Prostatitis 4.Prostate Abscesss

PROSTATE INFECTION

1. Acute Bacterial Prostatitis2. Chronic Bacterial Prostatitis3. Granulomatous Prostatitis4. Prostate Abscesss

PROSTATE INFECTION


Acute Bacterial Prostatitis

• inflammation of the prostate associated with a UTI.

• It is thought that infection results from ascending urethral infection or reflux of infected urine from the bladder into the prostatic ducts


• uncommon in prepubertal boys but frequent affects adult men

• most common urologic diagnosis in men younger than 50 years

• Clinical presentation:– present with an abrupt onset of constitutional

• Fever, chills, malaise, arthralgia, myalgia, lower back/rectal/perineal pain

• urinary symptoms (frequency, urgency, dysuria)• Urinary retention due to swelling of the prostatate• DRE: tender, enlarged glands that are irregular and warm

Acute Bacterial Prostatitis• Laboratory findings:

– Urinalysis : WBCs and occasionally hematuria– Serum blood analysis: leukocytosis– Prostate-specific antigen levels: elevated– Culture of urine and prostate expressate: usually single oragnism but occasionally, polymicrobial infection may occur.

• Pathogens:– E. Coli: most common– Gram negative bacteria: Proteus, Klebsiella,

Enterobacter, Pseudomonas, and Serratia spp., enterococci – less frequent

– Anaerobic and other gram-positivebacteria -rare


• Management:• Empiric therapy against Gram negative bacteria

Enterococci, immediately while awaiting for culture results

• Trimethoprim and fluoroquinolones• Ampicillin and an aminoglycoside

– effective therapy against both gram-negative bacteria and enterococci

PROSTATE INFECTION


PROSTATE INFECTION


Chronic Bacterial Prostatitis

• In contrast to the acute form, chronic bacterial prostatitis has:– a more insidious onset, characterized by

relapsing, recurrent UTI caused by the persistence of pathogen in the prostatic fluid despite antibiotic therapy.


• Clinical Presentation:– dysuria, urgency, frequency, nocturia, and low

back/perineal pain– Afebrile– not uncommonly have a history of recurrent or relapsing

UTI, urethritis, or epididymitis caused by the same organism

– asymptomatic, but the diagnosis is made after investigation for bacteriuria

– DRE: normal; occasionally, tenderness, firmness, or prostatic calculi may be found on examination


• Laboratory findings:– Urinalysis: variable degree of WBC &bacteria – Serum blood analysis: no leukocytosis– Prostate-specific antigen levels: elevated– Diagnosis is made after

• causative oragnisms:– similar to those of acute bacterial prostatitis

• other gram-positive bacteria:– Mycoplasma, Ureaplasma, and

Chlamydia spp. are not causative pathogens in chronic bacterial prostatitis.


Diaganosis is made after the identification of bacteria from prostate expressate or urinespecimen after a prostatic massage, using the 4-cup test


• Management:– Similar to acute bacterial prostatitis– duration of antibiotic therapy: 3–4 months.– Using fluoroquinolones, some patients may

respond after 4–6 weeks of treatment.– addition of an alpha blocker to antibiotic therapy

has been shown to reduce symptom recurrences


• Recurrent episodes of infection occur despite antibiotic therapy:– TMP-SMX 1 single-strength tablet daily– Nitrofurantoin 100 mg daily, or– ciprofloxacin 250 mg daily

• Transurethral resection of the prostate has been used to treat patients with refractory disease; however, the success rate has been variable and this approach is not generally recommended

PROSTATE INFECTION


PROSTATE INFECTION


Granulomatous Prostatitis

• uncommon form of prostatitis• can result from bacterial, viral, or fungal

infection, the use of bacillus Calmette-Guerin therapy

• malacoplakia, or systemic granulomatous diseases affecting the prostate


• Clinical Presentation:– acutely, with fever, chills, and obstructive/irritative

voiding symptoms– Some with urinary retention– eosinophilic granulomatous prostatitis –severely ill

with high fevers– DRE: hard, indurated, and fixed prostate, which is

difficult to distinguish from prostate carcinoma.

Granulomtaous Prostatitis

• Laboratory findings:– Urinalysis and culture:• do not show any evidence of bacterial

infection

– Serum blood analysis – leukocytosis, marked eosinophilia in patients with eosinophilic type

• The diagnosis is made after biopsy of the prostate.


• Management:– Some patients respond to antibiotic therapy,

corticosteroids and temporary bladder drainage. – Transurethral resection of the prostate may be

required in patients who do not respond to treatment and have significant outlet obstruction.

PROSTATE INFECTION


PROSTATE INFECTION


Prostate Abscess

• complications of acute bacterial prostatitis that were inadequately or inappropriately treated.

• Seen in patient :– diabetes– chronic dialysis patients– Immunocompromised– chronic indwelling catheters

Prostate Abscess

• Clinical Presentation:– similar symptoms to those with acute bacterial

prostatitis. – these patients were treated for acute bacterial

prostatitis previously and had a good initial response to treatment with antibiotics.

– However, their symptoms recurred during treatment, suggesting development of prostatic abscesses.

– DRE: prostate is usually tender and swollen

Prostate Abscess

• Management:– Antibiotic therapy in conjunction with drainage of

the abscess is required– Transrectal ultrasonography or CT scan can be

used to direct transrectal drainage of the abscess– Transurethral resection and drainage may be

required if transrectal drainage is inadequate.– When properly diagnosed and treated, most cases

of prostatic abscess resolve without significant sequelae

Documents

PROSTATE INFECTION 1.Acute Bacterial Prostatitis 2.Chronic Bacterial Prostatitis 3.Granulomatous Prostatitis 4.Prostate Abscesss