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• 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.
• 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
• 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
• Obstructive urinary tract symptoms,
including frequency, urgency, dysuria,
nocturia, hesitancy, weak stream, and
• Low back pain
• Low abdominal pain
• Spontaneous urethral discharge
• History of sclerotherapy for rectal prolapse
• Typically have no systemic symptoms.
Instead, these patients may present with the
• Intermittent dysuria
• Intermittent obstructive urinary tract
• Recurrent urinary tract infections [
• 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
• Obstructive urinary tract symptoms,
• Ejaculatory pain
• Erectile dysfunction
• Tender, nodular, hot, boggy, or normal-
feeling gland on digital rectal examination
• Suprapubic abdominal tenderness
• Enlarged tender bladder due to urinary
• Bladder outlet obstruction/urinary retention
• Abscess - Typically in immunocompromised
• Infertility due to scarring of the urethra or
• Recurrent cystitis
• Renal damage
• Although various routes have been
postulated, none has been firmly
• Acutegram-negative organisms
(eg, Escherichia coli, Enterobacter,
Enterococcus, and Proteusspecies).
• Chronic -cytomegalovirus
(CMV). Mycobacteria, such
as Mycobacterium tuberculosis, and fungi,
such as Candida albicans,
• 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
• Urinalysis and urine culture can confirm the
presence of infection and identify
• Fractional urine examination
• Cytology of expressed prostatic secretions
• Prostate inflammation can lead to elevation
of serum prostate-specific antigen (PSA).
• On transrectal ultrasonography-capsular
thickening and prostatic calculi.
• Computed tomography (CT)
• 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-
• 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
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