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Introduction
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.
Classification
•
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
CPPS
CPPS
• CPPS is characterized primarily by
urological pain complaints in the absence of
urinary tract infection
Asymptomatic inflammatory
prostatitis
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
Clinical Features
Clinical Features
Acute Prostatitis
• Fever
• Chills
• Malaise
• Arthralgias
• Myalgias
• Perineal/prostatic pain
• Dysuria
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
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 [
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
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
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
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,
Pathophysiology
Pathophysiology
• Neisseria gonorrhoeae and Chlamydia
trachomatis
• indwelling urethral catheters
• Sclerotherapy for rectal prolapse
Complications
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.
Investigations
Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
Diagnostic Studies
Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan
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).
Diagnostic Studies
Imaging Studies
• On transrectal ultrasonography-capsular
thickening and prostatic calculi.
• Computed tomography (CT)
Management
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
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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Prostatitis.pptx

  • 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide.
  • 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.
  • 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
  • 7. CPPS • CPPS is characterized primarily by urological pain complaints in the absence of urinary tract infection
  • 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
  • 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,
  • 19. Pathophysiology • Neisseria gonorrhoeae and Chlamydia trachomatis • indwelling urethral catheters • Sclerotherapy for rectal prolapse
  • 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.
  • 23. Investigations • Laboratory Studies – Routine – Special • Imaging Studies • Tissue diagnosis – Cytology • FNAC – Histology
  • 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)
  • 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,
  • 31. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  • 32.
  • 33.
  • 34. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

Editor's Notes

  1. drpradeeppande@gmail.com 7697305442
  2. drpradeeppande@gmail.com 7697305442