Prostatitis

Prostatitis 

Updated: 01/29/2021

© Jun Wang, MD, PhD

General features

• Various etiology
• Chronic pelvic pain syndrome (CPPS): including prostatodynia, category III or abacterial prostatitis, is the most common urological diagnosis in men older than 50 years

Diagnostic approaches

• Quantitative bacterial cultures and microscopic examination of fractionated urine specimens and expressed prostatic secretions

Acute bacterial prostatitis

• Commonly due to Gram-negative bacteria
  
• Associated with reflux, surgical manipulation or sexually transmitted disease
• Usually localized, may cause obstruction, retention, abscess 
• Diagnosis: Symptoms, digital rectal exam for edematous prostate, urine Gram stain and culture

Chronic bacterial prostatitis

• Chronic or recurrent urogenital symtoms
  
• Evidence of prostate bacterial infection
  
• Diagnosis: symptom, enlarged prostate, prostate fluid culture

Chronic prostatitis/Chronic pelvic pain syndrome

• Pelvic pain or discomfort for at least 3 of the preceding 6 months
  
• Commonly with urologic symptoms and sexual dysfunction
  
• Diagnosis clinically after excluding other etiology
  

Granulomatous prostatitis

• Usually idiopathic
• Necrotizing or non-necrotizing granulomas
• May be associated with BCG treatment for bladder cancer
• Also occurs post-transurethral resection
• Other causes include fungal infection

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