PROSTATITIS PROSTATE INFLAMMATION

Urology

Prostatitis
Definition : Infection and/or inflammation of the prostate.
Epidemiology : Overall prevalence in men is 5%. Age groups at increased risk are 20 - 50 and >70 years old.
Pathogenesis : The tissues surrounding the prostatic acini become infiltrated with inflammatory cells (lymphocytes). The most common infective agents are gram-negative Enterbacteriacae (Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Serratia, Enterobacter aerogenes). Both type 1 and P pili are important bacterial virulence factors that facilitate infection. 5 - 10% of infections are caused by gram-positive bacteria (Staphylococcus aureus and saprophyticus, Streptococcus faecalis). The aetiology of inflammatory and non-inflammatory forms of prostatitis is not well understood.

Risk factors
UTI; acute epididymitis; urethral catheters; transurethral surgery; intraprostatic ductal reflux; phimosis; prostatic stones (which can provide a nidus of infection for chronic prostatitis).
Segmented urine cultures
localize bacteria to a specific part of the urinary tract by sampling different parts of the urinary stream, with or without prostatic massage (which produces expressed prostatic secretions EPS).
- VB1 first 10mls of urine voided. Positive culture indicates urethritis or prostatitis.
- VB2 midstream urine. Positive culture indicates cystitis.
- VB3 first 10mls of urine voided following prostatic massage. Positive culture indicates prostatitis.
- EPS Positive culture indicates prostatitis.

Classification of prostatitis
- Acute bacterial prostatitis (ABP)
- Chronic bacterial prostatitis (CBP)
- Chronic pelvic pain syndrome (CPPS)
IIIA Inflammatory CPPS (chronic non-bacterial prostatitis): WBC in EPS, VB3, or semen
IIIB Non-inflammatory CPPS (prostatodynia): no WBC in EPS, VB3 or semen
- Asymptomatic inflammatory prostatitis (histological prostatitis)

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