Description

• Inflammatory or painful condition affecting the prostate gland; variety of etiologies
• National Institutes of Health’s (NIH) prostatitis classification:
  • Acute infection (NIH class I): Febrile illness with perineal pain, dysuria, and obstructive symptoms
  • Chronic bacterial prostatitis (NIH class II): Recurrent infection with pain and voiding disturbances
  • Chronic abacterial prostatitis/chronic pelvic pain syndrome (NIH class III):
    • Inflammatory (NIH class IIIa): Significant inflammatory cells in prostatic secretions, postprostatic massage urine, or semen
    • Noninflammatory (NIH class IIIb): Insignificant number of inflammatory cells (prostatosis)
  • Asymptomatic inflammatory prostatitis (NIH class IV): Incidental finding during prostate biopsy for infertility, cancer workup
• System(s) affected: Renal/Urologic; Reproductive

Epidemiology

• 2 million cases annually in the US
• Predominant age: 30–50 years, sexually active; chronic more common in those >50
• Bacterial prostatitis occurs more frequently in patients with HIV.

Prevalence
2.2–9.7% of male population

Risk Factors

• Age >50 years
• Prostate biopsy (especially in patients with prior exposure to quinolones) (1)
• Prostatic calculi
• UTI
• Trauma (e.g., bicycle, horseback riding)
• Dehydration
• Sexual abstinence
• Chronic indwelling catheter
• Intermittent catheterization
• HIV infection
• Urethral stricture
• Cystoscopy
• Urethral dilatation
• Transurethral resection of prostate

General Prevention

Antibiotic prophylaxis and enema prior to prostatic biopsy

Pathophysiology

• Extension of UTI
• May occur following manipulation/biopsy of prostate or urethra
• Ascending infection through urethra

Etiology

• Infectious: NIH classes I and II:
  • Aerobic gram-negative bacteria (e.g., E. coli, Klebsiella, Proteus, Pseudomonas, N. gonorrhoeae, B. pseudomallei)
  • Miscellaneous: C. trachomatis, Ureaplasma, trichomoniasis
  • Gram-positive bacteria (S. faecalis, S. aureus)
  • Organisms suspected but unproven (S. epidermidis, S. micrococci, non–group D Streptococcus, diphtheroids)
  • Uncommon: M. tuberculosis, parasitic, mycoses (blastomycosis, coccidioidomycosis, cryptococcus, histoplasmosis, paracoccidioidomycosis, candidiasis)
• Nonbacterial: Cause unknown: Leading theory suggests nonrelaxation (spasm) of the internal urinary sphincter and pelvic floor striated muscles leading to increased prostatic urethral pressure and intraprostatic urinary reflux.

Commonly Associated Conditions

• Prostatic hypertrophy
• Cystitis
• Urethritis
• Pyelonephritis
• Sexual dysfunction