Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.

Prostatitis is an inflammatory disease of the prostate gland that can present with lower abdominal pain, urinary incontinence, and sexual dysfunction. The diagnosis of prostatitis encompasses two main conditions: acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). Urinary dysfunction is a key factor in the pathogenesis of chronic prostatitis. Overactive contraction of the urinary sphincter can cause bladder outlet obstruction and residual urine, which can lead to urinary reflux into the prostate. Alpha-1-adrenergic receptor antagonists (alpha blockers) are a class of drugs that inhibit smooth muscle contraction in the prostate and bladder neck. Tamsulosin is the first selective 1-adrenergic receptor antagonist, primarily the 1A and 1D subtypes, which are found in the smooth muscle of the prostate, bladder neck, and prostatic urethra. Blockade of these receptors reduces smooth muscle tone in these structures, which, in turn, improves urine flow from the bladder. We carried out a systematic review of the literature to evaluate the efficacy of tamsulosin in the treatment of acute and chronic bacterial and abacterial prostatitis, as well as chronic pelvic pain syndrome (CPPS). A search for clinical trials was carried out in the PubMed database, the clinical trials registry clinicaltrials.gov, and the Russian electronic library elibrary.ru by two independent researchers using keywords describing treatments that potentially included tamsulosin. The search yielded information on 21 publications, 20 of which were included in the systematic review. Five studies were non-comparative, meaning they analyzed only patients receiving tamsulosin in addition to background therapy. The remaining studies had different comparison groups and could include active strategies such as antibacterial, analgesic, anti-inflammatory, herbal (urological) medications, and others. Treatment duration ranged from 4 to 52 weeks. The prescribed dose of tamsulosin was 0.4 mg orally once daily. Most studies used the NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) scores to evaluate outcomes. The average age of the participants ranged from 28.9 to 59.1 years. The quality of the included studies was highly variable. Of the 20 studies included in this review, 19 examined the use of tamsulosin in patients with CP/CPPS. Positive treatment outcomes were observed in all studies using tamsulosin. Increases in maximum urinary flow rate, significant symptom regression, as measured by standardized scales, and improvements in quality of life were observed. The greatest differences in symptom regression were observed early in treatment, up to 45 days. This is likely due to the fact that urinary dysfunction, pain, and decreased quality of life become more prominent early in the disease course. The safety of the treatment was assessed in 15 of the 20 studies. No standardized scales were used to assess safety. The safety of tamsulosin was assessed based on the reporting of adverse reactions. The development of serious adverse reactions (defined in Roszdravnadzor Order No. 1071 of February 15, 2017) was reported in two studies, but it was not possible to reliably link them to tamsulosin use. CONCLUSION: The results of this systematic review confirm that tamsulosin is an effective drug for inclusion in combination treatment regimens for various forms of prostatitis, including CBP, chronic abacterial prostatitis, and CPPS. Its use significantly reduces symptoms such as pain and dysuria, which in turn improves patients' quality of life.

The management of male urinary tract infections (UTIs) has historically been based on a monolithic approach, under which every episode was treated as acute prostatitis, leading to prolonged antibiotic courses. To address rising bacterial resistance and promote antimicrobial stewardship, the French Infectious Diseases Society (SPILF) updated its guidelines in 2026, introducing a stratified management framework. This review outlines the scientific evidence underlying these updated recommendations. A comprehensive review of recent literature, including randomized controlled trials and large-scale retrospective cohorts, was conducted so as to evaluate antibiotic efficacy, resistance patterns, and optimal treatment durations for male cystitis, febrile UTIs (prostatitis/pyelonephritis), and acute epididymo-orchitis. Evidence validates distinguishing male cystitis from febrile UTI. For male cystitis, 7-day regimens using narrow-spectrum oral agents-such as fosfomycin trometamol, nitrofurantoin, or pivmecillinam-achieve satisfactory clinical success with minimal risk of complications. Conversely, febrile UTIs require initial parenteral third-generation cephalosporins or oral fluoroquinolones. For targeted oral step-down therapy in prostatitis, cotrimoxazole is preferred over fluoroquinolones so as to minimize ecological impact, while amoxicillin remains the drug of choice for enterococcal coverage. Although recent data show that seven days can be sufficient for selected bacteremic presentations, to prevent relapses a conventional 14-day duration remains the standard for acute prostatitis. Non-sexually transmitted orchitis and epididymitis require a 10-day course of fluoroquinolones or cotrimoxazole. The 2026 SPILF guidelines represent a paradigm shift toward a tailored, stratified approach.

The diagnosis of acute community-acquired bacterial urinary tract infections (UTIs) in adult men presently recognizes four key clinical entities: cystitis, prostatitis, pyelonephritis, and epididymo-orchitis, each with distinct diagnostic criteria. Bacteriuria of clinically undetermined significance, defined as documented bacteriuria with non-specific systemic symptoms (e.g., confusion, functional decline, or isolated fever) but no localized UTI signs, is common in elderly patients and requires evaluation with sepsis risk scores so as to avoid unnecessary antibiotics. Urinary colonization, frequent in older men, does not warrant treatment unless prior to urological procedures. Cystitis is diagnosed by local symptoms (dysuria, urgency, suprapubic pain), absence of fever, and positive urine culture, ruling out prostatitis or pyelonephritis. Acute prostatitis is identified by cystitis symptoms plus fever or sepsis, with imaging reserved for complications. Acute pyelonephritis is diagnosed by fever or sepsis, flank pain (spontaneous or on percussion), and positive urine culture; cystitis symptoms may be absent. Urine culture (thresholds: ≥10[3] CFU/mL for bacteriuria, leukocyturia >30 × 10[3]/mL) remains the gold standard, while urine dipstick testing is not recommended due to low predictive value. Routine blood tests (inflammatory markers, PSA, or blood cultures) are unnecessary in outpatient management, even for febrile UTIs, unless acute kidney injury or complications are suspected. Pyelonephritis requires imaging (urgent in cases of sepsis or obstruction) to assess for uropathy, and epididymo-orchitis mandates STI screening.

Contained rupture of a mycotic abdominal aortic aneurysm (AAA) is rare and potentially fatal. While most cases involve Salmonella or Staphylococcus aureus, Escherichia coli is an uncommon cause.A man in his early 60s presented with acute E. coli prostatitis and a prostatic abscess. Abdominal ultrasound incidentally revealed a 3.8 cm infrarenal saccular AAA suspicious for contained rupture. Contrast-enhanced CT confirmed focal aortic wall disruption without active extravasation. Intravenous ceftriaxone and vancomycin were initiated, and serial imaging demonstrated stability. After infection control, endovascular aneurysm repair (EVAR) with an Endurant II stent graft was successfully performed. Recovery was uneventful and the patient completed targeted antibiotic therapy.This case illustrates an unusual presentation of E. coli-associated mycotic aneurysm detected before frank rupture. Early imaging, infection control and multidisciplinary coordination enabled a staged strategy with a favourable outcome.

Seminal fluid is more than a vehicle for sperm transport. It contains a complex mix of immune-regulatory cytokines that, together with other bioactive factors, influence sperm maturation and survival, and interact with female reproductive tract cells and tissues to facilitate conception and stimulate female receptivity to pregnancy. Cytokines synthesized in the seminal vesicles, prostate, and other male accessory glands come into contact with sperm at ejaculation, and upon intromission are delivered to the cervix and uterus in soluble form, as cargo of seminal extracellular vesicles, or in physical association with sperm. The relative concentrations of different cytokines vary between individual men and can fluctuate over time - in response to local and systemic viral or bacterial infection, acute and chronic inflammatory and metabolic disorders, such as varicocele, prostatitis and diabetes, and environmental exposures including heat stress, chemical toxin exposures, and smoking. Although seminal fluid cytokines in healthy men promote fertility through permissive effects on embryo development and implantation, elevated abundance of certain proinflammatory cytokines is linked with infertility and subfertility. Emerging insight on the identity and biological functions of key permissive and inhibitory seminal fluid cytokines indicates potential clinical applications in evaluating and managing male and female infertility, and for developing improved assisted reproduction techniques. However, knowledge gaps on the significance of cytokines in reproductive biology and pathophysiology, the most informative cytokines to measure and their normal ranges, and technical challenges regarding optimal assay platforms and protocols, first must be overcome.

We report the case of a man in his 70s who presented with constitutional symptoms and intermittent confusion, ultimately diagnosed with a large, complex retroperitoneal and extraperitoneal abscess. He had a background of recurrent urinary tract infections over the preceding year. Initial imaging revealed a multi-loculated collection. Surgical incision and drainage yielded 1000 mL of pus, and cultures identified multiple strains of Escherichia coli required tailored antibiotic therapy. Interval imaging revealed a residual collection requiring a second surgical intervention. Further inpatient investigations also raised suspicion for underlying prostate carcinoma. The patient made a full recovery and demonstrated complete resolution of inflammatory markers.This case illustrates the diagnostic complexity of deep-seated polymicrobial infections presenting with non-specific constitutional symptoms and underscores the need to consider multistrain pathogens and underlying urological pathology in patients with a history of recurrent urinary tract infections. It also underscores the value of holistic assessment and management during and after hospital admission.

BACKGROUND: Klebsiella pneumoniae is a common nosocomial pathogen capable of causing invasive disease, including sepsis and meningitis, even in immunocompetent hosts. Involvement of the scrotum, manifesting as scrotal abscess or Fournier’s gangrene, is uncommon and under-recognized. We report three K. pneumoniae scrotal infections and provide microbiological characterization to highlight their clinical relevance and novelty. CASE PRESENTATION: Three elderly male patients (aged 68, 78, and 85 years) with diabetes and a history of rectal or prostate cancer presented with acute scrotal swelling, erythema, and ulceration. Two cases progressed to Fournier’s gangrene (necrotizing fasciitis). All underwent urgent surgical debridement or abscess drainage, combined with susceptibility-directed antimicrobial therapy (cefazolin, cefotaxime, or ciprofloxacin). K. pneumoniae was identified as the sole pathogen in all cases, including one hypervirulent ST23 strain. All patients achieved significant clinical improvement and were discharged with healed or healing wounds. CONCLUSION: Although rare, K. pneumoniae should be considered as a potential pathogen in scrotal infections, especially in patients with diabetes and cancer. Early recognition, prompt surgical source control and susceptibility-directed antimicrobial therapy are crucial for favorable outcomes. CLINICAL TRIAL: Clinical trial number: Not applicable. This study was not registered as a clinical trial because it was a descriptive cross-sectional study involving the analysis of bacterial isolates from clinical specimens, which did not meet the criteria for a clinical trial.