Causative & risk factors
Acute prostatitis is caused by a bacterial infection, and is frequently associated with a urinary tract infection.
Repeated urinary tract infections can lead to chronic bacterial prostatitis.
Bacterial prostatitis can be transmitted through sexual intercourse in some patients.
Chronic non-bacterial prostatitis is the commonest form of prostatitis. It is an inflammation of the prostate, however bacteria are absent.
Certain factors are associated with an increased risk of developing prostatitis. They include having BPH (benign prostatic hypertrophy), having a urinary catheter, suffering from cystitis or indulging in anal intercourse.
Clinical presentation
Acute bacterial prostatitis: Men with acute bacterial prostatitis develop sudden and severe urinary symptoms such as increased frequency, urgency and pain along the genito-urinary tract. They may have a high fever with chills. Untreated patients with acute bacterial prostatitis can develop complications like cystitis, prostatic abscess, hypotension and even death.
Prostatitis caused due to bacterial infection that lasts more than 3 months is known as chronic bacterial prostatitis. The symptoms are similar to those caused by acute bacterial prostatitis, however the intensity is lesser.
Non-bacterial chronic prostatitis is characterized by chronic pelvic pain. Pain is also experienced while ejaculating or during intercourse.
Men with prostatitis may develop a weak urinary stream and may sometimes have hematuria (blood in urine).
Investigations
All patients must undergo a digital rectal examination. A sample of the prostatic fluid is usually sent for analysis. A routine urine analysis is also performed.
A transrectal ultrasound may be performed to view the prostate. Biopsy of the prostate tissue is advised to some patients.
Uroflowmetry study may be done to assess the release of urine.
Other tests such as cystoscopy, semen analysis or blood tests may be done if deemed necessary.
Treatment
Patients with severe acute bacterial prostatitis may need to be hospitalized. They are treated with oral or intravenous antibiotics. IV fluids and analgesic drugs are given as and when necessary.
Patients with chronic bacterial prostatitis need not be hospitalized, but they do need long term antibiotic therapy.
For bacterial as well as non-bacterial chronic prostatitis, Sitz’s baths are recommended for pain relief. Anti-inflammatory medications are prescribed.
Severe cases of chronic prostatitis may necessitate surgical excision of the infected portion of the gland.
