Chronic prostatitis is characterized by an onset of more than three months.
Bacteria can infect the prostate through ascending urethral infection, rectal bacteria spread through lymphogen, systemic spread of bacteria, recurrent UTI with prostatic reflux, or inadequate management of acute bacterial prostatitis. Etiologies may include gram-negative rods, Escherichia coli, fungi, Chlamydia trachomatis, Trichomonas vaginalis, Ureoplasma urealyticum, and Mycobacterium.
Non-bacteria etiologies, such as nerve problems, previous secondary infection, and chemical irritation, can cause chronic prostatitis. It can show without positive bacterial cultures from prostatic secretions.
Chronic prostatitis can occur as an inflammation of the prostate due to a secondary previous infection.
Nerve problems are suggested to contribute as a cause of chronic prostatitis due to neurogenic inflammation. This inflammation may cause nerves to secrete mediators, which can induce local inflammation and/or hyperalgesia. Nerve damage can also cause neuromuscular dysfunction, resulting in bladder-neck spasms. As a result, intraprostatic urinary reflux will occur.
Chemical irritation can cause chronic prostatitis due to urine reflux, even if it's sterile. An example of this chemical is urate, one of the metabolites of urine.
Patients may experience urinary frequency (frequent urinates: around every 1-2 hours, especially at night) and urgency (patient has the urge to urinate). Inflammation causes these symptoms to occur.
Dysuria is a pain or burning sensation when the patient urinates. This symptom can occur in any source of inflammation in the urinary tract, especially the prostate, bladder, or urethra.
Patients can experience pain. This pain can occur in the lower back, suprapubic, penis, testes, or scrotum. Patients can also experience painful ejaculation.
Digital rectal examination in patients can show a warm, tender, and enlarged prostate.
Treatment may include underlying causes such as antibiotics, alpha-blockers such as tamsulosin, which helps lower urinary tract symptoms, cognitive behavioral therapy, and physiotherapy to reduce symptoms. The antibiotic is chosen empirically based on local resistance patterns: uropathogenic treatment with trimethoprim and sulfamethoxazole or fluoroquinolone, and sexually transmitted pathogens are treated with ceftriaxone and azithromycin.
Picmonic's rapid review multiple-choice quiz allows you to assess your knowledge.
*Average video play time: 2-3 minutes
Unforgettable characters with concise but impactful videos (2-4 min each)