prostatitis

Synopsis

 Diagnosis based on quantitative bacterial cultures and microscopic examination of fractionated urine specimens (first 10 ml of urine is urethral, midstream urine is from bladder) and expressed prostatic secretions
 Definition: >10 WBC/HPF in prostatic secretions without pyuria; prostatic secretion cultures should have bacterial counts 10x urethral/bladder cultures
 Clinical: elevated PSA
 Treatment: difficult because antibiotics penetrate poorly into prostate
 Micro: macrophages in stroma, neutrophils in ducts/acini are specific for acute prostatitis and usually localized; lymphoid aggregates are common with aging and nodular hyperplasia and not specific for prostatitis

Differential diagnosis

 lymphoid aggregates:

• SLL
• CLL

PSA

Prostatitis can elevate the serum prostate specific antigen (PSA), but generally not more than double normal, and generally not increasing significantly over time. (Potts, 2001){}

Types

 acute prostatitis

• Acute bacterial prostatitis: same bacteria types as urinary tract infections (E. coli, gram negative rods, enterococci, staphylococci), usually due to reflux, also following surgical manipulation or sexually transmitted disease; usually localized, may cause obstruction, retention, abscess

 chronic prostatitits

• Chronic bacterial prostatitis:
  • symptoms of low back pain, dysuria, perineal and suprapubic discomfort;
  • often have history of urinary tract infection by same organism;
  • may have NO symptoms

• Chronic abacterial prostatitis:
  • similar clinically to chronic bacterial prostatitis but negative cultures;
  • may be due to sexually transmitted disease organisms of Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma hominis

Links

 WebPathology