Prostatitis, Bacterial 

  • Author: Joe D Mobley III, MD, MPH; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Oct 8, 2009
 

Background

Chronic bacterial prostatitis represents an infection of the prostate gland. By definition, this condition is characterized by bacterial growth in culture of the expressed prostatic fluid, semen, or postmassage urine specimen. The expressed prostatic secretion (EPS) usually contains more than 10 white blood cells (WBCs) per high-power field (HPF) and macrophages.

Bacterial prostatitis. Expressed prostatic fluid cBacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.

The hallmark of chronic bacterial prostatitis is the occurrence of relapsing urinary tract infections, usually involving the same pathogen. Chronic bacterial prostatitis is often confused with nonbacterial prostatitis, chronic pelvic pain syndrome (CPPS), and prostatodynia.

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Pathophysiology

The prostate gland is an accessory sex gland, providing approximately 15% of the ejaculate. The base of the prostate abuts the bladder neck, while the apex is in continuity with the membranous urethra, resting on the urogenital diaphragm.

The adult prostate weighs approximately 20 g but may grow dramatically with age (see Prostate Hyperplasia, Benign). The approximate dimensions are 4.4 cm transversely at the base, 3.4 cm in length, and 2.6 cm in anteroposterior diameter. Antibacterial factors within the prostate, such as zinc, help to prevent infection.

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Epidemiology

Frequency

United States

Prostatitis accounts for approximately 2 million annual visits. Twenty-five percent of all men evaluated for urologic problems in the United States are estimated to have symptoms of prostatitis. Approximately 50% of men experience symptoms of prostatitis at some time in their life. However, less than 5-10% of men with symptoms of prostatitis have bacterial prostatitis. Evaluation for these symptoms makes up approximately 8% of all urology visits.

International

Worldwide, 8 million prostatitis-related visits are reported annually.

Mortality/Morbidity

  • Chronic bacterial prostatitis is not associated with mortality. However, acute bacterial prostatitis (discussed in Acute Bacterial Prostatitis and Prostatic Abscess) represents a potentially lethal process if untreated.
  • The morbidity associated with chronic bacterial prostatitis is related to its relapsing nature. Chronic bacterial prostatitis may be difficult to eradicate because of the persistence of bacteria within the prostatic acini. Factors that contribute to bacterial persistence include (1) a poor ductal drainage system within the prostate, which can lead to congestion of prostatic secretions, and (2) the tendency for urine to reflux into the prostatic ducts, which may cause irritation and inflammation.

Race

No racial predilections have been identified.

Sex

Bacterial prostatitis affects in males.

Age

Chronic bacterial prostatitis typically affects men aged 40-70 years. Benign prostatic hyperplasia typically affects the same age group.

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Contributor Information and Disclosures
Author

Joe D Mobley III, MD, MPH  Chief Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center

Joe D Mobley III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Shlomo Raz, MD  Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

References

  1. Weidner W, Diemer T, Huwe P, Rainer H, Ludwig M. The role of Chlamydia trachomatis in prostatitis. Int J Antimicrob Agents. Jun 2002;19(6):466-70. [Medline].

  2. Wood HM, Shoskes DA. The role of nanobacteria in urologic disease. World J Urol. Feb 2006;24(1):51-4. [Medline].

  3. NIH Summary Statement. NIDDK Workshop on Chronic Prostatitis, Bethesda, Md. December 1995.

  4. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. Mar 1968;5(5):492-518. [Medline].

  5. Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications. Asian J Androl. Jul 2009;11(4):461-77. [Medline].

  6. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. Mar 1998;159(3):883-7. [Medline].

  7. Paulson DF, White RD. Trimethoprium-sulfamethoxazole and minocycline- hydrochloride in the treatment of culture-proved bacterial prostatitis. J Urol. Aug 1978;120(2):184-5. [Medline].

  8. Sohn DW, Han CH, Jung YS, Kim SI, Kim SW, Cho YH. Anti-inflammatory and antimicrobial effects of garlic and synergistic effect between garlic and ciprofloxacin in a chronic bacterial prostatitis rat model. Int J Antimicrob Agents. Sep 2009;34(3):215-9. [Medline].

  9. Meares ET. Chronic bacterial prostatitis: role of transurethral prostatectomy (TURP) in therapy. In: Schmiedt E, Alken JE, Bauer HW, eds. Therapy of prostatitis. Munich, Germany: Zuckerschwerdt Verlag; 1986:193-197.

  10. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84. [Medline].

  11. Plomp TA, Baert L, Maes RA. Treatment of recurrent chronic bacterial prostatitis by local injection of thiamphenicol into prostate. Urology. Jun 1980;15(6):542-7. [Medline].

  12. Jiménez-Cruz JF, Tormo FB, Gómez JG. Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control. J Urol. May 1988;139(5):967-70. [Medline].

  13. Magri V, Perletti G, Montanari E, Marras E, Chiaffarino F, Parazzini F. Chronic prostatitis and erectile dysfunction: results from a cross-sectional study. Arch Ital Urol Androl. Dec 2008;80(4):172-5. [Medline].

  14. Weidner W, Schiefer HG, Brahler E. Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median followup of 30 months. J Urol. Aug 1991;146(2):350-2. [Medline].

  15. Bjerklund Johansen TE, Grüneberg RN, Guibert J, Hofstetter A, Lobel B, Naber KG, et al. The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol. Dec 1998;34(6):457-66. [Medline].

  16. Budía A, Luis Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. 2006;40(4):326-31. [Medline].

  17. Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA, et al. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology. Sep 2003;62(3):537-41. [Medline].

  18. Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006;57:195-206. [Medline].

  19. Kaplan SA, Santarosa RP, D'Alisera PM, Fay BJ, Ikeguchi EF, Hendricks J, et al. Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. J Urol. Jun 1997;157(6):2234-7. [Medline].

  20. Krieger JN. Prostatitis revisited: new definitions, new approaches. Infect Dis Clin North Am. Jun 2003;17(2):395-409. [Medline].

  21. Kurzer E, Kaplan S. Cost effectiveness model comparing trimethoprim sulfamethoxazole and ciprofloxacin for the treatment of chronic bacterial prostatitis. Eur Urol. Aug 2002;42(2):163-6. [Medline].

  22. Leigh DA. Prostatitis--an increasing clinical problem for diagnosis and management. J Antimicrob Chemother. Jul 1993;32 Suppl A:1-9. [Medline].

  23. McGuire EJ, Lytton B. Bacterial prostatitis: treatment with trimethoprim-sulfamethoxazole. Urology. May 1976;7(5):499-500. [Medline].

  24. Meares EM Jr. Prostatitis. Med Clin North Am. Mar 1991;75(2):405-24. [Medline].

  25. Moon TD. Questionnaire survey of urologists and primary care physicians' diagnostic and treatment practices for prostatitis. Urology. Oct 1997;50(4):543-7. [Medline].

  26. Pansadoro V, Emiliozzi P, Defidio L, Scarpone P, Sabatini G, Brisciani A, et al. Prostate-specific antigen and prostatitis in men under fifty. Eur Urol. 1996;30(1):24-7. [Medline].

  27. Schaeffer AJ, Wendel EF, Dunn JK, Grayhack JT. Prevalence and significance of prostatic inflammation. J Urol. Feb 1981;125(2):215-9. [Medline].

  28. Shoskes DA, Katz E. Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. Jul 2005;6(4):296-9. [Medline].

  29. Shoskes DA, Thomas KD, Gomez E. Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol. Feb 2005;173(2):474-7. [Medline].

  30. Stamey TA, Meares EM Jr, Winningham DG. Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol. Feb 1970;103(2):187-94. [Medline].

  31. Wagenlehner FM, Naber KG. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Urol Rep. Aug 2004;5(4):309-16. [Medline].

  32. Wiygul RD. Prostatitis: epidemiology of inflammation. Curr Urol Rep. Jul 2005;6(4):282-9. [Medline].

  33. Wright ET, Chmiel JS, Grayhack JT, Schaeffer AJ. Prostatic fluid inflammation in prostatitis. J Urol. Dec 1994;152(6 Pt 2):2300-3. [Medline].

 
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Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
A nonspecific mixed inflammatory infiltrate that consists of lymphocytes, plasma cells, and histiocytes is typical in chronic bacterial prostatitis.
Urine culture with greater than 100,000 colony-forming units (CFU) of Escherichia coli, the most common pathogen in acute and chronic prostatitis. Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.
 
 
 
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