eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions
Nonbacterial Prostatitis: Differential Diagnoses & Workup
Updated: Mar 18, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Bladder Cancer | Nonbacterial Prostatitis |
| Chronic Pelvic Pain | Prostatitis, Bacterial |
| Chronic Pelvic Pain Syndrome and
Prostatodynia | Prostatitis, Tuberculous |
| Mycoplasma Infections | Urethral Strictures |
Other Problems to Be Considered
Pelvic floor tension myalgia
Dysfunctional voiding
Benign prostatic hyperplasia
Workup
Laboratory Studies
- A patient with abacterial prostatitis can be evaluated in 2 ways, described as follows:
- The first approach is to adhere strictly to the fact that these patients do not have an infection by performing an exhaustive search to exclude an infectious source. This often involves repetitive culturing of EPSs or prostate biopsy specimens using nonstandard culture media for Chlamydia, Ureaplasma, gonorrheal organisms, or anaerobes. Sophisticated research methods using RT-PCR techniques can also be employed. This first approach is very time-consuming and likely only of value in the research setting.
- A second method involves a trial of antibiotics for 2-4 weeks followed by a reevaluation of the patient for symptomatic improvement. If the patient improves, continued therapy with antibiotics for another 2-4 weeks is required for a clinical cure. This second method is often the one most commonly employed and is used first to treat patients with nonbacterial prostatitis. It succeeds approximately 50% of the time when used over a course of 4-6 weeks. If the patient does not improve with antibiotics, then another cause of symptoms must be sought and different treatment regimens must be initiated until symptoms are controlled.
- Category III prostatitis is divided into IIIa and IIIb based on whether greater or fewer than 10 WBCs are seen on microscopic examination of the EPS, respectively. However, the management approaches for these two categories do not differ, so they can be grouped together.
Imaging Studies
- Voiding cystourethrography findings can aid in the diagnosis of bladder neck dysfunction by demonstrating intraprostatic and ejaculatory duct urinary reflux.
- Retrograde urethrography findings may demonstrate a urethral stricture. This test is indicated if the patient demonstrates decreased peak urinary flow on uroflowmetry findings.
Other Tests
- If no improvement is observed after treatment with antibiotics and the patient has symptoms that are mostly irritative (eg, dysuria with urinary urgency and frequency), then carcinoma in situ of the bladder must be excluded using urine cytology studies and cystoscopy.
- Other causes can also be sought, and they are evaluated in no particular order. Further workup is based on the clinical suspicion of the urologist. In addition, some patients may complain of symptoms that are not life-limiting, whereas others are completely limited in their activities of daily life. The search for a cause to these symptoms may be based on each individual, and the appropriate health care consultant should be used for the more esoteric diagnoses.
- Interstitial cystitis requires a more complex workup. See Interstitial Cystitis.
- Many patients with abacterial prostatitis have emotional strife and some psychological difficulties (ie, socially, sexually, or both). Patients should be questioned with regard to their overall social adjustment. Stress level is important because stress is responsible for increased tension of the pelvic floor and the internal urinary sphincter, resulting in the symptoms of prostatitis.
Procedures
- Obstructive symptoms from a urethral stricture can be determined based on uroflow and retrograde urethrogram findings.
- Prostatic enlargement can be investigated using uroflowmetry or a pressure flow study and the International Prostate Symptom Score.
- Problems such as pelvic floor tension are more difficult to diagnose, but videourodynamic findings may be helpful in diagnosis. Patient symptoms of a dull ache or pressure in the rectal area may also suggest this diagnosis. A consultation with physical medicine and rehabilitation (PM&R) specialist may be beneficial for these patients.
- Myofascial trigger point release (TPM), a manipulative therapy that uses pressure on joints and soft tissue as trigger points to relieve pelvic floor muscle dysfunction has been shown to improve symptoms in some patients.
More on Nonbacterial Prostatitis |
| Overview: Nonbacterial Prostatitis |
 Differential Diagnoses & Workup: Nonbacterial Prostatitis |
| Treatment & Medication: Nonbacterial Prostatitis |
| Follow-up: Nonbacterial Prostatitis |
| Multimedia: Nonbacterial Prostatitis |
| References |
| Further Reading |
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References
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Keywords
nonbacterial prostatitis, chronic pelvic pain syndrome, CPPS, prostatodynia, abacterial prostatitis, noninflammatory chronic pelvic pain syndrome, noninflammatory CPPS, inflammatory chronic pelvic pain syndrome, inflammatory CPPS, asymptomatic inflammatory prostatitis, prostate pain, prostatitis symptom complex, chronic prostatitis symptom index, CPSI, irritative urologic symptoms, obstructive urologic symptoms
