Prostatitis Clinical Presentation

  • Author: Paul J Turek, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jun 27, 2011
 

History

Patients with acute bacterial prostatitis may present with the following:

  • Fever
  • Chills
  • Malaise
  • Arthralgias
  • Myalgias
  • Perineal/prostatic pain
  • Dysuria
  • Obstructive urinary tract symptoms, including frequency, urgency, dysuria, nocturia, hesitancy, weak stream, and incomplete voiding
  • Low back pain
  • Low abdominal pain
  • Spontaneous urethral discharge
  • History of sclerotherapy for rectal prolapse

Patients with chronic bacterial prostatitis typically have no systemic symptoms. Instead, these patients may present with the following:

  • Intermittent dysuria
  • Intermittent obstructive urinary tract symptoms
  • Recurrent urinary tract infections[2]

Patients with chronic prostatitis and chronic pelvic pain syndrome may present with the following:

  • Pelvic pain or discomfort, including perineal, suprapubic, coccygeal, rectal, urethral, and testicular/scrotal pain for more than 3 of the previous 6 months without documented urinary tract infections from uropathogens[2]
  • Obstructive urinary tract symptoms, including frequency, dysuria, and incomplete voiding
  • Ejaculatory pain
  • Erectile dysfunction

Asymptomatic inflammatory prostatitis by definition produces no symptoms.

Consider a diagnosis of sexually transmitted prostatitis in sexually active adolescents.

Do not overlook the prostate gland when searching for a source of sepsis in patients with diabetes mellitus, patients on dialysis for chronic renal failure, patients who are immunocompromised, and postsurgical patients who have had urethral instrumentation. In all those settings, prostatitis can lead to urosepsis.

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Physical Examination

Of importance, the physical examination findings, especially the rectal examination, are not specific for each diagnostic category of prostatitis. However, the examination in patients with acute bacterial prostatitis may reveal the following:

  • Tender, nodular, hot, boggy, or normal-feeling gland on digital rectal examination
  • Suprapubic abdominal tenderness
  • Enlarged tender bladder due to urinary retention

Avoid prostatic massage in patients with acute bacterial prostatitis.

Physical examination in patients with chronic bacterial prostatitis may reveal the following:

  • Normal examination findings between acute episodes
  • Tender, nodular, or normal gland on digital rectal examination
  • Suprapubic tenderness during acute episodes

Physical examination in patients with chronic prostatitis and chronic pelvic pain syndrome may reveal the following:

  • Mildly tender or normal prostate on digital rectal examination
  • Tight anal sphincter on digital rectal examination

Digital rectal examination in patients with asymptomatic inflammatory prostatitis may reveal a normal prostate.

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Complications

Potential complications of prostatitis include the following:

  • Bladder outlet obstruction/urinary retention
  • Abscess - Typically in immunocompromised patients
  • Infertility due to scarring of the urethra or ejaculatory ducts
  • Recurrent cystitis
  • Pyelonephritis
  • Renal damage
  • Sepsis
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Contributor Information and Disclosures
Author

Paul J Turek, MD  Director, The Turek Clinic; Former Professor in Residence, Academy of Medical Educators Endowed Chair, Department of Urology, Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine

Paul J Turek, MD is a member of the following medical societies: American Association of Clinical Urologists, American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Society for the Study of Male Reproduction

Disclosure: BioQuiddity, Inc Ownership interest Board membership; HealthLoop.com Ownership interest Board membership; MandalMed, Inc Intellectual property rights Management position

Coauthor(s)

Tarlan Hedayati, MD  Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christine R Stehman, MD  Resident Physician, Department of Emergency Medicine, John H Stroger Hospital of Cook County

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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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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