History
Patients with acute bacterial prostatitis may present with the following:
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Fever
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Chills
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Malaise
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Arthralgias
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Myalgias
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Perineal/prostatic pain
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Dysuria
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Obstructive urinary tract symptoms, including frequency, urgency, dysuria, nocturia, hesitancy, weak stream, and incomplete voiding
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Low back pain
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Low abdominal pain
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Spontaneous urethral discharge
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History of sclerotherapy for rectal prolapse
Patients with chronic bacterial prostatitis typically have no systemic symptoms. Instead, these patients may present with the following:
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Intermittent dysuria
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Intermittent obstructive urinary tract symptoms
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Recurrent urinary tract infections [2]
Patients with chronic prostatitis and chronic pelvic pain syndrome may present with the following:
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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]
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Obstructive urinary tract symptoms, including frequency, dysuria, and incomplete voiding
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Ejaculatory pain
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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.
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:
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Tender, nodular, hot, boggy, or normal-feeling gland on digital rectal examination
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Suprapubic abdominal tenderness
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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:
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Normal examination findings between acute episodes
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Tender, nodular, or normal gland on digital rectal examination
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Suprapubic tenderness during acute episodes
Physical examination in patients with chronic prostatitis and chronic pelvic pain syndrome may reveal the following:
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Mildly tender or normal prostate on digital rectal examination
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Tight anal sphincter on digital rectal examination
Digital rectal examination in patients with asymptomatic inflammatory prostatitis may reveal a normal prostate.
Complications
Potential complications of prostatitis include the following:
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Bladder outlet obstruction/urinary retention
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Abscess - Typically in immunocompromised patients
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Infertility due to scarring of the urethra or ejaculatory ducts
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Recurrent cystitis
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Renal damage
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Sepsis
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Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
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A nonspecific mixed inflammatory infiltrate that consists of lymphocytes, plasma cells, and histiocytes is typical in chronic bacterial prostatitis.
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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.
