1. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

2. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

3. Acute Bacterial Prostatitis
inflammation of the prostate associated with a UTI.
It is thought that infection results from ascending urethral infection or reflux of infected urine from the bladder into the prostatic ducts

4. Acute Bacterial Prostatitis
uncommon in prepubertal boys but frequent affects adult men
most common urologic diagnosis in men younger than 50 years
Clinical presentation:
present with an abrupt onset of constitutional
Fever, chills, malaise, arthralgia, myalgia, lower back/rectal/perineal pain
urinary symptoms (frequency, urgency, dysuria)
Urinary retention due to swelling of the prostatate
DRE: tender, enlarged glands that are irregular and warm

5. Acute Bacterial Prostatitis
Laboratory findings:
Urinalysis : WBCs and occasionally hematuria
Serum blood analysis: leukocytosis
Prostate-specific antigen levels: elevated
Culture of urine and prostate expressate: usually
single oragnism but occasionally, polymicrobial infection may occur.
Pathogens:
E. Coli: most common
Gram negative bacteria: Proteus, Klebsiella,
Enterobacter, Pseudomonas, and Serratia spp.,
enterococci – less frequent
Anaerobic and other gram-positivebacteria -rare

6. Acute Bacterial Prostatitis
Management:
Empiric therapy against Gram negative bacteria
Enterococci, immediately while awaiting for culture results
Trimethoprim and fluoroquinolones
Ampicillin and an aminoglycoside
effective therapy against both gram-negative bacteria and enterococci
Hospitalization and treatment with parenteral antibiotic – patients with sepsis who are immunocompromised or in acute urinary retention or with medical comorbidities
Trimethoprim and fluoroquinolones - high drug penetration into prostatic tissue and are recommended for 4–6 weeks
The long duration of antibiotic treatment is to allow complete sterilization of the prostatic tissue to prevent complications such as chronic prostatitis and abscess formation.
Patients with urinary retention secondary to acute prostatitis should be managed with a suprapubic catheter because transurethral catheterization or instrumentation is contraindicated

7. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

8. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

9. Chronic Bacterial Prostatitis
In contrast to the acute form, chronic bacterial prostatitis has:
a more insidious onset, characterized by relapsing, recurrent UTI caused by the persistence of pathogen in the prostatic fluid despite antibiotic therapy.

10. Chronic Bacterial Prostatitis
Clinical Presentation:
dysuria, urgency, frequency, nocturia, and low back/perineal pain
Afebrile
not uncommonly have a history of recurrent or relapsing UTI, urethritis, or epididymitis caused by the same organism
asymptomatic, but the diagnosis is made after investigation for bacteriuria
DRE: normal; occasionally, tenderness, firmness, or prostatic calculi may be found on examination

11. Chronic Bacterial Prostatitis
Laboratory findings:
Urinalysis: variable degree of WBC &bacteria
Serum blood analysis: no leukocytosis
Prostate-specific antigen levels: elevated
Diagnosis is made after
causative oragnisms:
similar to those of acute bacterial prostatitis
other gram-positive bacteria:
Mycoplasma, Ureaplasma, and
Chlamydia spp. are not causative pathogens
in chronic bacterial prostatitis.

12. Chronic Bacterial Prostatitis
Diaganosis is made after the identification of bacteria from prostate expressate or urine
specimen after a prostatic massage, using the 4-cup test

13. Chronic Bacterial Prostatitis
Management:
Similar to acute bacterial prostatitis
duration of antibiotic therapy: 3–4 months.
Using fluoroquinolones, some patients may respond after 4–6 weeks of treatment.
addition of an alpha blocker to antibiotic therapy has been shown to reduce symptom recurrences
Despite maximal therapy, cure is not often achieved due to poor penetration of
antibiotic into prostatic tissue and relative isolation of the
bacterial foci within the prostate.

14. Chronic Bacterial Prostatitis
Recurrent episodes of infection occur despite antibiotic therapy:
TMP-SMX 1 single-strength tablet daily
Nitrofurantoin 100 mg daily, or
ciprofloxacin 250 mg daily
Transurethral resection of the prostate has been used to treat patients with refractory disease; however, the success rate has been variable and this approach is not generally recommended

15. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

16. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

17. Granulomatous Prostatitis
uncommon form of prostatitis
can result from bacterial, viral, or fungal infection, the use of bacillus Calmette-Guerin therapy
malacoplakia, or systemic granulomatous diseases affecting the prostate

18. Granulomatous Prostatitis
Clinical Presentation:
acutely, with fever, chills, and obstructive/irritative voiding symptoms
Some with urinary retention
eosinophilic granulomatous prostatitis –severely ill with high fevers
DRE: hard, indurated, and fixed prostate, which is difficult to distinguish from prostate carcinoma.

19. Granulomtaous Prostatitis
Laboratory findings:
Urinalysis and culture:
do not show any evidence of bacterial
infection
Serum blood analysis – leukocytosis,
marked eosinophilia in patients with
eosinophilic type
The diagnosis is made after biopsy
of the prostate.

20. Granulomatous Prostatitis
Management:
Some patients respond to antibiotic therapy, corticosteroids and temporary bladder drainage.
Transurethral resection of the prostate may be required in patients who do not respond to treatment and have significant outlet obstruction.
Those with eosinophilic
granulomatous prostatitis dramatically response to
corticosteroids

21. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

22. PROSTATE INFECTION Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Prostate Abscesss

23. Prostate Abscess
complications of acute bacterial prostatitis that were inadequately or inappropriately treated.
Seen in patient :
diabetes
chronic dialysis patients
Immunocompromised
chronic indwelling catheters

24. Prostate Abscess Clinical Presentation:
similar symptoms to those with acute bacterial prostatitis.
these patients were treated for acute bacterial prostatitis previously and had a good initial response to treatment with antibiotics.
However, their symptoms recurred during treatment, suggesting development of prostatic abscesses.
DRE: prostate is usually tender and swollen

25. Prostate Abscess Management:
Antibiotic therapy in conjunction with drainage of the abscess is required
Transrectal ultrasonography or CT scan can be used to direct transrectal drainage of the abscess
Transurethral resection and drainage may be required if transrectal drainage is inadequate.
When properly diagnosed and treated, most cases of prostatic abscess resolve without significant sequelae