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Chronic Bacterial ProstatitisAka: Chronic Prostatitis

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  1. Pathophysiology
    1. Slow, indolent infection persisting more than 3 months
    2. Associated factors
      1. Recurrent Urinary Tract Infection
      2. Asymptomatic bacteruria despite antibiotics
    3. Causative organisms the same as in Acute Prostatitis
      1. Enterobacteriaceae (80%)
      2. Enterococcus (15%)
      3. Pseudomonas aeruginosa
  2. Symptoms (sudden onset)
    1. Irritative urinary symptoms (Mild to Moderate)
      1. Dysuria
      2. Urinary frequency
      3. Urinary urgency
      4. Ejaculatory pain
      5. Hematospermia
    2. Referred pain
      1. Low pack pain
      2. Perineal pain
      3. Lower Abdominal Pain
      4. Scrotal Pain
      5. Pain in penis
      6. Pain in inner thighs
    3. Absent Symptoms (Contrast with Acute Prostatitis)
      1. Systemic symptoms rare
      2. Obstructive urinary symptoms uncommon
  3. Signs: Digital Rectal Exam
    1. Prostate often normal on exam
    2. Prostate may be tender to palpation
    3. Prostate may be boggy or indurated
    4. Prostatic calculi or crepitation may be present
  4. Labs: Segmented Urine Culture
    1. See Prostatic Massage
  5. Differential Diagnosis
    1. Chronic Noninfectious Prostatitis
  6. Management
    1. See Prostatitis General Measures
    2. General
      1. Antibiotics penetrate chronic Prostatitis poorly
      2. Prolonged antibiotic regimens are required
      3. Antibiotics until Segmented Urine Culture sterile
    3. Antibiotics
      1. Ciprofloxacin 500 PO bid for 4 weeks
      2. Ofloxacin 300 PO bid for 6 weeks
      3. Trimethoprim Sulfamethoxazole DS PO bid for 1-3 month
    4. Refractory Cases
      1. Consider Chronic Noninfectious Prostatitis
  7. References
    1. Cooner (1994) Prostate Disease, AAFP, p. 9-15
    2. Gilbert (2000) Sanford Guide, p. 18-9
    3. Krieger (Summer, 1998) Patient Care Suppl.: Prostatitis
    4. Schwager (1991) Am Fam Physician 44(6):2137

Chronic prostatitis (C0085696)

ConceptsDisease or Syndrome (T047)
ICD9601.1
EnglishChronic Prostatitis
Spanishprostatitis cronica
Parent Conceptsprostatitis (C0033581), Duplicate concept (C1274013)
SourcesDXP, ICD9CM, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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