Chronic bacterial prostatitis
Chronic bacterial prostatitis refers to chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate, usually defined as symptoms > 3 of the last 6 months. It's relatively rare.
- Etiology
- Often a complication of acute bacterial prostatitis, due to inadequate or too short treatment
- Clinical features
- Same as acute, but intermittent and less severe
- No systemic symptoms
- Diagnosis
- Meares-Stamey four-glass test
- Used to determine the location of the bacterial infection within the urinary tract
- Only performed in men
- Four glasses are taken
- 1st glass – the first 10 mL of urine
- The patient then voids another approx. 100 mL of urine
- 2nd glass – another 10 mL of urine
- 3rd glass – the patient’s prostate is massaged, and the fluid ejected from the urethra is collected
- 4th glass – another 10 mL of urine after the prostate massage
- The first glass represents the urethral specimen
- The second glass represents the bladder specimen
- The third and fourth glasses represent the prostate specimen
- Each glass is cultured for bacteria and examined for WBCs -> which glass has bacteria will give information on the location of the infection
- In chronic bacterial prostatitis, the third or fourth glasses will have evidence of bacteria
- Enlarged, soft or boggy, moderately tender prostate on DRE
- Meares-Stamey four-glass test
- Treatment
- Long duration antibiotic treatment (6 – 12 weeks)
- Fluoroquinolones and sulphamethoxazole/trimethoprim penetrate the prostate
- NSAIDs
- Long duration antibiotic treatment (6 – 12 weeks)