Chronic bacterial prostatitis

From greek.doctor

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
  • 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
  • Treatment
    • Long duration antibiotic treatment (6 – 12 weeks)
      • Fluoroquinolones and sulphamethoxazole/trimethoprim penetrate the prostate
    • NSAIDs