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