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Introduction

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Mind and body, like man and wife, do not always agree to die together.

Charles Colton (1780–1832)

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The main function of the prostate gland is to aid in the nutrition of sperm and keep the sperm active. It does not produce any hormones so there is usually no alteration in sexual drive following prostatectomy.

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Prostatitis
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Prostatitis embraces a group of conditions with voiding discomfort and pain in the prostate referred to the perineum, low back, urethra and testes. It typically affects men aged 25–50 years. Prostatitis usually occurs in the absence of identifiable bacterial growth, when it is termed non-bacterial prostatitis. The prostate may develop acute or chronic bacterial infection. Acute bacterial prostatitis, while uncommon, can be life threatening if left untreated.1

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Bacterial prostatitis is usually caused by urinary pathogens—Escherichia coli (commonest), Enterococcus, Proteus, Klebsiella, Pseudomonas or Staphylococcus. Rarely, chronic infections have been shown to be associated with Chlamydia trachomatis.2

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Prostatodynia means the presence of symptoms typical of prostatitis but without objective evidence of inflammation or infection (see Table 116.1).

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Table Graphic Jump Location
Table 116.1

Classification of prostatitis syndromes

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It is preferable to use the term ‘prostatitis syndromes’ to embrace the four terms used in Table 116.1.

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Clinical features of acute bacterial prostatitis

++ Symptoms
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  • Fever, sweating, rigors

  • Pain in perineum (mainly), back and suprapubic area

  • Urinary frequency, urgency and dysuria

  • Variable degrees of bladder outlet obstruction (BOO)

  • ± Haematuria

++ Signs
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  • Fever

  • Rectal examination: prostate exquisitely tender, swollen, firm, warm, indurated

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Diagnostic triad

DxT dysuria + fever + perineal pain → acute prostatitis

++ Complications
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  • Abscess

  • Recurrence

  • Epididymo-orchitis

  • Acute retention

  • Bacteraemia/septicaemia

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Chronic bacterial prostatitis

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Chronic bacterial prostatitis is diagnosed by a history of mild irritative voiding with perineal, scrotal and suprapubic pain. Ejaculatory pain can occur. The gland may be normal on clinical examination or tender and boggy. It should be suspected in men with recurrent UTI (see Table 116.2).

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Table Graphic Jump Location
Table 116.2

Features of chronic bacterial prostatitis

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Investigations

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  • Urine specimens and expressed prostatic secretions ...

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