Mind and body, like man and wife, do not always agree to die together.
CHARLES COLTON (1780–1832)
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.
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
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
Prostatodynia means the presence of symptoms typical of prostatitis but without objective evidence of inflammation or infection (see TABLE 114.1).
Table 114.1Classification of prostatitis syndromes ||Download (.pdf) Table 114.1 Classification of prostatitis syndromes
| ||Prostatic pain ||Prostatic rectal examination ||Positive urine or prostate secretion culture ||Positive prostatic secretion or urine white cells |
|Acute bacterial prostatitis ||Yes ||Very tender, swollen ||Yes ||Yes |
|Chronic bacterial prostatitis ||Often ||Normal or indurated ||Occasionally ||Low counts |
|Chronic prostatitis/chronic pelvic pain syndrome ||Often ||Normal ||No ||Nil or occasional |
It is preferable to use the term ‘prostatitis syndromes’ to embrace the three terms used in TABLE 114.1.
Clinical features of acute bacterial prostatitis
Fever, sweating, rigors
Pain in perineum (mainly), back and suprapubic area
Urinary frequency, urgency and dysuria
Variable degrees of bladder outlet obstruction (BOO)
Rectal examination: prostate exquisitely tender, swollen, firm, warm, indurated
DxT dysuria + fever + perineal pain → acute prostatitis
Chronic bacterial prostatitis
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 114.2).
Table 114.2Features of chronic bacterial prostatitis ||Download (.pdf) Table 114.2 Features of chronic bacterial prostatitis
|Difficult to treat |
|Relapsing infection |
|Perineal pain |
|Some leucocytes in expressed prostatic secretions |