Chapter 106: Disorders of the prostate

INTRODUCTION

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

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 106.1).

It is preferable to use the term ‘prostatitis syndromes’ to embrace the three terms used in TABLE 106.1.

Clinical features of acute bacterial prostatitis

Symptoms

• 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

• Fever

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

Complications

• Abscess

• Recurrence

• Epididymo-orchitis

• Acute retention

• Bacteraemia/septicaemia

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 106.2).