Chronic Bacterial Prostatitis

  • This generally denotes a patient with a history of recurrent urinary tract infection (bacterial cystitis) with the same organism secondary to seeding from a reservoir in the prostatic tissue. It is extremely rare, and in the absence of a history of recurrent, culture-documented urinary tract infection, a diagnosis of chronic bacterial prostatitis is rarely made.
  • As opposed to the nonbacterial forms of prostatitis, the patients are often completely asymptomatic between episodes of acute bacterial cystitis.
  • Physical examination is normal. Patients may complain of pelvic or perineal discomfor or irritative voiding symtpoms or ejaculatory pain.
  • Bacterial localization tests are helpful and will be positive for prostate infection if the patient does not have an untreated, acute cystitis. E. Coli is found in 80% of cases. Pseudomonas, proteus, and Klebsiella are less common.
  • Antibiotics can either eradicate the infection, or at least suppress it such that the patient can be rendered asymptomatic. Trimethoprim-sulfamethoxazole and the fluorouinolones are lipid soluble and can penetrate the lipid membrane of the prostate and are concentrated in prostatic tissue. As opposed to the inflamed prostate of acute bacterial prostatitis, the chronically infected gland will not allow non-lipid soluble antibiotics to penetrate the tissue, and thus those antibiotics will not be effective as they are in the acutely inflamed prostate. Four to six weeks of antibiotics will be effective in eradicating infection in up to 50% of patients. Treatment can be continued for up to 3 months.
  • Prostatic massage, zinc, and vitamin suppliments have not been proven beneficial in this disorder.
  • Radical transurethral resection of the prostate in an attempt to rid the gland of infected tissue is a rather aggressive form of management with no guarantee of success and the potential for significant side-effects including retrograde ejaculation and stress incontinence.

Suggested Reading

  • Selman, HC and Pontari, M: Prostatitis and lower urinary tract infections in men. In: Clinical Manual of Urology, Hanno, PM, Malkowicz, SB, and Wein, AJ (eds); WB Saunders, Philadelphia, pp185-193, 2001.
  • Abarbanel, J, Engelstein, D, Lask, D, and Livne, PM: Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation? Urology, 62:27-29, 2003.
  • Scheaffer, AJ, (ed): Advances in the diagnosis and treatment of prostatitis; Urology, 60, number 6A, December 2002 supplement.
  • Potts, JM: Diagnosing the prostatitis patient: the dilemma continues. Curr Urol Rep. 2002 Aug; 3(4):319-323.
  • Anderson, RU: Management of chronic prostatitis-chronic pelvic pain syndrome. Urol Clin North Am, 29:235-239, 2002.
  • Kreiger, JN, Ross, SO, Penson, DF, and Riley, DE: Symptoms and inflammation in chronic prostatitis/chronic pelvic pain syndrome. Urology, 60:959-963, 2002.
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