MODULE 18
PROSTATE INFECTION
PROSTATE INFECTION
PROSTATITI
DEFINITION
S
• An inflammation of the prostate
gland surrounding tissue as a result
ETIOLOGY of infection
EPIDEMIOLOG
Y
PATHOPHYSIOLOG
Y
S/SX
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
FOUR TYPES OF PROSTATITIS
DEFINITION • Chronic prostatitis or chronic pelvic pain
syndrome
ETIOLOGY • Acute bacterial prostatitis
EPIDEMIOLOG • Chronic bacterial prostatitis
Y
• Asymptomatic inflammatory prostatitis
PATHOPHYSIOLOG
Y
S/SX
Prostate Infection CLINPHAR2. AJMT, VAA, JCM
RISK FACTOR
• Race/Ethnicity
DEFINITION • Gender
• Comorbidities
• Environment
ETIOLOGY • Age
Lifestyle Risk Factor
EPIDEMIOLOG
Y • Sexual Habits
• Personal Hygiene
PATHOPHYSIOLOG
• Perineal Trauma
Y • Diet
S/SX
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
CAUSES
DEFINITION • Bacterial Infection commonly Escherichia
coli (87%), Pseudomonas, Klebsiella,
Enterobacteria, Proteus, and Serratia. As
ETIOLOGY well as gram positive bacteria such as
Staphylococcus aureus. E. coli is the major
infectious agent that causes chronic
EPIDEMIOLOG prostatitis.
Y
• Recent urinary tract infection (UTI)
PATHOPHYSIOLOG
• Injured Pelvis
Y
S/SX
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
ETIOLOGY
STATISTICS
EPIDEMIOLOG
Y 1.4 Million Globally per Annum
CLASSIFICATION
PATHOPHYSIOLOG 19.3% out of 100,000 Filipino men
Y
S/SX
Male>Female
DIAGNOSIS
TREATMENT Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
EPIDEMIOLOG
Y
CLASSIFICATION
PATHOPHYSIOLOG
Y
S/SX
DIAGNOSIS
TREATMENT
GOALS
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOGY
EPIDEMIOLOG
Y
PATHOPHYSIOLOG
Y
S/SX
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
EPIDEMIOLOG
Y
PATHOPHYSIOLOG • Feeling a need to urinate often
Y or right away (Urination)
• Fever and chills
• Pain or burning during
S/SX urination (Dysuria)
• Pain in the back or lower
DIAGNOSIS abdomen
• Cloudy or bad-smelling urine
• Pain during sexual intercourse
TREATMENT
(Dyspareunia).
GOALS • Blood in the urine or semen
(Hematuria/Hematospermia)
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y LABORATORY TEST
S/SX • Digital Rectal Examination
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y LABORATORY TEST
S/SX • Urine Analysis
• Urine Dipstick Test
DIAGNOSIS - Nitrites
- Leukocyte
TREATMENT - RBC
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y LABORATORY TEST
S/SX • Blood Tests
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y
Diagnostic Imaging
S/SX • Male & Female Cystoscopy
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y
Diagnostic Imaging
S/SX • Transrectal ultrasound
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y
Diagnostic Imaging
S/SX • Urodynamic testing
DIAGNOSIS
TREATMENT
GOALS
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
PATHOPHYSIOLOG
Y
S/SX
DIAGNOSIS
TREATMENT
GOALS
TREATMENT
ALGORITHM
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
S/SX Chronic Prostatitis and Chronic Bacterial
Prostatitis
DIAGNOSIS
TREATMENT
GOALS
TREATMENT
ALGORITHM
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
S/SX Acute Bacterial Prostatitis
DIAGNOSIS
TREATMENT
GOALS
TREATMENT
ALGORITHM
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
DIAGNOSIS
TREATMENT Acupuncture
GOALS
Physical Activity
TREATMENT
ALGORITHM
Lifestyle Modification
NON-
PHARMACOLOGIC
TXT Personal Hygiene
PHARMACOLOGIC
Heating Pad
TXT
EVALUATION OF Drink Plenty of Water
OUTCOME
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
DIAGNOSIS
TREATMENT
GOALS
TREATMENT
ALGORITHM
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
EVALUATION OF
OUTCOME
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. AJMT, VAA, JCM
TREATMENT
ACUTE BACTERIAL PROSTATITIS
GOALS
Drug Dose Adverse Effect
TREATMENT
ALGORITHM First line (Ceftriaxone, Cefixime) 250mg IM /400mg oral
Then
NON-
Doxycycline 100mg oral for 10 days
PHARMACOLOGIC
Ciprofloxacin (Cipro,Bayer) 500mg oral twice daily for 10-14 Common: Dizziness,
TXT days Restlessness, Headache,
Diarrhea, Nausea, and Rash.
PHARMACOLOGIC Rare: Convulsion, Psychosis,
TXT Severe Hypersensitivity, and
Tendon Rupture
EVALUATION OF Levofloxacin (Levaquin, Ortho- 500mg-750mg oral once daily for
OUTCOME McNeil) 10-14 days
Piperacillin/Tazobactam 3.375g IV every 6hrs with
REFERENCES aminoglycosides
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS
TREATMENT
ACUTE BACTERIAL PROSTATITIS
GOALS
TREATMENT
ALGORITHM
NON-
PHARMACOLOGIC
TXT
PHARMACOLOGIC
TXT
EVALUATION OF
OUTCOME
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS
TREATMENT
CHRONIC BACTERIAL PROSTATITIS
GOALS
Antibiotic Regimen
TREATMENT Drug Dose Adverse Effect
ALGORITHM
Fluoroquinolones 500mg daily for 1 week Common: Dizziness,
Restlessness, Headache,
NON- Diarrhea, Nausea, and Rash.
PHARMACOLOGIC Rare: Convulsion, Psychosis,
Severe Hypersensitivity, and
TXT Tendon Rupture
PHARMACOLOGIC Ciprofloxacin (Cipro,Bayer)
TXT
Levofloxacin (Levaquin, Ortho-
McNeil)
EVALUATION OF
OUTCOME Trimethoprim-sulfamethoxazole 160/800mg twice daily for 4 Common: Anorexia, Nausea and
weeks Vomiting, Rash and Urticaria
Rare: Blood dycrasias,
REFERENCES Hypersensitivity, Photosensitivity,
and Hepatic Necrosis.
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS
TREATMENT CHRONIC PELVIC PAIN SYNDROME
GOALS
Alpha-Blockers
TREATMENT Drug Dose Adverse Effect
ALGORITHM
Alfuzosin (Uroxatral, Sanofi- 10mg twice daily for 12 weeks Common: Rhinitis and Fatigue
Aventis) Rare: Decrease Blood Pressure
NON- and Headache
Contraindication: Moderate
PHARMACOLOGIC hepatic insufficiency or with
CYP450 3A4 inhibitors
TXT
Doxazosin (Cardura, Pfizer) Dose escalation from 1mg-4mg Common: Decrease Blood
dose daily for 12 weeks Pressure and Headache
PHARMACOLOGIC
TXT Tamsulosin (Flomax, Ingelheim) 0.4mg once daily for 12 weeks Common: Decease Ejaculate
Volume and Headache
Rare: Decrease Blood Pressure
EVALUATION OF and Absent Ejaculation
OUTCOME
Terazosin (Hytrin, Abbott) Dose escalation from 1m-5mg Common: Dizziness, Decrease
dose daily for 12 weeks Blood Pressure, and Headache
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS
TREATMENT
ALGORITHM
Patients who respond to antibiotics have a good outcome. However,
NON- those who do not seek treatment or do not respond to antibiotics may
PHARMACOLOGIC have lower rates of fertility. Other studies have reported that patients
TXT with heavy bacterial inoculation also tend to have impaired sperm
motility and viability. Abscess formation is a rare complication of acute
bacterial prostatitis and is known to occur in patients with diabetics,
PHARMACOLOGIC
those who are immunocompromised, and those who have undergone
TXT urethral instrumentation or have prolonged indwelling urinary catheters.
Rare reports exist of pyelonephritis, chronic prostatitis, and sepsis. At
EVALUATION OF least 10% of patients with acute bacterial prostatitis will develop chronic
OUTCOME pelvic pain syndrome
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS
TREATMENT
GOALS
[Link]
NON- [Link]
PHARMACOLOGIC
[Link]
TXT
%20symptoms%20of%20acute,counts%20and%20culture%20are
%20necessary.
PHARMACOLOGIC
TXT
REFERENCES
Module 18 PROSTATITIS CLINPHAR2. GROUP MEMBERS