Urology
Prostatitis
전립선염
Acute/chronic inflammatory or painful condition of prostate
- How common
- Lifetime 8–10% in men
- Typical age
- Ages 30–50
What is it?
Gram-negative bacteria (E. coli) invade via prostatic ducts; chronic forms are often non-bacterial pain syndromes.
Commonly affected: Prostatic parenchyma, perineal nerves
How it develops
- Pathogen entryUrethral reflux or lymphatic spread
- Prostatic colonizationColonizes stagnant prostatic secretions
- Acute inflammationNeutrophil infiltration, edema
- ChronificationInadequate treatment → chronic pain syndrome
Symptoms
- Perineal/pelvic painWorse when sitting
- Fever/chillsHallmark of acute form
- LUTSDysuria, frequency, urgency
- Acute retentionWith severe edema
- Painful ejaculationCommon in chronic form
How it is examined
- DREHot, boggy, tender (massage contraindicated)
- UA + cultureBacteriuria, leukocytes
- 4-glass test (chronic)Compare urine pre/post prostatic massage
Imaging
TRUS to evaluate for abscess.
- Hypoechoic abscess
- Enlarged prostate
MRI for abscess/complications.
- T2-bright abscess
Non-surgical care
- PO ciprofloxacin 4–6 wkFirst-line acute bacterial
- TMP-SMX 4–6 wkAlternative
- Chronic: 4–12 wk antibioticsLong-course fluoroquinolone
- Alpha-blockerRelieves voiding symptoms
- NSAIDs, sitz bathsPain relief
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Prostatic abscess
Procedures that may be discussed
- Transperineal/transurethral drainage
- Abscess aspiration
Outlook
Acute bacterial cures with antibiotics; chronic pain syndromes need long-term management.