Humpath.com - Human pathology

Home > E. Pathology by systems > Genital system > Male genital system > Prostate > prostatitis

prostatitis

Saturday 21 January 2012

Synopsis

- Diagnosis based on quantitative bacterial cultures and microscopic examination of fractionated urine specimens (first 10 ml of urine is urethral, midstream urine is from bladder) and expressed prostatic secretions
- Definition: >10 WBC/HPF in prostatic secretions without pyuria; prostatic secretion cultures should have bacterial counts 10x urethral/bladder cultures
- Clinical: elevated PSA
- Treatment: difficult because antibiotics penetrate poorly into prostate
- Micro: macrophages in stroma, neutrophils in ducts/acini are specific for acute prostatitis and usually localized; lymphoid aggregates are common with aging and nodular hyperplasia and not specific for prostatitis

Differential diagnosis

- lymphoid aggregates:

  • SLL
  • CLL

PSA

Prostatitis can elevate the serum prostate specific antigen (PSA), but generally not more than double normal, and generally not increasing significantly over time. (Potts, 2001){}

Types

- acute prostatitis

  • Acute bacterial prostatitis: same bacteria types as urinary tract infections (E. coli, gram negative rods, enterococci, staphylococci), usually due to reflux, also following surgical manipulation or sexually transmitted disease; usually localized, may cause obstruction, retention, abscess

- chronic prostatitits

  • Chronic bacterial prostatitis:
    • symptoms of low back pain, dysuria, perineal and suprapubic discomfort;
    • often have history of urinary tract infection by same organism;
    • may have NO symptoms
  • Chronic abacterial prostatitis:
    • similar clinically to chronic bacterial prostatitis but negative cultures;
    • may be due to sexually transmitted disease organisms of Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma hominis

Links

- WebPathology