Acute bacterial prostatitis is most commonly caused by ascending infections through the urethra, often associated with procedures involving urethral instrumentation. Hematogenous infections may originate from furuncles, carbuncles, tonsillitis, dental caries, or respiratory infections. The condition can also result from retrograde flow of infected urine into the prostate ducts, as seen in cases of acute cystitis, acute urinary retention, or acute gonococcal posterior urethritis. The most common pathogens are gram-negative bacilli or Pseudomonas species, with Escherichia coli being the most frequently isolated. Other pathogens include Staphylococcus, Streptococcus, Neisseria gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. Histologically, the prostatic acini exhibit significant infiltration of white blood cells and tissue edema. In most patients, the inflammation resolves with treatment, though incomplete treatment may lead to chronic prostatitis, and severe cases may result in prostatic abscesses.
Clinical Manifestations
The onset is abrupt, characterized by acute pain, urinary irritative and obstructive symptoms, and systemic manifestations such as fever. Typical symptoms include urinary frequency, urgency, dysuria, with obstructive symptoms such as hesitancy, interrupted stream, or acute urinary retention. Pain in the perineum and suprapubic region is often accompanied by discomfort or pain in the external genitalia. Systemic symptoms include chills, high fever, nausea, vomiting, and sometimes sepsis. Acute bacterial prostatitis is frequently associated with acute cystitis.
Diagnosis
Diagnosis is based on typical clinical manifestations and a history of acute infection. Digital rectal examination reveals an enlarged, tender prostate with increased local temperature and a smooth surface. The presence of an abscess may be indicated by a fullness or fluctuation during the examination. The spread of infection may lead to complications such as seminal vesiculitis, epididymitis, or bacteremia, making prostatic massage or puncture contraindicated. Common complications include acute urinary retention, epididymitis, rectal or perineal fistulas, and hematogenous infections, which may also result in acute pyelonephritis. Urinalysis often shows increased white blood cells in the sediment, while blood and/or urine cultures may test positive for the causative organism.
Treatment
The primary therapeutic approach involves the use of antibiotics, with common choices including fluoroquinolones such as levofloxacin and ciprofloxacin, as well as cephalosporins, tobramycin, and ampicillin. In cases involving Chlamydia infection, macrolides such as erythromycin or azithromycin are used. Neisseria gonorrhoeae infections are treated with ceftriaxone, while Metronidazole is effective against anaerobic bacterial infections. The typical duration of treatment is 7 days, which may be extended to 14 days depending on the severity.
The treatment plan involves bed rest, adequate nutrition, increased fluid intake, and the use of analgesics, antispasmodics, and antipyretics to alleviate symptoms. For acute urinary retention, suprapubic catheterization is preferred over transurethral catheterization to avoid exacerbating the infection. The prognosis is generally favorable, though prostatic abscess formation may occur in some cases, requiring prompt drainage for resolution.