Sexual Health and Genital Medicine in Clinical Practice by Christopher Sonnex

Author:Christopher Sonnex
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

13. Prostatitis, Chronic Pelvic Pain Syndrome, and Hematospermia

Christopher Sonnex1

(1)Cambridgeshire Community Services, Cambridge, UK

Men with “prostatitis” usually find their way to either urology or GU medicine. Although common, the condition has often proved difficult to define, diagnose and manage. A classification system developed by the National Institutes of Health (NIH) has helped to clarify diagnostic criteria and it is now accepted that only a minority of men with prostatitis have bacterial infection (type 1 and type 2).

The classification is as follows:

Acute bacterial (Type I) prostatitis accounts for <1 % of cases and commonly presents with fever, chills, frequency, dysuria or strangury, and rectal pain. Examination reveals a tender, swollen prostate gland.

Chronic bacterial (Type II) prostatitis (CBP) may be more difficult to diagnose clinically. Symptoms may include perineal or suprapubic discomfort or pain sometimes radiating to the testes and penis. This may be associated with dysuria, frequency, and postejaculatory pain. CBP may also present as recurrent urinary tract infection. Rectal examination may reveal some tenderness and a softening or nodularity. True CBP is thought to account for approximately 5 % of cases of symptomatic prostatitis. Escherichia coli is the commonest cause of bacterial prostatitis (50–80 % of cases). Other causative organisms include Enterobacteriaceae (e.g., Klebsiella and Proteus), Enterococcus species, non-fermenting gram-negative bacilli (e.g., Pseudomonas species), Staphylococcus and Streptococcus species.

Chronic pelvic pain syndrome (CPPS) (Type III) is subdivided into inflammatory (Type IIIa – formerly known as “chronic abacterial prostatitis”) in which leucocytes are present in the semen or in urine post-prostatic massage, and non-inflammatory (Type IIIb) (formerly known as “prostatodynia”). Type IIIa and IIIb are equally prevalent and may even be the same condition. Men with CPPS are usually young to middle-aged and present with perineal or genital pain lasting for several weeks or months. Pain is central to the diagnosis and is usually variable in intensity and typically widely distributed in the genital, perineal, and pelvic areas. There may be associated urinary symptoms such as frequency, variable urine flow, and urgency and sexual disturbance in the form of ejaculatory discomfort.

Asymptomatic inflammatory prostatitis (category IV), presents with similar symptoms and is defined by an abnormal semen analysis, elevated prostate-specific antigen (PSA), or evidence of inflammatory changes on prostatic biopsy.

Other causes of “prostatitis-like” symptoms are as follows:Bladder neck dyssynergia (muscular incoordination) may present with frequency, urgency, and postmicturition dribbling. Diagnosis is usually by urinary flow studies.

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