Aetiology

Acute bacterial prostatitis is most commonly caused by organisms entering the prostate from urinary tract infections, particularly the Enterobacteriaceae group of bacteria (e.g., Escherichia coli) accounting for over 80% of infections.[10] A further 10% of cases are thought to be due to infection with Enterococcus and some cases are due to Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella, and Serratia spp.[10] In rare cases, prostatitis is a complication of urethritis caused by a sexually transmitted infection (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium).[11] In patients with immune deficiency or HIV infection, prostatitis may be caused by fastidious pathogens, such as Mycoplasma tuberculosis, Candida spp. and other rare pathogens, such as Coccidioides immitis, Blastomyces dermatitidis, and Histoplasma capsulatum.[12]

Pathophysiology

Several contributory factors have been associated with the development of prostatitis. Intraprostatic reflux (reflux of urine into the prostatic ducts) is thought to be an important associated finding.[5][13] Reflux of infected urine may potentially be associated with the reflux of bacteria from urethra to prostate, contributing to the development of the condition.[14] However, a causative pathogen is detected by routine methods in only 5% to 10% of cases.[15] Serum immunoglobulin (Ig)G and IgA are both elevated in acute prostatitis and fall to normal levels after treatment, suggesting an immunological role in disease evolution.[16] By contrast, serum IgG and IgA are not elevated in chronic bacterial prostatitis.[17]

Classification

Clinical classification[3]

Acute bacterial prostatitis

Chronic bacterial prostatitis

Non-bacterial prostatitis

Prostatodynia

National Institutes of Health classification[4]

I. Acute bacterial prostatitis

II. Chronic bacterial prostatitis

III. Chronic abacterial prostatitis - chronic pelvic pain syndrome (CPPS)

  • IIIA. Inflammatory CPPS

  • IIIB. Non-inflammatory CPPS

IV. Asymptomatic inflammatory prostatitis (histological prostatitis).

Use of this content is subject to our disclaimer