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Prostate Disease

Prostatitis - bacterial acute

Definition

Prostatitis is swelling and irritation (inflammation or infection) of the prostate gland. When prostatitis is caused by an infection with bacteria, it is called bacterial prostatitis.

  • Acute bacterial prostatitis is an infection that starts quickly.
  • Chronic bacterial prostatitis is an infection that lasts for 3 months or more.

For information on chronic prostatitis that is not caused by bacteria, see: Chronic nonbacterial prostatitis

Alternative Names

Chronic prostatitis - bacterial; Acute prostatitis

Causes

Prostatitis is usually caused by a bacterial infection of the prostate gland. Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Some sexually transmitted diseases (STDs) can cause bacterial prostatitis, including chlamydia and gonorrhea. STDs are more likely to occur from:

  • Certain sexual practices, such as having anal sex without wearing a condom
  • Having many sexual partners

In men over age 35, E. coli and other common bacteria usually cause prostatitis. This type of prostatitis may occur after:

  • Epididymitis
  • Urethritis
  • Urinary tract infections

Acute prostatitis may also be caused by problems with the urethra or prostate, such as:

  • Bladder outlet obstruction
  • Foreskin of the penis that cannot be pulled back (phimosis)
  • Injury to the area between the scrotum and anus (perineum)
  • Urinary catheter, cystoscopy, or prostate biopsy (removing a piece of tissue to look for cancer)

Men age 50 or older who have an enlarged prostate (benign prostatic hyperplasia) are at increased risk for prostatitis. The prostate gland may become blocked, making it easier for bacteria to grow. Symptoms of chronic prostatitis can be very similar to symptoms of an enlarged prostate gland.

Symptoms

Symptoms of acute prostatitis can start quickly, and can include:

  • Chills
  • Fever
  • Flushing of the skin

Symptoms of chronic prostatitis are similar, but not as severe. They usually begin more slowly. Some people have no symptoms between episodes of prostatitis.

Urinary symptoms include:

  • Blood in the urine
  • Burning or pain with urination (dysuria)
  • Difficulty starting to urinate or emptying the bladder
  • Foul-smelling urine
  • Weak urine stream

Other symptoms that may occur with this condition:

  • Pain or achiness in the abdomen above the pubic bone, in the lower back, in the area between the genitals and anus, or in the testicles
  • Pain with ejaculation or blood in the semen
  • Pain with bowel movements

If prostatitis occurs with an infection in or around the testicles (epididymitis or orchitis), you may also have symptoms of that condition.

Exams and Tests

During a physical exam, your health care provider may find:

  • Enlarged or tender lymph nodes in your groin
  • Fluid released from your urethra
  • Swollen or tender scrotum

To examine your prostate, the health care provider will perform a digital rectal exam. During this exam, the provider will insert a lubricated, gloved finger into your rectum.

The prostate may feel:

  • Large and soft (with a chronic prostate infection)
  • Warm, soft, swollen, or tender (with an acute prostate infection)

Your doctor may do a prostatic massage to see whether you have an infection:

  • The health care provider will rub a gloved finger over the prostate gland a few times to release fluid from the urethra
  • The fluid will be examined for white blood cells and bacteria -- signs of an infection

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test used to screen for prosate cancer.

Treatment

Antibiotics are often used to treat prostate infections.

  • For acute prostatitis, you take antibiotics for 4 to 6 weeks.
  • For chronic prostatitis, you take antibiotics for at least 4 to 6 weeks. Because the infection can come back, you may need to take medicine for even longer -- up to 12 weeks -- to get rid of the infection.

Often, the infection will not go away, even if you've been taking antibiotics for a long time. After you stop taking antibiotics, your symptoms may return.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it through your abdomen (suprapubic catheter), or from inside your body (indwelling catheter).

To care for prostatitis at home:

  • Urinate often and completely.
  • Take warm baths to relieve pain.
  • Take stool softeners to make bowel movements more comfortable.
  • Avoid substances that irritate your bladder, such as alcohol, caffeinated foods and drinks, citrus juices, and hot or spicy foods.
  • Drink more fluid (64 - 128 ounces per day) to urinate often and help flush bacteria out of your bladder.

After you finish antibiotic treatment, get examined by your health care provider to make sure the infection is gone.

Outlook (Prognosis)

Acute prostatitis should clear up completely with medicine and minor changes to your diet and behavior.

Acute prostatitis may come back or turn into chronic prostatitis.

Possible Complications

  • Abscess
  • Inability to urinate (urinary retention)
  • Spread of bacteria from the prostate to the bloodstream (sepsis)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of prostatitis.

Prevention

Not all types of prostatitis are preventable.

You can prevent infections caused by STDs by practicing safe sex behaviors.

References

Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9.

Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 130.


Bladder stones

Definition

Bladder stones are hard buildups of minerals that form in the urinary bladder.

Alternative Names

Stones - bladder; Urinary tract stones; Bladder calculi

Causes

Bladder stones are usually the result of another urologic problem, such as:

  • Bladder diverticulum
  • Enlarged prostate
  • Neurogenic bladder
  • Urinary tract infection

Approximately 95% of all bladder stones occur in men. Bladder stones are much less common than kidney stones.

Bladder stones may occur when urine in the bladder is concentrated and materials crystallize. Bladder stones may also result from foreign objects in the bladder.

Symptoms

Symptoms occur when the stone irritates the lining of the bladder or obstructs the flow of urine from the bladder. Symptoms can include:

  • Abdominal pain, pressure
  • Abnormally colored or dark-colored urine
  • Blood in the urine
  • Difficulty urinating
  • Frequent urge to urinate
  • Inability to urinate except in certain positions
  • Interruption of the urine stream
  • Pain, discomfort in the penis
  • Urinary tract infection
    • Dysuria (painful urination)
    • Fever
    • Urinary urgency

Incontinence may also be associated with bladder stones.

Exams and Tests

The health care provider will perform a physical exam, including a rectal examination. The exam may reveal an enlarged prostate or other problems.

Testing may reveal the following:

  • Bladder or pelvic x-ray may show stones.
  • Cystoscopy can reveal a stone in the bladder.
  • Urinalysis may show blood in the urine, crystals, or an infection.
  • Urine culture (clean catch) may reveal infection.

Treatment

Drinking 6 - 8 glasses of water or more per day to increase urinary output may help the stones pass.

Your health care provider may remove stones that do not pass on their own using a cystoscope (a small tube that passes through the urethra to the bladder).

Some stones may need to be removed using open surgery.

Medications are rarely used to dissolve the stones.

Causes of bladder stones should be treated. Most commonly bladder stones are seen with benign prostatic hyperplasia (BPH) or bladder outlet obstruction.

For patients with BPH and bladder stones, transurethral resection of the prostate (TURP) can be performed with stone removal.

Outlook (Prognosis)

Most bladder stones are expelled or can be removed without permanent damage to the bladder. They may come back if the cause is not corrected.

If the stones are left untreated, they may cause repeated urinary tract infections or permanent damage to the bladder or kidneys.

Possible Complications

  • Acute bilateral obstructive uropathy
  • Bladder cancer in severe, long-term cases
  • Chronic bladder dysfunction (incontinence or urinary retention)
  • Obstruction of the urethra
  • Recurrence of stones
  • Reflux nephropathy
  • Urinary tract infection

When to Contact a Medical Professional

Call your health care provider if you have symptoms of bladder stones.

Prevention

Prompt treatment of urinary tract infections or other urologic conditions may help prevent bladder stones.

References

Ho K-LV, Segura JW. Lower urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 84.


Bladder outlet obstruction

Definition

Bladder outlet obstruction (BOO) is a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra, the tube that carries urine out of the body.

Alternative Names

BOO; Lower urinary tract obstruction; Prostatism

Causes

Bladder outlet obstruction (BOO) can have many different causes, including:

  • Benign prostatic hyperplasia (BPH), or enlarged prostate
  • Bladder stones
  • Bladder tumors (cancer)
  • Pelvic tumors (cervix, prostate, uterus, rectum)
  • Urethral stricture (scar tissue)

Less common causes include:

  • Cystocele
  • Foreign objects
  • Posterior urethral valves (congenital birth defect)
  • Urethral spasms
  • Urethral diverticula

This condition is most common in aging men. It is often caused by BPH. Bladder stones and bladder cancer are also more commonly seen in men than women. As a man ages, the chance of developing these diseases increases dramatically.

See also:

  • Benign prostatic hypertrophy
  • Bladder stones
  • Obstructive nephropathy
  • Reflux nephropathy

Symptoms

The symptoms of bladder outlet obstruction may vary, but can include:

  • Abdominal pain
  • Continuous feeling of a full bladder
  • Delayed onset of urination (urinary hesitancy)
  • Frequent urination
  • Inability to urinate (acute urinary retention)
  • Pain on urination (dysuria)
  • Slow urine flow
  • Urinary tract infection
  • Urine stream starts and stops (urinary intermittency)
  • Waking up at night to urinate (nocturia)

Exams and Tests

If bladder outlet obstruction is suspected, your health care provider will take a thorough history of your problems. During a physical exam, your provider may find one or more of the following possible causes:

  • Abdominal mass
  • Cystocele (women)
  • Distended bladder
  • Enlarged prostate (men)

Tests may include:

  • Blood chemistries to look for signs of kidney damage
  • Cystoscopy and retrograde urethrogram (x-ray) to look for narrowing of the urethra
  • Ultrasound to locate the blockage of urineand find out how well the bladder empties
  • Urinalysis to look for blood or signs of infection in the urine
  • Urine culture to check for an infection
  • Uroflowmetry to determine how fast urine flows out of the body
  • Urodynamic testing to see how much the urine flow is blocked and how well the bladder contracts

Treatment

Treatment of bladder outlet obstruction depends on the cause of the problem. For most cases, a tube, called a catheter, inserted through the urethra into the bladder, will relieve the obstruction temporarily.

Occasionally, a suprapubic catheter (a tube placed through the belly area into the bladder) is needed to drain the bladder.

Long-term treatment of bladder outlet obstruction usually involves surgery. However, medical treatment options are available for many of the diseases that cause this problem. Discuss treatment options with your health care provider.

Outlook (Prognosis)

If diagnosed early, most causes of bladder outlet obstruction can be treated with great success. However, if diagnosis is delayed, permanent damage can result.

Possible Complications

Long-term or high-grade bladder outlet obstruction can permanently damage all parts of the urinary system.

Complications include:

  • Bladder and kidney stones
  • Kidney failure
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Urinary retention

When to Contact a Medical Professional

If you have symptoms of bladder outlet obstruction, call your provider. Early diagnosis is important and can often lead to a simple and effective cure.

Prevention

The condition may be prevented by identifying and treating the cause of the blockage.

References

Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Tseng TY, Stoller ML. Obstructive uropathy. Clin Geriatr Med. 2009 Aug;25(3):437-43.