PROSTATITIS
Prostatitis is an inflammation of the prostate gland caused by infections agents (bacteria, fungi, mycoplasma) or by a variety of other problems (e.g. urethral stricture, prostatic hyperplasia).
Causes
Urethritis or instrumentation of the urethra, as occurs in the use of an indwelling catheter.
Pathophysiology
Acute bacterial invasion of prostate
1. From reflex of infected urine into ejaculatory and prostatic ducts.
2. From hematogenous (blood stream) origin or lymphogenous spread.
3. Secondary to urethritis from ascent of bacteria from urethra.
4. May be stimulated by urethral instrumentation or rectal examination of the prost when bacteria are present.
5. Often caused by gram-ve enteric bacteria such as pseudomonas and gram +ve co such as streptococcus and staphylococcus.
Chronic Bacterial Prostatitis
1. From bacteria ascending from urethra in cases of urethritis.
2. From hematogenous spread.
3. Often caused by gran ve bacteria such as E.coli, proteus mirabilis, Klebsi pneumoniae and pseudomonas aeruginosa.
Nonbacterial prostatitis
1. May be complications of urethritis, no bacterial cause may be identified, or may caused by C. trachamatis. Prostatodynia.
2. Symptoms of prostatitis in the absence of +ve cultures or known etiologic cause difficult to diagnose and manage].
Classification
Acute
1. Bacterial prostatitis
Chronic
2. Non bacterial prostatitis.
Clinical manifestations
1. Sudden chills and fever (moderate to high fever) and body aches with acute prostatitis.
2. Symptoms are more subtle with chronic prostatitis.
3. Bladder irritability degrees]. frequency, dysuria, nocturia, urgency, haematuria [to varying degrees]
4. Pain in perineum, rectum, lower back, lower abdomen and penile head.
5. Pain after ejaculation, symptoms of urethral abstraction.
Diagnostic Evaluation
1. Careful history.
2. C/s tests of divided urine specimens.
a. First 10-15ml voided after cleansing are sent as urethral specimen.
b. Next 50-75 ml of urine are collected as bladder specimen.
C. Prostate is massaged and either prostatic fluid drips out by gravity and is collected, or patient voids urine mixed with prostatic fluid.
3. Rectal examination reveals tender, painful, swollen prostate, warm to touch with acute prostatitis.
4. Serum white blood cell count is elevated in bacterial prostatitis
Medical Management
1. A broad spectrum antimicrobial (to which the organism causing the infection is susceptible)] is given for 10-14 days.
2. Bed rest-alleviates symptoms rapidly.
3. Comfort with analgesics, antispasmodics and bladder sedatives (relieves bladder irritability), sitz baths (relieves pain & spasm) and stool softness (prevent straining at stool, which increases pain).
4. Treatment of nonbacterial prostatitis is directed towards symptomatic relief - sitz bath, analgesics, etc. [the sexual partner should be investigated because of the possibility of cross - infection]
5. [Prostatodynia Alpha adrenergic blockers and skeletal muscle relaxants may provide some relief of symptoms. Aggressive diagnostic intervention should take place to rule out other conditions such as cancer of the prostate or interstitial cystitis]
Complications
1. Bacteriuria, urethritis, epididymitis, prostatic abscess, bacteraemia, septicaemia
2. Acute urinary retention.
3. Constipation.
Nursing interventions
1. Maintain bed rest in acute prostatitis to relieve perineal and suprapubic pain.
2. Maintain high fibre diet and give stool softness as needed to prevent constipation, which increases pain.
3. Administer analgesic or anti-inflammatory medication as ordered.
4. Keep the patient well hydrated, IV or orally, due to fluid loss thro' fever & avoid overhydration, which increases urine volume and reduces antibiotic concentration.
5. Administer antipyretics, antibiotics, as ordered.
6. Advise warm sitz bath 10-15 minutes several times a day, to relieve pain [and promote muscular relaxation of pelvic floor and reduce potential for urinary retention.
7. [Perform gentle prostatic massage if indicated (nonbacterial prostatitis only).]
8. Emphasize the importance of completing long course of therapy to prevent recurrence and resistance of organism. Encourage prescribed follow-up.
