Acute Bacterial Prostatitis

Acute bacterial prostatitis is a severe inflammatory disease that leads to a significant decrease in the quality of life for any patient. In 90% of cases, it occurs spontaneously, against a backdrop of general well-being following various urological (even preventive) procedures on the urogenital tract (for example, after prolonged catheterization of the bladder). Acute bacterial prostatitis (ABP) is a relatively common disease, with some data indicating it is diagnosed in 10-40% of men.

The composition of the prostate gland's secretion, which contains a large amount of organic substances, facilitates the onset of the inflammatory process. These substances provide an excellent environment for the rapid proliferation of pathogenic microflora, which enters from the urogenital tract. Whether seeding of the urethra under normal conditions is considered normal remains a controversial question raised in many studies.

The primary cause of inflammation is the proliferation of pathogenic microflora in the secretion of the prostate gland. However, the bacteria themselves can vary from case to case:

• Staphylococcus group – in some studies, this group is identified as the most common cause of acute bacterial prostatitis;
• Escherichia coli – often highlighted in research as a leading cause of ABP;
• Enterococcus faecalis – gram-positive facultative aerobes that inhabit the human gastrointestinal tract;
• Pseudomonas aeruginosa – gram-negative aerobic motile rods, often causing nosocomial diseases;
• Proteus spp. – gram-negative bacteria, conditionally pathogenic flora of the intestine, also present in the external environment;
• Klabsiella spp. – immobile gram-negative bacteria that often cause pneumonia in humans but can also infect the urinary tract and the prostate gland.

However, most research focuses on the bacterial microflora of chronic bacterial prostatitis, with acute forms receiving less attention, hence the data on it is ambiguous.

Bacteria can enter the prostate gland in various ways (through the bloodstream and lymph, or by ascending), so acute bacterial prostatitis can be caused by other infectious-inflammatory diseases. Certain factors also increase the risk of developing the pathology:

• Frequent unprotected sexual contacts, constant change of sexual partners;
• Presence of a chronic disease or another inflammatory process;
• Reduced immunity (temporary or permanent immunodeficiency);
• Hypothermia;
• Sedentary lifestyle, lack of sufficient physical activity;
• Recently undergone surgical interventions on the pelvic organs.

"Acute nonbacterial prostatitis" is distinguished separately as patients often inquire about other causes of inflammation. However, the nonbacterial process is associated with chronic (long-term, constant) retention of prostate gland secretion outflow, making such a process rarely acute.

ABP is a severe systemic disease with a vivid, pronounced clinical picture, quickly leading the patient to seek medical attention:

• Various urination disorders – frequent urination, intermittent urination, pain or burning during or after, appearance of different impurities in the urine, cloudiness;
• Consequences of the inflammatory process in the prostate gland – pain in the lumbar or sacral area, pain in the perineum, penis, or even rectum;
• Symptoms of general malaise – usually subfebrile temperature, joint and muscle pain, rapid heartbeat (tachycardia), weakness, and rapid fatigue.

Without proper or timely therapy, the patient may face the following complications:

• Acute urinary retention or disruption of its outflow, fluid accumulation in the renal pelvis;
• Pyelonephritis, urosepsis (generalized infection);
• Inflammation of the testicular appendages (epididymitis);
• Abscess (accumulation of pus in a confined cavity) of the prostate;
• Infertility;
• Chronic bacterial prostatitis and pelvic pain syndrome.

With appropriately chosen treatment and timely access to a specialist, all listed problems can be avoided. Currently, with correct treatment of acute bacterial prostatitis, complete recovery and regression of symptoms can be achieved.

Therapeutic measures for ABP include the following points:

• Bed rest, avoidance of physical exertion;
• Adequate hydration, hydrotherapy;
• Intake of analgesics (mainly non-steroidal anti-inflammatory drugs);
• Antibacterial agents;
• In case of acute urinary retention – suprapubic diversion (cystostomy).

As the disease presents with a rather severe course and acute, painful symptoms, the first antibiotics for acute bacterial prostatitis are prescribed empirically, using broad-spectrum drugs. After identifying the strain and antibiotic sensitivity, therapy may be adjusted to a more suitable one; therefore, patients should not independently purchase antibacterial drugs. A patient cannot determine whether their bacteria are sensitive to a specific medication. To prescribe the right therapy, it is essential to consult a doctor.