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Prostatitis

Prostatitis is acute or chronic inflammation of the prostate. It can be caused by infection, in the case of acute inflammation. The responsible bacteria is most often Escherichia coli. Chronic pain, however, more likely implies an imbalance in the urinary microbiota.

Prostatitis affects around 10% of men. Symptoms, like in cystitis in women, include a burning sensation when urinating and the frequent need to urinate. Other symptoms may be present, such as pelvic, perianal, or rectal pain, and fever, which requires emergency treatment.

Acute prostatitis: an infectious origin?

The main bacteria responsible, Escherichia coli or other enterobacteria, come from the intestinal microbiota. Escherichia coli bacteria are implicated in 80% of cases of acute prostatitis. The infection most often starts in the urethra, which is the tube coming from the bladder. Sexually transmitted bacteria, like chlamydia or gonococci, can also cause prostatitis.

Urinary microbiota involved in chronic forms

In the case of chronic prostatitis, the origin is less clear; the bacteria are less frequently isolated. Recent studies suggest that an alteration in the urinary microbiota could play a role in the appearance of chronic prostatitis. In fact, we had long believed that urine was sterile, which is not the case. There is such a thing as the urinary microbiota. Furthermore, there is a difference in the composition of the urinary microbiota between patients with chronic prostatitis and that of healthy men. Modification of the urinary microbiota via antibiotic treatment may be the cause of chronic forms.

Antibiotic treatment 

Treatment of acute prostatitis is based on the prescription of antibiotics and sometimes requires hospitalization in the event of serious symptoms. Treating chronic prostatitis  remains more complicated. Probiotic options are still at a very preliminary stage.

 

Sources :
Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. 2001;165(3):842-845.
Shoskes DA, Altemus J, Polackwich AS, Tucky B, Wang H, Eng C. The Urinary Microbiome Differs Significantly Between Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Controls as Well as Between Patients With Different Clinical Phenotypes. Urology. 2016;92:26-32.
Amarenco G. Microbiote urinaire et troubles mictionnels. Prog Urol 2015; 25,11:625-27. http://www.urofrance.org/nc/science-et-recherche/base-bibliographique/article/html/microbiote-urinaire-et-troubles-mictionnels.html
SPILF 2014. Mise au point. Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l’adulte. http://www.infectiologie.com/UserFiles/File/medias/Recos/2014-infections_urinaires-long.pdf