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What Is Prostatitis?

Author/s: 
Rebecca Voelker

Prostatitis involves infection, inflammation, or pain in the prostate gland and affects about 9% of men during their lifetime.

What Is Acute Bacterial Prostatitis?
Acute bacterial prostatitis is a urinary tract infection that involves the prostate.1 Patients with acute prostatitis typically have fever, chills, pelvic pain, sudden onset of frequent urination, and pain or burning during urination. Some patients cannot empty their bladder adequately (urinary retention).

Risk factors include medical procedures such as cystoscopy, urethral catheterization, prostate biopsy, urinary obstruction such as benign prostatic hyperplasia and strictures, anal intercourse without condom use, immunosuppression, and certain neurological disorders such as multiple sclerosis, stroke, and spinal cord injury. Digital rectal examination often reveals prostate swelling and tenderness. The diagnosis of acute bacterial prostatitis is made based on symptoms, urinalysis, and urine culture. First-line treatment is 2 to 4 weeks of antibiotics. Men with urinary retention due to a swollen prostate should have a urinary catheter placed to relieve discomfort and to drain the infected urine.

What Is Chronic Bacterial Prostatitis?
Chronic bacterial prostatitis is a persistent bacterial infection of the prostate despite antibiotic therapy. Patients typically do not have fever or chills, and between episodes of infection they may have no symptoms or have persistent pelvic pain and/or lower urinary tract symptoms.

Risk factors include age 50 years or older, prior acute bacterial prostatitis, urethral surgery or catheterization, anal intercourse without condom use, and genitourinary tuberculosis. The diagnosis is made when multiple urine culture samples grow the same bacterial strain during episodes of urinary tract infection. First-line treatment for chronic bacterial prostatitis is at least 4 weeks of oral antibiotics such as ciprofloxacin or levofloxacin.

Keywords 
Prostatitis Humans pelvic pain male Urinary Tract Urinary Retention Prostatic Hyperplasia

Approach to pelvic venous disorders

Author/s: 
Andrew D Brown

Objective: To provide a practical guide to help family physicians recognize, diagnose, and manage patients with pelvic venous disorders (PeVDs), often overlooked as causes of chronic pelvic pain and varicose veins.

Sources of information: This review is based on guidelines from the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, the Society of Interventional Radiology, and the European Society for Vascular Surgery.

Main message: PeVDs are common, though frequently misdiagnosed, causes of chronic pelvic pain and varicose veins predominantly in female patients. These conditions arise from venous reflux or obstruction, which can cause varicose veins and venous hypertension in the renal hilum, pelvis, perineum, and lower extremities. Family physicians should recognize the clinical signs of PeVDs and use appropriate imaging to confirm diagnoses. Interventional treatments, including embolization and stenting, are effective for symptom management and improving patient outcomes.

Conclusion: Early recognition of patients with PeVDs by family physicians is crucial for timely and effective treatment. By using appropriate diagnostic tools and making timely referrals, physicians can substantially improve patients' quality of life.

Keywords 
Perineum female quality of life physicians family Radiology Interventional Varicose Veins Vascular Surgical Procedures hypertension

Women’s health update: A literature review impacting primary care

Author/s: 
Dolan, B. M., Merriam, S., Prifti, C. A., Walsh, J. M.

The authors review studies on key issues in women’s health with potential impact on internal medicine practice. The reviewed articles discuss cardiovascular disease risks, bone health, breast cancer genetics, cervical cancer prevention, depression in the peripartum period, pelvic pain, and emergency contraception.

Keywords 
Women's Health primary care Literature Review Internal Medicine Practice Disease Risks

Rethinking mechanisms, diagnosis and management of endometriosis

Author/s: 
Chapton, Charles, Marcellin, Louis, Borghese, Bruno, Santulli, Pietro

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.

Keywords 
Pregnancy women Endometriosis Infertility Uterus Pain
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