Prostatitis, Orchitis, and Epididymitis

CPSI to assess prostatitis symptoms, from Litwin 1999

Acute prostatitis (I)

Definitions of prostatitis

Evaluation of acute prostatitis

Sepsis after prostate biopsy

Chronic Prostatitis (II)

Evaluation

Treatment

Chronic Prostatitis + Pelvic Pain Syndrome (IIIa+IIIb)

Pelvic pain index, from Clemens 2009

Causes

Evaluation/Diagnosis

Treatment via UPOINT system

Types of Prostatitis (in table form)

NIH Classification Symptoms Pyuria? Bacteruria? Treatment Key findings
Acute bacterial (I) UTI symptoms
Systemic (fever/chills)
Pelvic pain
Yes Yes PO/IV antibiotics x2-4 weeks
6mo if TB related
Acute infectious + systemic symptoms
Chronic bacterial (II) Recurrent UTIs Yes Yes, 10x increase after prostate massage Antibiotics x4-6 weeks Recurrent UTI with same organism
Chronic prostatitis/pelvic pain
Inflammatory (IIIa)
Pelvic pain without positive urine cultures Yes (especially after prostate massage) No UPOINT Pelvic pain in absence of infectious symptoms
Chronic prostatitis/pelvic pain
non-Inflammatory (IIIb)
No (even after prostate massage)
Asymptomatic inflammatory (IV) None Yes No None Discovered incidentally

Prostate Abscesses

Evaluation

Treatment

Other types of prostatitis

Granulomatous prostatitis

IgG4 prostatitis

Nickel, J. Curtis. "Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma." Reviews in urology 5.4 (2003): 209.

Orchitis/Orchalgia

Acute orchitis

(Chronic) Orchalgia

Granulomatous orchitis

Epididymitis

Acute epididymitis

Chronic epididymitis

Pontari, M. "Inflammatory and Pain Conditions of the Male Genitourinary Tract: Prostatitis and Related Pain Conditions, Orchitis, and Epididymitis." Campbell-Walsh-Wein Urology. 12th ed. Elsevier (2020): 1202-1223.

Non-Medical (Invasive) Therapies for Chronic Scrotal Pain

Minimally invasive therapies

Surgery

References