Prostatitis (Prostate Inflammation): Causes

Pathogenesis (development of disease)

The underlying pathophysiology of prostatitis is still poorly understood. It is recognized that there is a multifactorial etiology (cause).

Acute bacterial prostatitis (ABP; NIH type I).

Acute bacterial prostatitis can be either urogenic (originating in the urinary organs), hematogenic (caused by the blood), or, in rare cases, caused by the spread of inflammation to neighboring organs. The causative agents of acute bacterial prostatitis are usually gram-negative germs from the enterobacteria family such as E. coli or Klebsiella. Furthermore, mycoplasma infections (Mycoplasma hominis, Ureaplasma urealyticum) can be the cause of prostatitis.More rarely, chlamydia, trichomonads, streptococci or staphylococci are the cause.

Urogenic causes include:

• Phimosis (narrowing of the foreskin).
• Urethradiverticulum (outpouching of the urethra).
• Urethral strictures (narrowing of the urethra).

Benign prostatic hyperplasia (BPH; benign prostatic enlargement) also constricts the urethra (urethra), causing urinary obstruction and thus promoting prostatitis.

Approximately 10% of all acute bacterial prostatitis progresses to chronic disease.

Chronic bacterial prostatitis (CBP; NIH type II)

Chronic bacterial prostatitis usually develops from an unhealed acute inflammation, but may also develop from other pre-existing conditions/misformations such as urethral stenosis (narrowing of the urethra).

Abacterial prostatitis In abacterial prostatitis or prostatodynia (synonyms: chronic pelvic pain syndrome; CPPS), no pathogens can be detected, although symptoms exist. This affects 35% of the urine cultures taken.

CPPS is differentiated into two subclasses:

• Inflammatory CPPS (NIH type IIIa) and.
• Non-inflammatory CPPS (NIH type IIIb).

The cause of abacterial prostatitis is not yet exactly clear, possibly a sexually transmitted pathogen is present, as this form of prostatitis often occurs in young, sexually active men.

For more on the NIH types, see classification below.

Etiology (causes)

Behavioral causes

• Diet
  • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
• Psycho-social situation
  • Psychological factors
  • Sexual problems
  • Relationship problems
  • Stress,
• “Risky” sexual behavior, such as insertive anal sex/anal sex (person inserting their penis).
• Too little exposure to sunlight

Causes related to disease

• Benign prostatic hyperplasia – benign prostate enlargement.
• Phimosis (narrowing of the foreskin)
• Urethradiverticulum (urethral bulge)
• Urethral strictures (high-grade urethral stenosis).
• Genitourinary infections such as epididymitis (epididymitis, cystitis (cystitis) or urethritis (urethritis).
• Venereal diseases (sexually transmitted diseases).

Other causes

• Permanent catheterization
• Invasive diagnostic measures, e.g. cystoscopy, which may be associated with the introduction of bacteria
• Surgical manipulations of the prostate: prostate biopsy (tissue removal from the prostate) or transurethral prostate resection (urological surgical technique in which pathologically altered prostate tissue is removed without an external incision through the urethra (urethra)).
• Oxidative stress – promotes inflammatory processes.
• Sedentary cycling (indirect – chronic).