Advanced pathophysiology
Prostatitis-Men’s Health
A 42-year-old male arrives at the Emergency Department with a two-day complaint of dysuria, lower back pain, unable to fully empty his bladder, perineal pain, fever, and chills. The patient also explains the pain worsens when he stands up, but decreases when lying down. Vital signs show the patient to be febrile with a temperature of 104°F, tachycardic with a pulse rate of 138 bpm, and tachypneic with a respiration rate of 24. The digital rectal exam (DRE) reveals the prostate to be enlarged, incredibly tender, swollen, and warm to touch. The patient is diagnosed with acute bacterial prostatitis (ABP). The purpose of this paper is to explore the pathophysiology, system reaction of prostatitis, and its effect on male fertility.
Pathophysiology/System Reaction
Prostatitis is an inflammation of the prostate. Some degree of inflammation of the prostate is present in 4% to 36% of the male population, increasing to 50% in older men (McCance & Huether, 2019). Prostatitis can be classified into four categories; acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic pelvic pain syndrome, and nonbacterial prostatitis (McCance & Huether, 2019). ABP and CBP are caused mostly by gram-negative Enterobacteriaceae and Enterococci species, which originate in the gastrointestinal flora (McCance & Huether, 2019). The most common microorganism is E. Coli. The organisms responsible for sexually transmitted diseases that can cause prostatic infection includes; Neisseria gonorrhea, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis, and Gardnerella vaginalis (Paulis, 2018). In the scenario, the patient complains of dysuria, lower back pain, inability to entirely empty bladder, perineal pain, fever, and chills. Upon the digital rectal exam revealed an enlarged, tender, swollen, and warm prostate. The patient is exemplifying signs and symptoms of acute bacterial prostatitis. ABP is an ascending infection of the urinary tract that tends to occur in men between the ages of 30 and 50 years old (McCance & Huether, 2019). Clinical manifestations of ABP are similar to those with a urinary tract infection or pyelonephritis (McCance & Huether, 2019). The infection stimulates an inflammatory response in which the prostate becomes enlarged, tender, firm, or boggy (McCance & Huether, 2019). Other symptoms include malaise, low back pain, perineal pain, high fever, chills, dysuria, inability to empty bladder, nocturia, and urinary retention (McCance & Huether, 2019). The patient’s pain worsens in an upright position because the pelvic floor muscles tighten with standing, and the prostate gland is compressed (McCance & Huether, 2019).
Why does prostatitis happen?
Unfortunately, the cause of prostatitis in men is still a mystery. However, certain factors can increase the chances of prostatitis, such as dehydration, catheterization, cystoscopy, recent bladder infection, and the presence of a sexually transmitted disease (STD) (Paulis, 2018). A healthcare provider should educate the patient on ways to decrease the risks of prostatitis. Preventative measures include remaining hydrated by drinking water, practicing good perineal hygiene to reduce infection, reducing caffeine intake to avoid irritating the prostate, practicing safe sex, proper dieting, and maintaining a healthy weight. Adequate knowledge of prostatitis, including the causes and preventative factors can help decrease the chances of the patient having a recurrent infection.
How does prostatitis affect fertility?
The relationship between chronic prostatitis and fertility has been controversial for many years. Yet, prostatitis is one of the most prevalent healthcare problems in urology practice in adult males younger than 50 years old and the third most frequent urologic diagnosis in men more aged than 50 years old (Paulis, 2018). Prostatitis is considered among the most poorly understood medical problems but has been linked with male infertility. The volume of prostatic secretions is known to diminish during male sex gland infections (Alshahrani, McGill, & Agarwal, 2015). Prostatitis has been linked with decreased prostatic excretory function, including decreases in citric acid, alpha-glucosidase, fructose, and zinc secretions (Alshahrani, McGill, & Agarwal, 2015). These factors play significant roles in prostate function, from enzyme activity to sperm motility (Alshahrani, McGill, & Agarwal, 2015). Although decreased semen volume can negatively affect male infertility, the mechanism of glandular secretory dysfunction in prostatitis and the effects of lower concentrations of prostatic enzymes and trace elements remain unclear (Alshahrani, McGill, & Agarwal, 2015).
Another factor that plays a role in prostatitis and infertility is oxidative stress. Oxidative stress is an excess of reactive oxygen species (ROS) coupled with decreased total antioxidant capacity (Biotech Week, 2018). Seminal ROS are thought to originate predominantly from leukocytes and partially from sperm themselves (Biotech Week, 2018). ROS is produced by leukocytes in response to stimuli such as infection or inflammation (Biotech Week, 2018). High levels of ROS can lead to damage of cell membranes, intracellular proteins, organelles, and sperm DNA (Biotech Week, 2018). ROS produced by activated seminal leukocytes during genitourinary inflammation has been correlated with impairment of sperm motility and metabolism (Biotech Week, 2018). Also, increased oxidative stress affects the sperm chromatin integrity and may lead to sperm DNA damage (Paulis, 2018). Furthermore, increased ROS levels are associated with leukocytospermia (Paulis, 2018).
Summary
Prostatitis is an infection that can affect men of all ages. Not only can prostatitis affect a man’s daily life but also fertility. Prevention of prostatitis involves making a number of lifestyle and dietary changes towards maintaining a healthy prostate. The prostate plays a crucial role in the male reproductive system. As healthcare providers, it is important to assess patients thoroughly and educate them on modifiable risk factors to decrease the risk of prostatitis, which can play a negative role in procreation.
References
Alshahrani, S., McGill, J., & Agarwal, A. (2015). Prostatitis and male infertility. Journal of Reproductive Immunology, 100(1), 30-36. Retrieved from http://www.clevelandclinic.org/reproductiveresearchcenter/docs/agradoc474.pdf
Biotech Week. (2018, September 19). Reproductive medicine - male infertility; recent findings from southeast university provides new insights into male infertility (role of oxidative stress in pathology of chronic prostatitis/chronic pelvic pain syndrome and male infertility and antioxidants function in ameliorating ...). Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2103189625%3Facco
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Paulis, G. (2018). Inflammatory mechanisms and oxidative stress in prostatitis: The possible role of antioxidant therapy. Research and Reports in Urology, 10, 75-87. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.2147/RRU.S170400