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• Prostatitis is an infection or inflammation of the prostate

gland that presents as several syndromes with varying C/F…
• The term prostatitis is defined as microscopic inflammation of
the tissue of the prostate gland and is a diagnosis that spans a
broad range of clinical conditions.
• The National Institutes of Health (NIH) has recognized and
defined a classification system for prostatitis in 1999.
• Inflammation of the prostate i.e. prostatitis
may be 
• Acute
• chronic
• granulomatous types.
• The 4 syndromes of prostatitis are as follows:
• I - Acute bacterial prostatitis
• II - Chronic bacterial prostatitis
• III - Chronic prostatitis and chronic pelvic pain
syndrome (CPPS; further classified as
inflammatory or non inflammatory)
- Granulomatous prostatitis
• IV - Asymptomatic inflammatory prostatitis

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• ACUTE PROSTATITIS : caused by 
• E Coli
• Klebsiella
• Proteus
• Pseudomonas
• Enterobacter
• Gonococci
• Staphylococci

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• A primary voiding dysfunction problem, either structural or functional .
• E coli is responsible for 75-80% of chronic bacterial prostatitis cases.
• Enterococci
• Pseudomonas
• C trachomatis,
• Ureaplasma species,
• Uncommon organisms, such as M tuberculosis and
Histoplasma, and Candida species , must also be considered.
• Tuberculous prostatitis may be found in patients
with :
• Renal tuberculosis
• Human immunodeficiency virus
• Cytomegalovirus
• Inflammatory conditions (eg, sarcoidosis)
• Age-related demographics:
• Among older patients, nonbacterial prostatitis types II and IV are
the most common.
• According to case reports of Wegener granulomatosis in the fourth
and fifth decades of life, prostatitis can be a presenting feature of
Wegener granulomatosis and a clinical manifestation of relapse.
• Fungal infection with C albicans and mycobacterial infection with
M tuberculosis have also been reported.
• Acute prostatitis and chronic bacterial prostatitis are
defined by documented bacterial infections of the
prostate and are treated with antibiotic therapy and
supportive care
• In bacterial prostatitis :
• sexual transmission of bacteria is common, but hematogenous
,lymphatic , contiguous spread of infection from surrounding
organs must also be considered.
• Although various routes have been postulated,none has been
firmly substantiated
• A history of sexually transmitted diseases is associated with an
increased risk for prostatitis symptoms.
• Viral and granulomatous prostatitis may be associated with HIV
infection and is another cause of culture-negative disease.
• A common viral pathogen of prostatitis in HIV- infected patients
is cytomegalovirus (CMV).
• Mycobacteria, such as Mycobacterium tuberculosis, and fungi, such
as Candida albicans, have also been associated with culture-negative
disease in this population
• Acute bacterial prostatitis may be caused by
ascending infection through the
Urethra---------- refluxing urine into

prostate ducts
or direct extension or lymphatic spread from
the rectum.
• Acute prostatitis may occur spontaneously or may be a
complication of urethral manipulation such as :
Catheterisation
Cystoscopy
Urethral dilatation
Surgical procedure on prostate
• The common pathogens are those which cause UTI, most frequently …..
• E Coli
• Klebsiella
• Proteus
• Pseudomonas
• Enterobacter
• Gonococci
• Staphylococci
• The diagnosis is made by culture o urine specimen.
• Grossly :
• The prostate is enlarged
• Swollen and tense.
• C/s- multiple abscess and foci of necrosis.

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• Microscopic:
• The prostatic acini are dilated and filled with neutrophilic
exudate.
• There my be diffuse acute inflammatory infiltrate.
• Oedema, hyperaemia and foci of necrosis frequently
accompany acute inflammatory involvement.

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• Chronic prostatitis is more common and foci of chronic inflammation
are frequently present in the prostate of men > 40 yrs of age.
• Chronic prostatitis is usually asymptomatic but may cause :
• Allergic reactions
• Iritis
• Arthritis
• 2 Types :

1. Chronic bacterial prostatitis

2.Chronic abacterial prostatitis
• CBP  is caused in much the same way and by the same org. as
the Acute prostatitis.
• It is generally a consequence of recurrent UTI.
• Diagnosis is made by detection of WBC > 10- 12/hpf in expressed
prostatic secretions.
• This condition is more difficult to treat since antibiotics
penetrate the prostate poorly.
• C . Abac. Prostatitis is more common.
• There is no H/o of recurrent UTI & U.Culture & prostatic
secretions is always (–), though leukocytes demonstrable in
prostatic secretions.

• The pathogens implicated  Chlamydia trachomatis &

ureplasma urealyticum.
• Pathologic changes in both bacterial and abacterial prostatitis
are similar.
• Grossly :
• Prostate may be enlarged
• Fibrosed
• Shrunken
• The diagnosis of chronic prostatitis is made by foci of :
• lymphocytes
• plasma cells
• macrophages and
• neutrophils within in the prostatic
substance
• Prostatic calculi & foci of Squamous metaplasia in prostatic
acini may accompany inflammatory changes.
• Seminal vesicles are invariably involved.
• Granulomatous Prostatitis is a variety of chronic prostatitis,
probably caused by leakage of prostatic secretions in to the
tissue, or could be of autoimmune origin.
• Gross findings :
• The glands is firm to hard, giving the clinical impression of prostatic
carcinoma on rectal ex.

• Microscopic :
• The inflammatory reaction consist of macrophages, lymphocytes,
plasma cells and some multinucleate giant cells.
• The condition may be confused with Tuberculous prostatitis .
• History
• Patients with acute bacterial prostatitis may present with the following:
• Fever
• Chills
• Malaise
• Arthralgias
• Myalgias
• Perineal/prostatic pain
• Dysuria
• Obstructive urinary tract symptoms, including ……..
• Frequency
• urgency
• dysuria,
• hesitancy, weak stream, and incomplete voiding
• Low back pain
• Low abdominal pain
• Spontaneous urethral discharge
• Patients with chronic bacterial prostatitis typically have no systemic
symptoms. Instead, these patients may present with the following:
• Intermittent dysuria
• Intermittent obstructive urinary tract symptoms
• Recurrent urinary tract infections
• Pelvic pain or discomfort including………
• Perineal, suprapubic, coccygeal, rectal, urethral, and testicular/scrotal pain for
more than 3 of the previous 6 months without documented urinary tract
infections from uropathogens.
• Obstructive urinary tract symptoms, including frequency, dysuria, and incomplete
voiding
• Ejaculatory pain
• Erectile dysfunction
• Potential complications of prostatitis include the following:
• Bladder outlet obstruction/urinary retention
• Abscess - Typically in immunocompromised patients
• Infertility due to scarring of the urethra or ejaculatory ducts
• Recurrent cystitis
• Pyelonephritis
• Renal damage
• Sepsis
• The differential diagnosis of prostatitis is based on the……
• History
• Physical examination findings, and,
• Frequently, analysis of expressed prostatic secretions.
• Absence of systemic symptoms and persistence of pain for at least 3
months indicate chronic prostatitis rather than acute disease.
• In addition to prostatitis, other conditions to consider include the
following:
• Benign prostatic hyperplasia
• Chronic pain syndromes (ie, inflammatory bowel disease)
• Cystitis
• Erectile dysfunction
• Prostate cancer
• Testicular cancer
• Urolithiasis
• Urine Analysis
• Microscopic Examination of urine
• Urine Culture
• Complete Blood counts
• Biochemistry – BUN,
• PSA
• US
• CT, MRI
• Voiding cystourethrography (VCUG)
• Cystoscopy
• Urine Cytology studies
• Urinalysis and urine culture can confirm the presence
of infection and identify pathogens.
• Fractional urine studies (urethral and bladder urine)
and cytology of expressed prostatic secretions can
help differentiate prostatitis from urethritis and
cystitis.
•
1.
2.
3.
4.
•
•
•
•
• supportive care
• Antibiotic therapy should initially include parental bactericidal agents such as:
• Kategori 1 :
• Floroquinolone
• Trimetropim-sulfametoksazole
• Aminoglycosides
• Kategori 2 :
• Trimetropim-sulfametoksazole
• Doksisiklin, minosiklin
• Karbenisilin
• floroquinolone
A: Caput or head of
the epididymis
B: Corpus or body of
the epididymis
C: Cauda or tail of the
epididymis
D: Vas deferens
E: Testicle
 EPIDIDIMITIS
EPIDIDIMITIS NON SPESIFIK
❑ EPIDIDIMITIS
❑ Akut
❑ Khronis

EPIDIDIMITIS AKUT
❑ ETIOLOGI
❑ PHS : - C. trachomatis
- N. gonorrhae
 ❑Non PHS
❑ Penyebaran infeksi tr.Urinarius & prostatitis
❑ Enterobacteriaceae pseudomonas
❑ Tekanan hydrostatik  urine patogen dari
uretra/prostat  duktus ejakulatorius  Vas
deferens epididimis
❑ Dari infeksi prostat & organ-organ sekitarnya
 melalui perivasal lymphatic epididimis
❑ Chemical epididymitis reflux urine steril ke
ductus ejakulatorius waktu mengedan
1. STAGE AWAL
❑ Inflamasi seluler  celulitis
❑ Mulai dari vas deferens & meluas ke pole
bawah epididimis

2. ACUTE STAGE
❑ Bengkak & indurasi
❑ Infeksi meluas dari pole bawah ke pole atas Abses
❑ kecil-kecil
❑ T.vaginalis sekresi cairan serous
inflamatory hydrocele
dapat purulent Spermatic cord
❑ menebal
GAMBARAN KLINIS
Gejala-gejala :
❑ G/urethritis/prostatitis
❑ Riwayat hub.sex >1 pasangan & tanpa kondom
❑ Komplikasi : instrumentasi uretra / prostatektomi
❑ Nyeri tiba-tiba pada scrotum: spermatic cord
 perut bag.bawah  pinggang
❑ Bengkak daripada 2x ukuran N dalam 3-4 jam
❑ Demam  400C
❑ Urethral discharge +/-
❑ Urine keruh +/-
❑ Gejala-gejala cystitis +/-
TANDA – TANDA
❑ Nyeri tekan epididimis : spermatic cord &
perut bag.bawah bag.yang sakit
❑ Scrotum >>
❑ Kulit kemerahan
❑ Abses  ruptur
❑ Stage awal : testis & epididimis >> masih
terpisah  menjadi satu massa
❑ Spermatic cord menebal oleh edema
❑ Hydrocele +/- inflamasi epididimis
❑ Urethral discharge +/-
❑ Testis >> : congestive
❑ WBC ↑ , shift to the left
❑ Anak : organisme coliform / pseudomonas ,
dewasa muda (<35 th): C.trachomatis & GO,
 penting kultur

DD
1. Torsio Testis biasa anak muda (10-20 tahun)
❑ Pada fase awal epididimis teraba di anterior testis
❑ Testis > retracted (Deming’s sign)
❑ Pada fase lanjut testis & epid.menjadi besar  sulit
❑ Prehn’s sign : nyeri + / ↑ (torsio)
nyeri ↓ (epididimitis)
• Color Doppler ultrasonography has become the imaging test
of choice for the evaluation of an acute scrotum.
 ❑ Jarang nyeri & demam
❑ Testis & epid.masih dapat dibedakan pada
palpasi
❑ Culture urine (tuberkel bacillis)
❑ Prostat & v.seminalis keras
3. Trauma Testis
❑ Ada trauma
4. MUMPS (parotitis)  orkitis epidemica
5. Tumor
6. Torsio app.testis
KOMPLIKASI
❑ Absces  fistel
❑ Bilateral infertility

PENGOBATAN
❑< 24 jam : inj.Hcl procain 20 cc 1%
spermatic cord
❑ Bed rest : fase akut 3-4 hari
❑ Scrotal support /T-verband
❑ Antibiotik : 2-4 minggu : analgetik
❑ Cegah hub.sex

PROGNOSA : Bilateral  Infertile

•
–
–

–
EPIDIDIMITIS KHRONIS
❑ Stadium akhir epid.acut yang parah
❑ Asymptomatis kecuai ada exacurbasi
❑ Fibroplasia,indurasi
❑ Epididimis menebal / >>
❑ dibedakan dengan testis pd palpasi
❑ Nyeri +/-
❑ Pyuria  mungkin pyuria steril
❑ Culture urine/cairan prostat
DD
❑ TBC epididimitis
❑Sterile pyuria
❑Tubercle (+)

KOMPLIKASI
❑ Infertile (bilateral epi.)

PENGOBATAN
❑ Exaserbasi kronis: antibiotika
❑ Vasoligasi
❑ Excisi + reanastomosis
EPIDIDIMITIS TBC
❑ Sekunder dari tbc organ lain  petunjuk : TBC ginjal,
prostat/ves.seminalis
❑ Jarang

INSIDENS
❑ Dewasa muda, 20-50 thn
❑ Kehidupan seksual yang masih aktif
❑ 20% dari penderita ada riwayat tbc
❑ Negara berkembang 2x dari yang maju
❑ TBC U.G.: - 2-4% dari seluruh tbc
- 15% dari tbc diluar paru-paru
❑ Mycobacteria tuberculosis
❑ Bisa : hematogen / limfogen dari luar tr.U.G :
❑TBC tulang, spondilitis tbc, tbc paru
❑ Umumnya : dari tbc tr.u.g : ginjal, buli-buli,
prostat
❑ Biasanya : dari atas  Epididimis
tbc epididimis  ada tbc prostat/vesica
seminalis ginjal
tbc prostat  tbc epididimis (-)
PATOLOGI
❑ Sama dengan organ lain : granuloma, infiltrat,
basic tbc, caseosa
❑ Granuloma : meliputi seluruh epididimis dari
penyebaran kuman  sampai ke vas deferens
❑ Granuloma akan teraba seperti tasbih/rosario  nodul-
nodul berderet
❑ Tidak diobati : nodul-nodul menyatu Lunak
perkejuan (caseosa)  fistel ddg post skrotum
❑ Meluas ke testis : orkitis tbc
❑ Ke vas deferens: vasitis tbc
❑ Infeksi sekunder  abses

GAMBARAN KLINIK
❑ Epid.vas tbc : perlahan & ada tbc bagian lain
❑ Gejala dini : benjolan keras, nodul-nodul nyeri (-) 
jika (+) : ada infeksi sekunder
❑ Dysuri, pyuri, hematuri : jarang
❑ Nodul-nodul menyatu  caseosa  fistel  gejala
patognomonis
❑ Kalau orkitis tbc  hidrokel inflamasi
❑ Epididimis & vas deferens  tasbih
DIAGNOSIS
❑ Pada fase awal  tidak khas hanya benjol-benjol keras
pada epididimis
❑ Pernah menderita tbc bag. Lain/paru
❑ Perlu pemeriksaan laboratorium : LED ↑ , Lymphocyt ↑ ,
RO : paru-paru, PA : sel Langhans,Caseosa
❑ Keluhan : lemas
❑ Mungkin BTA : urine & cairan hidrokel
❑ Fistel dinding post skrotum
DIAGNOSIS BANDING
1. Tumor testis/epididimis : keras, batas tegas, irregular
biopsi/prozen section Ca. orkidektomi
2. Gumma sifilis biasanya testis fistel dianterior,
VDRL- Kahn
3. Pyogenik epididimitis
- Akut, demam  abses
❑
❑ PYRAZINAMIDE 3-4 X 500 MG/HARI
❑ INH 1X300 MG/HARI
❑ ETAMBUTOL 1200 MG/HARI
❑ RIFAMPICIN 450-600 MG/HARI
❑
❑ INH 300 MG/HARI
❑ RIFAMPICIN 450-600 MG/HARI
2. PEMBEDAHAN INDIKASI
❑ Fistel skrotum yang menahun
❑ Abses yang menahun & meluas
❑ Epididimitis rekurent
❑ Kurang respons Th/konservatif
❑ Epididimitis cenderung meluas sampai orkitis
❑ Kalau terbatas epididimitis –>epididimektomi
❑ Kalau sampai (+) orkitis + abses  orkido-
epididimektomi
KOMPLIKASI
❑ Pengobatan terlambat / Th/ tidak adekuat  abses &
fistel
❑ Sub-fertility : epididimitis & orkitis tbc  sampai
prostatitis & vesiculitis seminalis tbc infertility

PROGNOSIS
❑ Kurang baik sering kambuh setelah obat
dihentikan
❑ Epididimitis tbc : bilateral atau melibatkan
prostat & v.seminalis  infertility
• Practicing safe sex
• Treating sexual partners as a contact to
epididymitis
• Repeat screening for STI ~ 2 months after initial
testing for re-infection
• Abstain from sex until the individual & sex
partners have completed treatment
❑ Radang dari testis sendiri jarang
❑ Penjalaran ke testis via :
❑Hematogen
❑Limfogen
❑Vas deferens  epididimis

ETIOLOGI
1. Banal
2. Spesifik
3. Virus : virus MUMPS
1. ORKITIS AKUTA (BANAL)
❑ Dari fokus lain : tonsilitis, osteomyelitis, dll
orkitis  orkitis pyogenik (abses)
❑ Juga bisa dari epididimitis

2. ORKITIS VIRUS
❑ Dari parotitis akuta epidemika paling
sering > orkitis 20-35% MUMPS
orkitis virus darah  ginjal urine
urethra duktus ejakulatorius vas
deferens epididimis orkitis.
❑ Umumnya unilateral
❑ 10-15% bilateral infertile
❑ Onset period + 3 – 4 hari post-parotitis
❑ Demam sampai 400C
❑ Gejala urine (-)

3. ORKITIS TBC
❑ Dapat hematogen dari paru atau lain
❑ Langsung dari epididimitis tbc
❑ Infeksi sekunder orkitis pyogenik
❑ Sifilisstad. III
❑ Testis  smooth, nyeri (-)
❑ Fistel skrotum ddg depan
❑ Dx. : PA dan Serologis

PATOLOGI
❑ NON SPESIFIK ORKITIS
❑ Testis >>, kongestif, tegang, nyeri, abses kecil-
 abses
❑ Jaringan ikat
❑ Tubulus seminiferus infark
❑ ORKITIS VIRUS
❑ Testis >> kebiruan
❑ Reaksi interstitial, oedem, pelebaran
pembuluh darah
❑ Degeneras tubulus
❑ Testis mengecil dan lembek
❑ Sel-sel Leydig normal
❑ Nyeritiba-tiba, bengkak
❑ Skrotum bengkak-kemerahan
❑ Demam sampai 400C
❑ Mungkin masih ada :
❑ Uretritis
❑ Parotitis
❑ Fokus infeksi tempat lain
❑ Orkitisabsedens  fluktuasi
❑ Bisa uni/bilateral
❑ Awal : dapat dibedakan epdidimis
LABORATORIUM
❑Darah : leukositosis
❑Urine : - Bisa (N)/Leukosit (+)
 Virus

DD : - Epididimitis akuta
- Torsio test, epididimis lain
❑ 25-35% infertility irreversibel
❑ Fungsi hormonal tetap baik

PENGOBATAN
1. Tindakan khusus : inj.20 ml. procain 1% di
funikulus  kurang sakit
2. Bed-rest dengan T-Verband  support
testis kurangi sakit/oedem
3. Antibiotika + analgetik, antiinflamasi
4. Orkitis MUMPS : symptomatis
5. Orkitis absedens  orkidektomi
6. Ragu-ragu dengan torsio  explorasi

PROGNOSIS
❑ Orkitis bilateral  infertile