Can you get prostatitis without a prostate?

Prostatitis Cannot Occur Without a Prostate

Prostatitis by definition cannot occur in individuals without a prostate gland, as the condition specifically refers to inflammation or infection of the prostate tissue. 1 This is anatomically and physiologically impossible in someone who has undergone complete prostatectomy or was born without a prostate.

Understanding Prostatitis and Its Relationship to the Prostate Gland

Prostatitis is classified by the National Institutes of Health into four distinct categories:

1. Acute bacterial prostatitis
2. Chronic bacterial prostatitis
3. Chronic prostatitis/chronic pelvic pain syndrome
4. Asymptomatic inflammatory prostatitis

All these conditions specifically involve inflammation or infection of the prostate gland itself 1, 2. The diagnostic procedures for prostatitis, such as the Meares-Stamey 4-glass specimen collection or the 2-specimen variant, rely on obtaining expressed prostatic secretions (EPS) from the prostate gland 3. Without a prostate, these secretions cannot be produced or collected.

Post-Prostatectomy Considerations

After radical prostatectomy, patients may experience various urinary symptoms that might superficially resemble prostatitis symptoms, but these are not prostatitis. These include:

• Stress urinary incontinence due to sphincteric insufficiency 3
• Urgency urinary incontinence due to bladder dysfunction 3
• Vesicourethral anastomotic stenosis or bladder neck contracture 3

These conditions require different diagnostic approaches and treatments than prostatitis. For example, stress urinary incontinence after prostate treatment may require artificial urinary sphincter placement or male sling procedures, while urgency incontinence would be treated according to overactive bladder guidelines 3.

Similar Symptoms, Different Diagnosis

Patients without a prostate who experience symptoms similar to prostatitis (pelvic pain, urinary symptoms) should be evaluated for alternative diagnoses:

• Urethritis
• Cystitis
• Pelvic floor dysfunction
• Bladder neck contracture
• Urethral stricture disease
• Chronic pelvic pain syndrome of non-prostatic origin

Diagnostic Approach for Post-Prostatectomy Urinary Symptoms

For patients who have undergone prostatectomy and experience urinary symptoms:

1. Evaluate for stress or urgency incontinence through history and physical examination 3
2. Consider cystourethroscopy to assess for urethral and bladder pathology 3
3. Assess for vesicourethral anastomotic stenosis or bladder neck contracture 3
4. Consider urodynamic studies to differentiate between different types of incontinence

Treatment Considerations

Treatment should target the actual underlying condition rather than prostatitis:

• For stress urinary incontinence: pelvic floor muscle exercises, male slings, or artificial urinary sphincter 3
• For urgency incontinence: treatment according to overactive bladder guidelines 3
• For bladder neck contracture: treatment of the obstruction prior to addressing incontinence 3

Key Pitfalls to Avoid

1. Misdiagnosing post-prostatectomy urinary symptoms as "prostatitis"
2. Attempting to treat non-existent prostatitis with antibiotics in patients without a prostate
3. Failing to identify the true cause of urinary symptoms in post-prostatectomy patients
4. Overlooking potential complications of prostate surgery that may cause urinary symptoms

In conclusion, prostatitis cannot occur in individuals without a prostate gland. Any symptoms resembling prostatitis in such individuals require thorough evaluation to identify the true underlying cause and appropriate treatment.