Does Prostatitis Cause Dysuria?
Yes, prostatitis commonly causes dysuria as a primary symptom, particularly in both acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Clinical Presentation
Acute Bacterial Prostatitis
- Dysuria is a hallmark urinary tract symptom alongside urinary frequency and urinary retention 1
- Patients typically present with painful urination accompanied by systemic symptoms including fever, chills, nausea, and malaise 1
- The main clinical manifestations consistently include frequency, urgency, and dysuria 2
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- CP/CPPS, which represents NIH type III prostatitis and accounts for over 90% of chronic prostatitis cases, is characterized by pain that is often exacerbated by urination 3
- Dysuria presents as one of the lower urinary tract symptoms in this condition, though pain remains the primary defining characteristic 4, 5
- The condition causes genitourinary pain, dysuria, urinary frequency, and sexual dysfunction 5
Distinguishing Features in Males
When evaluating male patients with dysuria, prostatitis should be strongly considered as a potential diagnosis. 3
- In men, early symptoms may begin with mild dysuria or urinary urgency, which can progress to severe voiding frequency, nocturia, and suprapubic pain 3
- The pain in CP/CPPS typically occurs in the perineum, suprapubic region, testicles, or tip of the penis, and is often exacerbated by urination or ejaculation 3
- Male urinary tract infections are classified as complicated UTIs, and when prostatitis cannot be excluded, a 14-day course of antibiotics is recommended 6
Clinical Pitfalls
A common diagnostic challenge is differentiating prostatitis from other conditions that cause dysuria:
- Interstitial cystitis/bladder pain syndrome (IC/BPS) shares similar symptoms with CP/CPPS, and some men may meet criteria for both conditions 3
- In IC/BPS, pain is perceived to be related to the bladder and worsens with bladder filling or improves with urination 3
- The diagnosis of IC/BPS should be strongly considered in men whose pain is perceived to be bladder-related, though treatment approaches can overlap 3
Treatment Implications
- After diagnosis of acute prostatitis, full-dose sensitive antibiotics should be given as early as possible, with temperatures typically returning to normal within 3 to 5 days 2
- For chronic prostatitis, a multimodal approach using antibiotics, α-blockers, antimuscarinic and anti-inflammatory drugs is recommended, though response is variable 5
- When prostatitis cannot be excluded in male UTIs, empiric therapy should include a 14-day antibiotic course with options such as amoxicillin plus an aminoglycoside, a second-generation cephalosporin plus an aminoglycoside, or an intravenous third-generation cephalosporin 6