Prostatitis

Question 1

What is prostatitis

Answer 1

Inflammation of the prostate

Question 2

What are the classifications of prostatitis

Answer 2

Acute bacterial prostatitis - acute infection in prostate with more rapid onset of symptoms
Chronic prostatitis - symptoms last for at least 3 months
Chronic prostatitis or chronic pelvic pain syndrome - no infection
Chronic bacterial prostatitis - infection

Question 3

Prostatitis presentation

Answer 3

Chronic:
Pelvic pain (may affect perineum, testicles, scrotum, penis, rectum, groin, lower back or suprapubic area)
Lower urinary tract symptoms e.g. dysuria, hesitancy, frequency, retention
Sexual dysfunction e.g. erectile dysfunction, pain of ejaculation, heamatospermia (blood in semen)
Pain with bowel movements
Tender and enlarged prostate on DRE
Acute:
Similar symptoms to chronic but may have systemic signs of infection e.g.
Fever
Myalgia
Nausea
Fatigue
Sepsis

Question 4

Prostatitis investigations

Answer 4

Urine dipstick - for infection
Urine microscopy & culture - causative organism
Chlamydia and gonorrhoea testing on first pass urine
DRE - enlarged prostate (smooth)

Question 5

Prostatitis complications

Answer 5

Sepsis
Prostate abscess
Acute urinary retention
Chronic prostatitis

Question 6

Acute prostatitis management

Answer 6

Hospital admission if systemically unwell
Oral ABX for 2-4 weeks (ciprofloxacin, trimethoprim)
Analgesia (paracetamol or NSAID’s)
Laxatives for pain during bowel movements

Question 7

Chronic prostatitis management

Answer 7

Alpha blockers (e.g. Tamsulosin) relax smooth muscle - rapid improvement in symptoms
Analgesia (Paracetamol or NSAID’s)
Psychological treatment
Antibiotics if symptoms less than 6 months or history of infection (Trimethoprim or doxycycline for 4-6weeks)
Laxatives for pain during bowel movements