Prostatitis

Question 1

NIDDK/NIH classification

Answer 1

I Acute bacterial prostatitis

II Chronic bacterial prostatitis

III Chronic pelvic pain syndrome (CPPS): chronic abacterial prostatitis

IIIA Inflammatory CPPS: white blood cells (wbc) in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or semen

IIIB Non-inflammatory CPPS: no wbc in EPS, VB3, or semen
IV Asymptomatic inflammatory prostatitis (histological prostatitis)

Question 2

segmented urine culture

Answer 2

VB1: first 10-15ml of urine voided
VB2: mid-stream urine collection of 10-15ml
EPS: the prostate is massaged whilst holding a sterile container below the glans to catch secretions
VB3: first 10-15ml of urine voided following prostatic massage

Question 3

symptoms of type II prostatitis

Answer 3

symptoms persist for 3 months or more
recurrent UTI
pelvic pain and voiding dysfunction
uropathogens in urine samples or blood

Question 4

organisms in bacterial prostatitis

Answer 4

90% gram -ve ecoli
proteus, kleb.
10% enteroccous

Question 5

symptom score in prostatitis

three main domains

Answer 5

NIH chronic prostatitis symptom index NIH CPSI

Pain - location freq severity
urinary symptoms - voiding, storage, impact on ADL

Impact on QOL

Question 5

symptom score in prostatitis
three main domains
how many questions each

Answer 5

NIH chronic prostatitis symptom index NIH CPSI

Pain - location freq severity
urinary symptoms - voiding, storage, impact on ADL

Impact on QOL

4 on pain
2 on luts
3 on QOL

Question 6

symptom score in prostatitis

three main domains

Answer 6

NIH chronic prostatitis symptom index NIH CPSI

Pain - location freq severity
urinary symptoms - voiding, storage, impact on ADL

Impact on QOL

Question 7

treatment acute bacterial prostatitis

Answer 7

secondary care
IV gent 7mg /kg
urine culture
2 sets blood cultures
review at 48 hours
max 72 hours
can step down to co trimoxazole or ciprofloxacin

Question 8

treatment chronic bacterial prostatitis

Answer 8

quinolone for 4-6 weeks

alpha blockers

Question 9

prostate cancer UK treatment algorithm for CBP

Answer 9

antibiotic 4-6 weeks, analgesia, alpha blockers
review 4-6 weeks
if symptoms ongoing and no response abx or no bacteria consider abuse
if some response further abx
otherwise treat
pain
luts
sexual problems
psychosocial problems

Question 10

prostatic abscess
mortality
fever
perineal pain
luts

Answer 10

mortality 1-16%
fever 30-72%
perineal pain 20%
urinary retention 1/3
luts in 96% of cases
need imaging trus ct or mri to confirm

Question 11

guidelines abcess more or less than 1cm

Answer 11

<1cm conservative
>1cm us drainage and antibiotics 
if doesn't improve CT scan
if localised to prostate TUR drainge
if extra prostatic penetration open drainage

Question 12

complications abscess

Answer 12

fistulation in bladder, urethra, rectum or perineum
severe sepsis
septic pul emboli and meningitis

Question 13

epididymorchitis risk factors for STI

Answer 13

age under 35 and sexually active
new partner 60 days
multiple partners
MSM
sexual partner with STI
prev history of STI
inconsistent or no condom use outside of a mutually monogomous relationship

Question 14

trust epididymitis guideline

Answer 14

STI high risk
cef 500mg IM one dose
100mg bd doxy 2 weeks

STI low risk
co trimoxazole if GFR above 30 960mg bd , caution use other meds raise pottasium

if egfr less than 30
ciprofloxacin 500mg od

Question 15

mumps orchitis
occurs in % of infected males
when onset after parotitis
how many bilateral
other action

Answer 15

30% of infected post pubertal males
occurs 5-7 days after parotitis
10% bilateral and can cause infertility
can result in testicular atrophy
notifiable disease
supportive treatment

Question 16

other causes orchitis

Answer 16

mumps
TB
syphilis
HIV
auto immune granulomatous orchitis