Prostatitis Flashcards
Causes of prostatitis?
Acute bacterial prostatitis caused by urinary pathogens, commonly E coli, then pseudomonas aeruginosa.
Rarely it can occur secondary to STI like chlamidyia or gonorrhoea.
Acute prostatitis can be caused by urethral intrumentation, trauma, bladder outflow obstruction or dissemination of infection from elsewhere in body.
Signs and symptoms of acute prostatitis?
UTI: dysuria, frequency, urgency.
Perineal, penile (often at base) or rectal pain.
Acute urinary retention, obstructive voiding sx.
Low back pain
Bain on ejaculation.
Tender, swollen warm prostate.
Severe pain on PR exam.
Bacteraemia: rigors, arthralgia, myalgia, fever tachy.
How to investigate and diagnose prostatitis?
Mid stream MSU (see leukocytes, nitrates + blood).
Arrange blood cultures and FBC.
PR exam#; prostate will be tender, enlarged, or boggy.
Consider screening for STIs
Differentials for prostatitis?
BPH (as it can present with gradual reduction of urinary flow etc and can present with acute urinary retention).
Chronic prostatitis: if sx ongoing for several weeks.
UTI: will not be sx of bladder outflow obstruction unless coexisting BPH or malignancy.
If scrotum/testis or epididymis swollen then think epididymo-orchitis.
How to manage prostatitis?
Oral abx for 14 days:
Ciprofolxacin
Or trimethoprin if unsuitable.
Follow up after 48hrs to check response to tx and see urine culture results- Alter abx when cultures return.
Consider urgent referral if immunocompromised or diabetic or pre-existing urological condition.
Advise men: OTC pain relief, drink fluids etc.
