Prostatitis

Question 1

What is prostatitis and what is it compresed of?

Answer 1

Inflammtion of the prostate gland. Most common urological problem in men under 50 years old.

Comprised of acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis and prostatogynia

Question 2

What is the pathophysiology of acute bacterial prostatitis and what are the causative organisms?

Answer 2

Ascending urethral infection. Although direct or lymphatic spread from rectum or hamaogenous spread via bacterial sepsis can be a cause.

Causative organisms - E.coli (most common), Enterobacter, Serratia, Pseudomonas and Proteus species. STI - Chlamydia or Gonorrhoea are rare causes.

Question 3

What is chronic bacterial prostatitis?

Answer 3

Chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be as a result of inadequately treated acute prostatitis.

Question 4

What are the risk factors for acute bacterial prostatitis?

Answer 4

Indwelling catheters
Phimosis or urethral strictures
Recent surgery, including cystoscopy or transrectal prostate biopsy.
Immunocompromised

Question 5

What are the risk factors for chronic prostatitis?

Answer 5

Intraprostatic ductal reflux
Neuroendocrine dysfunction
Dysfunctional bladder

Question 6

What are the clinical features of acute bacterial prostatitis?

Answer 6

LUTS
Systemic infection
Perineal or suprapubic pain
Urethral discharge

DRE - tender + boggy prostate, ingunial lymphadenopathy

Question 7

Whata are the clinical features of chronic prostatitis?

Answer 7

Pelvic pain or discomfort for at least 3 months alongside LUTS
Perineum is most common site for pain

Question 8

What are the initial investigations for prostatitis?

Answer 8

Urine culture - can guide antibiotic thearpy

STI screen an Routine bloods

Question 9

What further investigations be required if intially thearpy failed?

Answer 9

Transrectal prostatic ultrasound (TRUS) Or CT imaging - rule out prostate abscess

Question 10

What is the mainstay of management of acute bacterial prostatitis?

Answer 10

Prolonged antibiotic thearpy - quinolone due to good pentration into prostate
Sutible analgesia

Second line - alpha blockers and 5-alpha reductase, esp in chronic prostatitis

Question 11

When may admission to hospital be necessary for prostatitis?

Answer 11

Severely ill or unable to tolearte oral antibiotics

Specilaist input when - DM, long-term catheter, immunocompromised or suspected prostatic abscess

Question 12

What is the management of chronic prostatitis?

Answer 12

Symptomatic control

LUTS - 4-6 week trial of alpha blockers
6 week course of antibiotics if symptoms persistant for less then 6 months

If symptoms pesist after this the refferal to chroinc pain specialist.