Prostatitis Flashcards
What is prostatitis?
prostatic pain is the hallmark
What are the 4 types of prostatitis?
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Inflammatory Chronic Pelvic Pain Syndrome (Non-bacterial Prostatitis)
Non-inflammatory Chronic Pelvic Pain (Prostatodynia)
Presentation of acute bacterial prostatitis?
Fever, irritative, poss obstructive voiding sxs, warm boggy tender prostate
usually seen in young men
Typical pathogen of acute bacterial prostatitis?
E. coli
How do we eval for acute bacterial prostatitis?
H &P: no vigorous prostate exam
urine culture: not post prostate massage
CBC
blood cultures
Tx for acute bacterial prostatitis?
If significant fever, highly elevated WBC, sepsis, admit for IV abx
If in urinary retention: suprapubic tube might be preferable to urethral catheter
when no longer acutely toxic > switch to PO abx
on DC tx for a 4-6 wk course of abx
When might you check a CT in a pt with acute bacterial prostatitis? why?
if persistently febrile
r/o prostatic abscess
Presentation of chronic bacterial prostatitis?
Recurrent prostatic infections
Pain in genitals, urinary tract, perineum, low back
Irritative urinary symptoms (dysuria, urgency, frequency) and pain w/ejaculation
Who usually gets chronic bacterial prostatitis? typical pathogen?
older men
E. coli
What other organisms can cause chronic bacterial prostatitis?
Klebsiella, Pseudomonas, Proteus, Enterococcus, Staphylococcus saprophyticus, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis
Physical exam finding in chronic bacterial prostatitis?
tender boggy prostate
What labs would you check for chronic bacterial prostatitis?
Expressed prostatic secretion (EPS)
Post prostate massage urine culture
Meares Stamey 4 glass test -not really done
Tx for chronic bacterial prostatitis?
Abx: Bactrim, Fluroquinolones
- adjust based on culture
- prolonged therapy 8-16wks, may need longer
NSAIDS
Alpha Blockers
Anticholinergics
Other tx options for chronic bacterial prostatitis?
Phytotherapy- plant based therapy
Zinc
Diet
Stress management
Prostate massage, ejaculation
Sitz baths
Inflammatory Chronic Pelvic Pain Syndrome is also called…
nonbacterial prostatitis
Presentation of Inflammatory Chronic Pelvic Pain Syndrome
similar to chronic bacterial prostatitis
How do you evaluate for Inflammatory Chronic Pelvic Pain Syndrome?
similar to chronic bacterial prostatitis
-hx of UTIs with negative cultures
PE findings of Inflammatory Chronic Pelvic Pain Syndrome ?
prostatic tenderness
Labs consistent with Inflammatory Chronic Pelvic Pain Syndrome?
Prostatic fluid with leukocytes; but cultures do not grow out bacterial pathogen
Tx for Inflammatory Chronic Pelvic Pain Syndrome?
emperic abx: SMX-TMP x 6-8
If not responsive, doxycycline 4-6 wk (Ureaplasma, Chlamydia, Mycoplasma)
Other tx options for Inflammatory Chronic Pelvic Pain Syndrome?
NSAIDs
Anticholinergics/antimuscarinic for urinary urgency
Alpha blockers
Sitz baths
Stress reduction, biofeedback, counselling
Can try zinc, nickel, saw palmetto, quercitin
Prostate massage
Dietary (caffeine, alcohol, spicy acidic food)
Benzodiazepine
Tricyclic antidepressant
Analgesics, Pain specialist consult
Noninflammatory Chronic Pelvic Pain Syndrome is also called…
prostadynia
Presentation of Noninflammatory Chronic Pelvic Pain Syndrome?
Like Chronic bacterial prostatitis and Inflammatory chronic pelvic pain syndrome
Labs of Noninflammatory Chronic Pelvic Pain Syndrome?
no bacteria on culture, and no leukocytes in prostatic fluid
Tx for Noninflammatory Chronic Pelvic Pain Syndrome?
NSAIDs
Anticholinergics for urinary
Alpha blockers
Sitz baths
Stress reduction, biofeedback, counselling
Can try zinc, nickel, saw palmetto, quercitin
Prostate massage
Dietary (caffeine, alcohol, spicy acidic food)
Benzodiazepine
Tricyclic antidepressant
Analgesics, Pain specialist consult
