Prostatitis

Question 1

Prostatitis Types

Answer 1

• Non-bacterial and bacterial
• Non-bacterial more common
• Acute symptoms of bacterial prostatitis leads to more common consultations
• Prostate pain syndrome is without identifiable cause

Question 2

Prostatitis Epidemiology

Answer 2

• Common
• Chronic more common than acute
• Bacterial more common in those under 35 years old

Question 3

Prostatitis Aetiology

Answer 3

Bacterial

• Usually G-, E. coli, Enterbacteria…
• STIs
• Rarely mycobacterium tuberculosis

Non-bacterial

• Elevated prostatic pressures
• Pelvic floor myalgia
• Emotional disorders

Question 4

Prostatitis RFs

Answer 4

• STIs
• UTIs
• Catheters
• Biopsy

Question 5

Prostatitis Classification

Answer 5

Four broad categories

• Acute bacterial
• Chronic bacterial
• Chronic prostatitis/CPPS
• Asymptomatic inflammation

Question 6

Prostatitis Presentation (+Difference to BPH)

Answer 6

• Fever, malaise, arthralgia, myalgia
• Low back pain, low abdo pain, perineal pain, pain I urethra
• Frequency, urgency, dysuria, nocturia, hesitancy, incomplete voiding
• Pain on ejaculation
• Discharge
• Causes more pain than BPH and painful ejaculation
• Prostatitis more likely under 50, BPH more likely over 50

Question 7

Prostatitis Differentials

Answer 7

• Cystitis
• BPH
• Stones

Question 8

Prostatitis Investigations

Answer 8

• Screen for sepsis
• Bloods
• Urine culture

Question 9

Chronic Non-Bacterial Prostatitis Presentation, Diagnosis, Aetiology

Answer 9

• Pain, urinary symptoms, QoL impact
• Prostatitis symptoms for over three months, negative cultures of urine and prostatic fluid, leukocytes present in inflammatory type
• Infection with unidentified organism, immune reaction, nervous dysfunction

Question 10

Prostatitis Management Acute Bacterial

Answer 10

• Fluoroquinolones (ciprofloxacin), analgesia
• Admit if acutely unwell or inadequate response
• Suprapubic catheter if in retention
• Avoid repeated rectal exam
• GUM if STI suspected

Question 11

Prostatitis Management Chronic Infective

Answer 11

• Refer if chronic prostatitis
• Antibiotics as per acute
• Analgesia and stool softeners

Question 12

Prostatitis Management Chronic Abacterial

Answer 12

-OTC pain relief, antibiotics, alpha blocker