Prostatitis

Question 1

Types of prostatitis

Answer 1

Acute bacterial

Chronic bacterial

Non-bacterial

Prostatodynia

These flashcards will focus on acute bacterial

Question 2

Pathophysiology

Answer 2

Caused by most commonly ascending urethral infection (can however also spread directly or lympathic from rectum, or even from blood)

Question 3

Causative organisms

Answer 3

E. coli (most commonly)

Enterobacter

Serratia

Pseudomonas

Proteus

STIs like Chlamydia or Gonorrhoea can happen but are rare

Question 4

Cause of chronic bacterial

Answer 4

Usually due to inadequately treating acute prostatits

Question 5

Risk factors of acute

Answer 5

Indwelling cath

Phimosis or urethral stricture

Recent surgery, including cytoscopy or transrectal prostate biopsy

Immunocompromised

Question 6

Risk factors of chronic

Answer 6

Intraprostatic ductal reflux

Neuroendocrine dysfunction

Dysfunctional bladder

Question 7

Clinical features of acute

Answer 7

LUTS

Systemic infection features like pyrexia

Perineal or suprapubic pain or urethral discharge

Question 8

Clinical features of chronic

Answer 8

Should be suspected in men with pelvic pain or discomfort for >3 months (Prostatodynia) + LUTS

The perineum is the most common site for pain, but can also happen in the suprapubic area, lower back or rectum.

Question 9

Examination findings

Answer 9

Tender and boggy prostate

Inguinal lymphadenopathy might be present

Question 10

First line investigation

Answer 10

Urine culture

Abx therapy can be guided from sensitivities.

Question 11

Other investigations

Answer 11

STI screen and routine bloods with FBC, cRP and U&Es.
PSA is not usually done because it tends to be elevated.

Question 12

Indications of further investigations

Answer 12

Only done in secondary care and usually indicted when initial therapy has failed or to investiate for potential underlying cause.

Question 13

In patients who fail to respond to abx therapy, what should be done?

Answer 13

Prostate abscess needs to be reuled out using transrectal prostatic ultrasound TRUS or CT imaging.

Question 14

First line management

Answer 14

Prolonged abx therapy

It is usually done by a quinolone like ciprofloxacin due to their good penetration into the prostate.

Analgesia should also be given.

Question 15

Second line, especially in chronic

Answer 15

Alpha blockers or 5alpha-reductase inhibitors

Question 16

What should be done for patients that are severely ill or are unable to tolerate oral abx?

Answer 16

Admission to hospital

Especially if there is concurrent DM, long term catheter, immunocompromised or suspected prostatic abscess.

Question 17

When might you refer to urology?

Answer 17

Pre-existing urological condition like BPH for further management

Question 18

Further management of prostatitis.

Answer 18

in chronic explain that the cause is not always understood and it can be difficult to treat.

Focus on symptom control with oral analgesia and stool softeners if there is painful defecation.

4-6 week trial of alphablocker like doxazosin or tamsulosin can be trialled

6 week course of abx might be warranted if preesent for less than 6 months.

Question 19

What should be done if symptoms still persist even after further management?

Answer 19

Referral to a chronic pain specialist.

Psychological therapies can also help or an MDT approach.