prostatitis/CPPS

Question 1

how is prostatitis classified?

Answer 1

category 1- acute bacterial
category 2- chronic bacterial
category 3- chronic non bacterial / CPPS
category 4- asymptomatic inflammatory prostatitis

Question 2

symptoms of prostatitis /cpps

Answer 2

urogenital pain- perineum, loser abdomen, tip penis, back, testes, rectum, urethra

sexual dysfunction- pain with ejaculation, low libido, ED

lower UT symptoms. - frequency, nocturia, urgency, incomplete voiding, abnormal flow, urethral discharge, haematospermia

psychological - reduced qol, depression, anxiety

Question 3

what is acute bacterial prostatitis?

Answer 3

complication of lower UT infection caused by urinary pathogens especially E. coli
Rule out structural pathology

Question 4

how to diagnose acute bacterial prostatitis?

Answer 4

digital rectal exam- prostate enlarged,warm, boggy
MSU
STI screen
exclude sepsis
discuss with urology

Question 5

What is managent of ABP?

Answer 5

Start abx for 28 days
oral fluroquinolone eg cilrofloxacin, ofloxacin
if allergy - trimethoprim 
Analgesia
Admit it unwell

Question 6

What are the causes of haematospermia?

Answer 6

Trauma
Inflammation (urethritis, prostatitis, epidydimitis)
Obstruction or dilatation of urogenital ducts eg stricture or cysts
Vascular abnormalities
Systemic disorders eg severe hypertension, coag disorders
Drugs eg warfarin
Tumours - benign eg polyps, warts or malignant (carcinoma of genital tract)

Question 7

How common is chronic bacterial prostatitis?

Answer 7

Accounts for 2-5% of prostatitis cases

Question 8

what is aetiology of CBP?

Answer 8

usually recurrent or persistent prostate infection with Ecoliw
Different to acute as no systemic symptoms

Question 9

what is management of CBP?

Answer 9

antibiotics for 4-8 weeks
preferably a fluroquinolone as high concentration in prostatic tissue
Trimethoprim -2nd line

Question 10

what is prostatic assessment?

Answer 10

prostatic massage 
FVU and MSU before
left lateral
massage 4 poles
prostatic fluid should appear at meatus

Question 11

What is first line treatment for uncomplicated UTI in men?

Answer 11

Trimethoprim 200mg bd 7/7
Or Nitrofurantoin 100mg mr bd 7/7
(depending on local resistance)

Question 12

Who to refer to urology of men with UTI?

Answer 12

Ongoing symptoms despite abs
Underlying RF (eg calculi, obstruction, recurrent UTI- 2 or > in 6/12)

Refer nephrology is persistent microscopic haematuria, proteinuria or impaired renal function)

Question 13

Who needs 2 week cancer referral for urinary symptoms?

Answer 13

45 or over
unexplained visible haematuria without UTI
Visible haematuria that persists/recurs

> 60 and have non visible haematuria and dysuria/raised WCC

Non urgent referral for bladder ca in >60 with recurrent UTI