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prostatitis

prostatitis

introduction

  • prostatitis is an infection or inflammation of the prostate
  • there are said to be 4 syndromes:
    • acute bacterial prostatitis (5% of cases)
      • usually men with chronic IDCs, immunocompromised (incl. diabetes), intermittent self-catheterisation or following prostatic biopsy
    • chronic bacterial prostatitis
      • usually men with UTI's, undertreated acute bacterial prostatitis, or perhaps rectal spread (perhaps anal sex) or haematogenous spread infections
      • Enterococci can create a biofilm in the prostate and cause chronic prostatitis
    • chronic prostatitis and chronic pelvic pain syndrome
      • ~7% of men will develop this at some point in their lives, especially 30-50yr olds
      • men should consider ensuring they ejaculate regularly as this appears to help reduce symptoms and risk of prostatitis 1)
    • asymptomatic inflammatory prostatitis
  • culture negative prostatitis may also be due to:

acute bacterial prostatitis (ABP)

  • an important condition in ED as high risk of developing urosepsis

clinical features of ABP

aetiology of ABP

  • ascending infection through the urethra or direct or lymphatic spread from rectum

potential complications of ABP

  • acute urinary retention
  • prostatic abscess
  • chronic bacterial prostatitis
  • fistula formation
  • spread of infection to the spine or sacroiliac joints

Mx of ABP

  • iv access, FBE, U&E, CRP, blood cultures
  • exclude sepsis
  • MSU m/c/s
  • if younger adults, or high risk, send urethral swabs or 1st pass urine for STD screen (PCR) and commence appropriate antibiotics for sexually transmitted infections (STDs/STIs)
  • some advocate a 3rd stage urine sample taken after prostatic massage with pyuria suggesting ABP
  • iv antibiotics as indicated
  • consider Ix for prostatic abscess if:
    • immunocompromised
    • diabetic
    • recent instrumentation of urinary tract or prostatic biopsy
    • failure to respond to antibiotic Rx
  • if acute urinary retention develops, avoid IDC and use suprapubic catheter instead
prostatitis.txt · Last modified: 2019/06/27 13:34 (external edit)