prostatitis

see also:

• urinary tract infections (UTIs) / cystitis
• benign prostatic hyperplasia (BPH)
• https://www.andrologyaustralia.org/wp-content/uploads/Factsheet_Prostatitis.pdf

• 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:
  • cytomegalovirus (CMV), tuberculosis (TB) of fungi, particularly in patients with HIV / AIDS
  • can be a presenting feature of Wegener granulomatosis

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

• variable
• fever, chills
• perineal or lower abdominal pain
• symptoms of urinary tract infections (UTIs) / cystitis
• painful ejaculation
• haematospermia
• tender prostate on PR exam (avoid excessive massage as may precipitate sepsis)
• may cause a raised prostate specific antigen (PSA) as well as raised inflammatory markers

• ascending infection through the urethra or direct or lymphatic spread from rectum
  • 80% are Gram negatives such as E.coli
    • common following prostatic biopsies or urethral catheterisation
  • sexually transmitted infections (STDs/STIs) may be a cause, particularly in younger men

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

• 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
• non-steroidal anti-inflammatory drugs (NSAIDs)
• 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