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Prostatitis

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Topic updated on 08/22/17 11:32am

Snapshot
  • A 60-year-old man presents to his urologist for a 4-month history of pelvic pain. He denies fevers or chills and any recent sexual activity. His physical exam reveals a mildly tender prostate on digital rectal exam. His urinalysis is unremarkable. He is started on tamsulosin and ciprofloxacin.
Introduction
  • Clinical definition
    • infectious or non-infectious inflammation of the prostate
    • acute prostatitis
      • typically infectious
      • < 35 years of age
        • most commonly C. trachomatis and N. gonorrhoeae
      • > 35 years of age
        • most commonly E. coli, P. aeruginosa, K. pneumoniae
    • chronic prostatitis
      • can be due to recurrent infections lasting > 3 months (10% of chronic prostatitis)
      • can be due to chronic pelvic pain (90% of chronic prostatitis)
        • > 3 months of pain in the absence of other identifiable causes
        • noninfectious etiology but often unknown
        • can be due to trauma, psychological stress, and increased prostate tissue pressure
  • Epidemiology
    • incidence
      • 10-15% men have it once in their lifetime
    • risk factors
      • catheterization
      • benign prostatic hypertrophy
Presentation
  • Symptoms
    • dysuria
    • urinary frequency
    • urinary urgency
    • straining with urination or interrupted stream (obstruction)
    • lower back pain
  • Physical exam
    • fever
    • chills
    • digital rectal exam
      • enlarged prostate
      • very tender on exam may indicate acute prostatitis
      • less tender on exam may indicate chronic prostatitis
Studies
  • Urine studies for bacterial infection
    • urinalysis
      • pyuria
      • hematuria
    • urine culture
Differential
  • Urinary tract infection
  • Urethritis
Treatment
  • Medical
    • antibiotics
      • indications
        • acute or chronic bacterial infection
      • drugs chosen empirically based on local resistance patterns
        • uropathogens
          • trimethoprim and sulfamethoxazole
          • fluoroquinolone
        • sexually transmitted pathogens
          • ceftriaxone
          • azithromycin
    • α-blockers
      • indications
        • chronic pelvic pain syndrome or noninfectious chronic pain
        • typically given alongside a fluoroquinolone for initial therapy
      • drugs
        • tamsulosin
Complications
  • Prostatic abscess



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