Acute prostatitis is a severe, possibly life-threatening bacterial…
Acute prostatitis is a severe, possibly life-threatening bacterial infection of the prostate. It can be accompanied by a UTI.
rarely sexually transmitted infections.
follow urethral instrumentation trauma, bladder outflow obstruction or dissemination of infection elsewhere in the body.
urinary pathogens most commonly E.Coli
Acute urinary retention — this is a common complication of prostatitis and may be a presenting feature.
Prostatic abscess — this is a rare complication which may require surgical intervention. Risk factors include long-term urinary catheterization, recent urethral manipulation, and an immunocompromised state.
Benign prostatic hyperplasia (BPH) — typically presents with a gradual reduction in urinary flow, hesitancy, frequency, and nocturia. May also present with acute retention of urine.
Chronic prostatitis — consider this if the symptoms have been present for several weeks or months.
Urinary tract infection — there are usually no symptoms of bladder outflow obstruction unless there is coexisting BPH or prostatic malignancy.
Acute unilateral or bilateral epididymo-orchitis — consider these if the scrotum, testis, or epididymis are painful or swollen, there will usually also be symptoms of dysuria and frequency.
Prostate cancer — may present with similar symptoms to BPH.
Bladder cancer — usually presents with haematuria, and there may be dysuria and urinary frequency.
Colorectal cancer — typically presents with a change in bowel habit and there may be rectal bleeding or weight loss.
Suspect acute prostatitis in a man who presents with signs of UTI (Dysuria, frequency, urgency),
Bacteraemia- Rigors, arthralgia, or myalgia, Fever, tachycardia
Prostatitis (Perineal, penile, or rectal pain, difficulty voiding, hesitancy, straining to urinate, weak stream, Low back pain, pain on ejaculation, Tender, swollen, warm prostate (on gentle rectal examination)
Investigations- MSU, FBC and Blood Cultures
abdomen to detect a distended bladder
or costovertebral angle tenderness,
a genital examination
a digital rectal examination (DRE)- prostate will be tender, enlarged, or boggy
Consider screening for sexually transmitted infections (STIs), particularly in men considered to be at risk
consider and exclude differentials
Management- Acute Prostatitis
if stable and not for acute admission- commence oral ABx-Ciprofloxacin 500 mg BD or Trimethoprim (if sensitive) 200mg bd for 14 days
Self care advice- fluids, analgesia for pain/pyrexia- paracetamol or brufen if not contraindicated. Side effects of ABx, and how to take
Safety netting -if side effects from ABx, symptoms worsen or do not improve
Follow up after 48 hours or before if needed
Review ABx after 14 days,either stop treatment, or continue for an additional 14 days based on an assessment of history, symptoms, clinical examination, urine and blood tests.
Hospital admission if unable to take oral Abx, severe symptoms, signs of sepsis, acute retention, AKI
urgent referral- immunocompromised, diabetic, pre existing urological condition
Following recovery, refer for investigation to exclude structural abnormality of the urinary tract
Mx- Chronic Prostatitis
Explain that may be due to multifactorial cause.
Treatment may be indicated for long term symptom management rather than cure.
Provide reassurance that it is not cancer and is very rarely caused by and STI.
Signpost to self-help resources via online tools.
Most men require multimodal treatment aimed at symptom management and would require referral to specialists for review and assessment.
Consider treatment with paracetamol or NSAIDS, or alpha-blocker for 4-6 weeks if significant lower urinary tract symptoms, single course of antibiotic treatments if indicated or stool softener for constipation