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Prostatitis - acute - Coggle Diagram
Prostatitis - acute
Differential diagnosis
Acute unilateral or bilateral epididymo-orchitis
Prostate cancer
Urinary tract infection
Bladder cancer
Chronic prostatitis
Colorectal cancer
Benin prostatic hyperplasia
Management
Consider urgent referral for any man who is immunocompromised, has diabetes or pre-existing urological condition.
Start oral antibiotic treatment, taking into account local antimicrobial resistance data. Prescribe an oral antibiotic for 14 days: Ciprofloxacin or Levofloxacin.
Admit to hospital if the man is unable to take oral antibiotic, has severe symptoms or has signs/symptoms of a more serious condition.
Advise to take paracetamol or ibuprofen (is suitable) for pain, drink enough fluids, usual course of acute prostatitis, possible adverse effects on antibiotics. Seek medical help if symptoms worsen, do not start to improve with 48 hours of treatment or they become systemically unwell.
Arrange follow up after 48 hours to check response to treatment and the urine culture results.
Review antibiotic treatment after 14 days and either stop treatment, or continue for an additional 14 days based on an assessment of history, symptoms, clinical examination, urine and blood tests.
Following recovery, refer for investigation to exclude structural abnormality of the urinary tract.
Diagnosis
Carry out physical examination of abdomen to detect distended bladder or costovertebral angle tenderness, a genital examination and DRE.
Consider screening for sexually transmitted infections (STIs), particularly in men considered to be at risk.
Arrange blood cultures and FBC.
Consider and exclude other causes of symptoms.
Arrange collection of a mid-steam urine (MSU) sample to confirm urinary tract infection (UTI) by dipstick, culture and sensitivity.
When to suspect
Urinary tract infection - dysuria, frequency, urgency.
Prostatitis - perineal, penile or rectal pain, acute urinary retention, obstructive voiding symptoms, low back pain, pain of ejaculation, tender, swollen, warm prostate (on gentle rectal examination).
Suspect acute prostatitis in a man who presents with signs and symptoms of:
Bacteraemia - rigors, arthralgia, myalgia, fever or tachycardia.
Definition: Acute bacterial prostatitis is a severe, potentially life-threatening bacterial infection of the prostate. Acute bacterial prostatitis is accompanied by infection of the urinary tract.