Prostatitis Flashcards
What is prostatitis and what is it compresed of?
Inflammtion of the prostate gland. Most common urological problem in men under 50 years old.
Comprised of acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis and prostatogynia
What is the pathophysiology of acute bacterial prostatitis and what are the causative organisms?
Ascending urethral infection. Although direct or lymphatic spread from rectum or hamaogenous spread via bacterial sepsis can be a cause.
Causative organisms - E.coli (most common), Enterobacter, Serratia, Pseudomonas and Proteus species. STI - Chlamydia or Gonorrhoea are rare causes.
What is chronic bacterial prostatitis?
Chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be as a result of inadequately treated acute prostatitis.
What are the risk factors for acute bacterial prostatitis?
Indwelling catheters
Phimosis or urethral strictures
Recent surgery, including cystoscopy or transrectal prostate biopsy.
Immunocompromised
What are the risk factors for chronic prostatitis?
Intraprostatic ductal reflux
Neuroendocrine dysfunction
Dysfunctional bladder
What are the clinical features of acute bacterial prostatitis?
LUTS
Systemic infection
Perineal or suprapubic pain
Urethral discharge
DRE - tender + boggy prostate, ingunial lymphadenopathy
Whata are the clinical features of chronic prostatitis?
Pelvic pain or discomfort for at least 3 months alongside LUTS
Perineum is most common site for pain
What are the initial investigations for prostatitis?
Urine culture - can guide antibiotic thearpy
STI screen an Routine bloods
What further investigations be required if intially thearpy failed?
Transrectal prostatic ultrasound (TRUS) Or CT imaging - rule out prostate abscess
What is the mainstay of management of acute bacterial prostatitis?
Prolonged antibiotic thearpy - quinolone due to good pentration into prostate
Sutible analgesia
Second line - alpha blockers and 5-alpha reductase, esp in chronic prostatitis
When may admission to hospital be necessary for prostatitis?
Severely ill or unable to tolearte oral antibiotics
Specilaist input when - DM, long-term catheter, immunocompromised or suspected prostatic abscess
What is the management of chronic prostatitis?
Symptomatic control
LUTS - 4-6 week trial of alpha blockers
6 week course of antibiotics if symptoms persistant for less then 6 months
If symptoms pesist after this the refferal to chroinc pain specialist.
