Prostatitis

Question 1

Aetiology of prostatitis

Answer 1

Inflammation of the prostate due to:
E. coli (90%)
Pseudomonas aeruginosa
Proteus mirabilis
Klebsiella
Serratia spp
STIs e.g. gonorrhoea, chlamydia

Question 2

Risk factors for prostatitis

Answer 2

Recent UTI
Urogenital instrumentation
Intermittent bladder catheterisation
Recent prostate biopsy
BPH

Question 3

Symptoms and signs of prostatitis

Answer 3

Acute onset of LUTS:
- Dysuria
- urinary frequency
- perineal discomfort
Systemic: fever, chills, and malaise
Tender prostate
Referred pain (perineum, penis, rectum or back)

DRE:
- Tender
- Boggy prostate gland

Question 4

Investigations for prostatitis

Answer 4

Urinalysis: + leucocytes
MC&S: + for bacteria

Blood cultures

Transrectal US: rule out abscess
(4-glass/2-glass test)

Question 5

Management for prostatitis

Answer 5

Evidence of sepsis
1. A-E
2. Sepsis 6
a. IV abx: piperacillin ± gentamicin
3. NSAID
± catheter to relieve obstruction

No sepsis
Quinolones e.g. ciprofloxacin, ofloxacin, levofloxacin PO (14/7)
NSAIDs
screening for STIs
± catheter to relieve obstruction

Question 6

Complications and prognosis of prostatitis

Answer 6

Sepsis
Prostatic abscess
Chronic prostatitis
UTIs

Usually responds well to antibiotic therapy, with most patients becoming asymptomatic in due course.