Prostatitis

Question 1

What typically causes acute bacterial prostatitis?

Answer 1

Gram-negative bacteria entering the prostate gland via the urethra

Common pathogens include Escherichia coli.

Question 2

Which pathogen is most commonly isolated in cases of acute bacterial prostatitis?

Answer 2

Escherichia coli

It is a gram-negative bacterium.

Question 3

List risk factors for acute bacterial prostatitis.

Answer 3

• Recent urinary tract infection
• Urogenital instrumentation
• Intermittent bladder catheterisation
• Recent prostate biopsy

These factors increase the likelihood of bacterial entry into the prostate.

Question 4

What are some features of acute bacterial prostatitis?

Answer 4

• Pain in perineum, penis, rectum, or back
  *stinging sensation on urination
• Obstructive voiding symptoms
• Fever and rigors
• Tender, boggy prostate gland on digital rectal examination

Symptoms can vary widely among patients.

Question 5

What is the recommended management for acute bacterial prostatitis according to the BNF?

Answer 5

A 14-day course of a quinolone

Quinolones are a class of antibiotics effective against gram-negative bacteria.

Question 6

True or False: Screening for sexually transmitted infections is not recommended in the management of acute bacterial prostatitis.

Answer 6

False

Screening is considered as part of the management plan.

Question 7

What is balanitis?

Answer 7

Inflammation of the glans penis

Balanitis can also involve the foreskin, termed balanoposthitis.

Question 8

What are the most common causes of balanitis?

Answer 8

Infective causes (bacterial and candidal) and autoimmune causes

Proper hygiene is crucial in managing balanitis.

Question 9

What is the role of hygiene in the treatment of balanitis?

Answer 9

Key part of treatment; improper washing and tight foreskin can worsen balanitis.

Question 10

What is candidiasis and its common symptoms?

Answer 10

Very common condition, usually occurs after intercourse, associated with itching and white non-urethral discharge.

Question 11

What symptoms are associated with dermatitis in balanitis?

Answer 11

Itching and clear non-urethral discharge.

Question 12

What type of discharge is caused by bacterial infections in balanitis?

Answer 12

Acute yellow non-urethral discharge, typically due to Staphylococcus.

Question 13

What is lichen planus and its symptoms?

Answer 13

A condition causing itching with striae and pamphlets.

Question 14

What are the common bacterial causes of balanitis?

Answer 14

• Staphylococcus spp.
• Group B Streptococcus spp.

Treated with oral flucloxacillin or clarithromycin if allergic to penicillin.

Question 15

What is priapism?

Answer 15

A persistent penile erection lasting longer than 4 hours and not associated with sexual stimulation.

Question 16

What are the two types of priapism?

Answer 16

• Ischaemic priapism
• Non-ischaemic priapism

Question 17

What causes ischaemic priapism?

Answer 17

Impaired vasorelaxation and reduced vascular outflow, resulting in congestion of de-oxygenated blood.

Question 18

What is the cause of non-ischaemic priapism?

Answer 18

High arterial inflow, often due to fistula formation from congenital or traumatic mechanisms.

Question 19

What is the age distribution for priapism presentation?

Answer 19

Bimodal distribution with peaks between 5-10 years and 20-50 years of age.

Question 20

What is the estimated incidence of priapism?

Answer 20

Up to 5.34 per 100,000 patient-years.

Question 21

List some causes of priapism.

Answer 21

• Idiopathic
• Sickle cell disease or other haemoglobinopathies
• Erectile dysfunction medication (e.g. Sildenafil)
• Other drugs (anti-hypertensives, anticoagulants, recreational drugs)
• Trauma

Question 22

What are typical patient presentations for priapism?

Answer 22

• Persistent erection lasting over 4 hours
• Pain localized to the penis
• History of known haemoglobinopathy or use of certain medications

Question 23

What investigations help differentiate between ischaemic and non-ischaemic priapism?

Answer 23

• Cavernosal blood gas analysis
• Doppler or duplex ultrasonography
• Full blood count and toxicology screen

Question 24

What is the first-line treatment for ischaemic priapism lasting longer than 4 hours?

Answer 24

Aspiration of blood from the cavernosa combined with saline flush injection.

Question 25

What is used if aspiration and injection fail in ischaemic priapism?

Answer 25

Intracavernosal injection of a vasoconstrictive agent such as phenylephrine.

Question 26

Is non-ischaemic priapism a medical emergency?

Answer 26

No, it is not a medical emergency and is usually suitable for observation.

Question 27

What is a cause of phimosis?

Answer 27

Blank it is erotica orbiter and due to scarring. Increases risk of squamous cell cancer, infection.

Question 28

What is the case of acute prostatic?

Answer 28

Sudden onset caused by bacterial infection

Question 29

What is chronic prostatic?

Answer 29

Symptoms over 3 weeks due to E.coli

Question 30

What are the risks of rpostatits?

Answer 30

Preexisting urinary tract infection Epididymitis Catheter use Previous urethral surgery Presence of prostate stones