Prostatitis Flashcards Preview

Y3M - Urology > Prostatitis > Flashcards

Flashcards in Prostatitis Deck (19)
Loading flashcards...
1

Types of prostatitis

Acute bacterial

Chronic bacterial

Non-bacterial

Prostatodynia

 

 

These flashcards will focus on acute bacterial

2

Pathophysiology

Caused by most commonly ascending urethral infection (can however also spread directly or lympathic from rectum, or even from blood)

3

Causative organisms

E. coli (most commonly)

Enterobacter

Serratia

Pseudomonas

Proteus

STIs like Chlamydia or Gonorrhoea can happen but are rare

4

Cause of chronic bacterial

Usually due to inadequately treating acute prostatits

5

Risk factors of acute

Indwelling cath

Phimosis or urethral stricture

Recent surgery, including cytoscopy or transrectal prostate biopsy

Immunocompromised

6

Risk factors of chronic

Intraprostatic ductal reflux

Neuroendocrine dysfunction

Dysfunctional bladder

7

Clinical features of acute

LUTS

Systemic infection features like pyrexia

Perineal or suprapubic pain or urethral discharge

8

Clinical features of chronic

Should be suspected in men with pelvic pain or discomfort for >3 months (Prostatodynia) + LUTS

The perineum is the most common site for pain, but can also happen in the suprapubic area, lower back or rectum.

9

Examination findings

Tender and boggy prostate

Inguinal lymphadenopathy might be present

10

First line investigation

Urine culture

Abx therapy can be guided from sensitivities.

11

Other investigations

STI screen and routine bloods with FBC, cRP and U&Es.
PSA is not usually done because it tends to be elevated.

12

Indications of further investigations

Only done in secondary care and usually indicted when initial therapy has failed or to investiate for potential underlying cause.

13

In patients who fail to respond to abx therapy, what should be done?

Prostate abscess needs to be reuled out using transrectal prostatic ultrasound TRUS or CT imaging.

14

First line management

Prolonged abx therapy

It is usually done by a quinolone like ciprofloxacin due to their good penetration into the prostate.

Analgesia should also be given.

15

Second line, especially in chronic

Alpha blockers or 5alpha-reductase inhibitors

16

What should be done for patients that are severely ill or are unable to tolerate oral abx?

Admission to hospital

Especially if there is concurrent DM, long term catheter, immunocompromised or suspected prostatic abscess.

17

When might you refer to urology?

Pre-existing urological condition like BPH for further management

18

Further management of prostatitis.

in chronic explain that the cause is not always understood and it can be difficult to treat.

Focus on symptom control with oral analgesia and stool softeners if there is painful defecation.

4-6 week trial of alphablocker like doxazosin or tamsulosin can be trialled

6 week course of abx might be warranted if preesent for less than 6 months.

19

What should be done if symptoms still persist even after further management?

Referral to a chronic pain specialist.

Psychological therapies can also help or an MDT approach.