Types of prostatitis
These flashcards will focus on acute bacterial
Caused by most commonly ascending urethral infection (can however also spread directly or lympathic from rectum, or even from blood)
E. coli (most commonly)
STIs like Chlamydia or Gonorrhoea can happen but are rare
Cause of chronic bacterial
Usually due to inadequately treating acute prostatits
Risk factors of acute
Phimosis or urethral stricture
Recent surgery, including cytoscopy or transrectal prostate biopsy
Risk factors of chronic
Intraprostatic ductal reflux
Clinical features of acute
Systemic infection features like pyrexia
Perineal or suprapubic pain or urethral discharge
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.
Tender and boggy prostate
Inguinal lymphadenopathy might be present
First line investigation
Abx therapy can be guided from sensitivities.
STI screen and routine bloods with FBC, cRP and U&Es.
PSA is not usually done because it tends to be elevated.
Indications of further investigations
Only done in secondary care and usually indicted when initial therapy has failed or to investiate for potential underlying cause.
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.
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.
Second line, especially in chronic
Alpha blockers or 5alpha-reductase inhibitors
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.
When might you refer to urology?
Pre-existing urological condition like BPH for further management
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.
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.