Urology - Prostatitis

Question 1

Classes of prostatitis

Answer 1

Acute bacterial prostatitis – acute infection in the prostate, presenting with a more rapid onset of symptoms

Chronic prostatitis – symptoms lasting for at least 3 months - can be due to infection or non-infection cause

Question 2

Chronic prostatitis presentation

Answer 2

Pelvic pain - may affect the perineum, testicles, scrotum, penis, rectum, groin, lower back or suprapubic area

LUTS

Sexual dysfunction e.g. erectile dysfunction, pain on ejaculation and haematospermia (blood in the semen)

Pain with bowel movements

Tender, enlarged prostate on examination may be present

Question 3

Acute prostatitis presentation

Answer 3

More acute presentation of LUTS, pelvic pain etc…

Also may have systemic symptoms of infection:

• Fever
• Myalgia
• Nausea
• Fatigue
• Sepsis

Question 4

Investigations for suspected prostatitis

Answer 4

Urine dipstick

Urine MC+S to identify causative organism and sensitivities

Chlamydia and gonorrhoea NAAT testing on a first pass urine, if sexually transmitted infection is considered

Question 5

Management of acute bacterial prostatitis

Answer 5

Admit if systemically unwell

Oral antibiotics e.g. ciprofloxacin

Analgesia

May need laxatives if pain on bowel movements

Question 6

Management of chronic prostatitis

Answer 6

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms

Analgesia (paracetamol or NSAIDs)

Antibiotics if less than 6 months of symptoms or a history of infection (e.g., trimethoprim or doxycycline for 4-6 weeks)

Laxatives for pain during bowel movements

Question 7

Complications of acute bacterial prostatitis

Answer 7

Sepsis

Prostate abscess

Acute urinary retention

Chronic prostatitis