Essentials

Usually a febrile disease with intense symptoms. The prostate gland is typically very tender to palpation.

Etiology

Disturbances in emptying of the bladder may predispose to infections.
- A urinary tract pathogen that causes an abscess in the prostate.
- Benign prostatic hyperplasia
- Functional disturbance in opening of the urethra

Increased urinary frequency, burning sensation in lower abdomen = symptoms of urinary tract infection
Voiding difficulties, painful voiding
The patient often has fever and feels ill.

Urinary tract infection (pyelonephritis, urosepsis) Dynamed
- Always order CRP assay (usually elevated) and urinary bacterial culture.
- A large amount of leucocytes, mucus and bacteria are usually found in the urine specimen.
- Blood culture Dynamed
Sexually transmitted diseases (chlamydia, gonorrhoea)
- Primarily investigated with nucleic acid testing
Chronic bacterial prostatitis; see (Chronic prostatitis)

Oral fluoroquinolone or sulpha-trimethoprim in normal (UTI) doses is usually sufficient. Of the fluoroquinolones, ciprofloxacin and norfloxacin yield the highest concentrations. The duration of treatment is 10–14 days at the shortest, but depending on the severity of the disease up to 4–6 weeks.
In septic disease, antimicrobial therapy may also be started intravenously (piperacillin-tazobactam or fluoroquinolone), as required.
Massage of the prostate is contraindicated.
Suprapubic cystostomy may occasionally be necessary to secure the emptying of the bladder. Do not catheterize.
A prostatic abscess should be emptied surgically in a hospital.

1. Bonkat G, Bartoletti RR, Bruyère F, et al; European Association of Urology. Guidelines on urological infections. EAU 2023 https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelin...

2. Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician 2016;93(2):114-20 [PMID:26926407]