Acute bacterial prostatitis

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

Symptoms

  • 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.

Differential diagnosis and investigations

  • Urinary tract infection (pyelonephritis, urosepsis)
    • 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
  • Sexually transmitted diseases (chlamydia, gonorrhoea)
    • Primarily investigated with nucleic acid testing
  • Chronic bacterial prostatitis; see (1)

Findings

  • Tenderness in the lower abdomen.
  • Very tender prostate on palpation.

Treatment

  • 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 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.

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