Acute bacterial prostatitis
- Usually a febrile disease with intense symptoms. The prostate gland is typically very tender to palpation.
- 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.
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 (Chronic prostatitis)
- Tenderness in the lower abdomen.
- Very tender prostate on palpation.
- 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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