Acute bacterial prostatitis
- Usually a febrile disease with intense symptoms. The prostate gland is typically very tender to palpation.
- The condition is often preceded by prostate biopsy.
- 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.
- Sexually transmitted diseases (chlamydia, gonorrhoea)
- Primarily investigated with nucleic acid testing
- Chronic bacterial prostatitis; see 1
Clinical and laboratory findings
- 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 weeks.
- If the patient has fever and severe symptoms the initial treatment should consist of intravenous cefuroxime in a hospital for one week, followed by oral medication for 3 weeks.
- Massage of the prostate is contraindicated.
- Suprapubic cystostomy may occasionally be necessary to secure the emptying of the bladder. Do not catheterize.
- See UTI in a male patient: 2.
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