Prostatitis

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Background

Risk Factors

Clinical Features

Acute

  • Dysuria/urgency/frequency, perineal pain/low back pain, pain with ejaculation, fever
  • Rectal exam: Exquisitely tender and boggy prostate

Chronic

  • Similar to acute prostatitis with exception of fever/chills
  • Rectal exam is often unremarkable

Differential Diagnosis

Dysuria

Evaluation

Work-Up

Diagnosis

  • Clinical diagnosis (UA and Urine culture may be normal)

Management

Antibiotics

Associated with STD

Target organisms are E. coli, and STDs (GC)

No Associated STD and Chronic Bacterial Prostatitis

Aimed at Enterobacteriaceae, enterococci, Pseudomonas

  • Ciprofloxacin 500mg PO q12hrs x 28 days OR
  • Levofloxacin 500mg PO daily x 28 days OR
  • TMP/SMX 1 DS tablet PO q12hrs x 28 days
  • Consider extension to 6 wks of empiric therapy

Septic

Supportive Measures[1]

  • If severe obstruction suspected, may pass a Foley gently
  • If Foley does not pass easily, insert punch suprapubic catheter, to be removed 24-36 hrs later
  • Consider α-blocker for outflow obstruction and urinary reflux
    • Terazosin 5mg/d PO for 4 wks or long-term
    • OR tamsulosin
  • Prostatic abscesses frequently require surgical aspiration

Disposition

References

  1. Deem SG et al. Acute Bacterial Prostatitis. eMedicine. Dec 9, 2015. http://emedicine.medscape.com/article/2002872-treatment