Prostatitis: Difference between revisions

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==Background==
==Background==
*E. coli involved in 80% of cases
*[[E. coli]] involved in 80% of cases
*Other: [[Pseudomonas]], [[Klebsiella]], [[Enterobacter]], [[Serratia]], [[Staph]]


===Risk Factors===
===Risk Factors===
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*Indwelling urethral catheter
*Indwelling urethral catheter


==Diagnosis==
==Clinical Features==
===Acute Prostatitis===
===Acute===
*Clinical diagnosis (UA and Ucx may be normal)
*[[Dysuria]]/urgency/frequency, perineal pain/low back pain, pain with ejaculation, fever
**[[Dysuria]]/urgency/frequency, perineal pain/low back pain, fever
*Rectal exam: Exquisitely tender and boggy prostate
**Rectal exam: Exquisitely tender and boggy prostate


===Chronic Prostatitis===
===Chronic===
*Similar to acute prostatitis with exception of fever/chills
*Similar to acute prostatitis with exception of fever/chills
*Rectal exam is often unremarkable
*Rectal exam is often unremarkable


==Differential Diagnosis==
{{Dysuria DDX}}
==Evaluation==
===Work-Up===
===Work-Up===
*UA, Ucx
*[[Urinalysis]], urine culture


==Differential Diagnosis==
===Diagnosis===
{{Dysuria DDX}}
*Clinical diagnosis (UA and Urine culture may be normal)


==Treatment==
==Management==
===[[Antibiotics]]===
===[[Antibiotics]]===
*4-6 wk course
{{Prostatitis antibiotics}}
*PO
===Supportive Measures<ref>Deem SG et al. Acute Bacterial Prostatitis. eMedicine. Dec 9, 2015. http://emedicine.medscape.com/article/2002872-treatment</ref>===
**[[Cipro]] 500mg PO BID OR
*If severe obstruction suspected, may pass a Foley gently
**[[Bactrim DS]] 1 tab PO BID (less expensive but also less efficacious)
*If Foley does not pass easily, insert punch suprapubic catheter, to be removed 24-36 hrs later
*IV
*Consider α-blocker for outflow obstruction and urinary reflux
**[[Cipro]] 400mg IV q12 OR [[levofloxacin]] 500mg IV q24
**[[Terazosin]] 5mg/d PO for 4 weeks or long-term
**OR [[ceftriaxone]] 2g IV q24 +/- [[gentamycin]] 3-5mg/kg/day
**'''OR''' tamsulosin
*Prostatic abscesses frequently require surgical aspiration


==Disposition==
==Disposition==
*Admit toxic pts or pts with [[Urinary Retention]]
*Admit toxic patients or patients with [[Urinary Retention]]
*Urology f/u
*Urology follow up


==Source==
==References==
Rosens, Tintinalli
<references/>


[[Category:ID]]
[[Category:ID]]
[[Category:GU]]
[[Category:Urology]]

Revision as of 15:04, 30 March 2019

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 weeks 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