Prostatitis: Difference between revisions
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==Background== | ==Background== | ||
*E. coli involved in 80% of cases | [[File:Prostatelead.jpg|thumb|Prostate anatomy]] | ||
*Other: Pseudomonas, Klebsiella, Enterobacter, Serratia, Staph | *[[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 | ||
== | {{UTI types}} | ||
===Acute | |||
==Clinical Features== | |||
===Acute=== | |||
*[[Dysuria]]/urgency/frequency, perineal pain/low back pain, pain with ejaculation, fever | |||
*Rectal exam: Exquisitely tender and boggy prostate | |||
===Chronic | ===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=== | ||
*[[Urinalysis]], urine culture | *[[Urinalysis]], urine culture | ||
== | ===Diagnosis=== | ||
*Clinical diagnosis (UA and Urine culture may be normal) | |||
==Management== | ==Management== | ||
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*If severe obstruction suspected, may pass a Foley gently | *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 | *If Foley does not pass easily, insert punch suprapubic catheter, to be removed 24-36 hrs later | ||
*Consider | *Consider α-blocker for outflow obstruction and urinary reflux | ||
**Terazosin 5mg/d PO for 4 | **[[Terazosin]] 5mg/d PO for 4 weeks or long-term | ||
**OR tamsulosin | **'''OR''' tamsulosin | ||
*Prostatic abscesses frequently require surgical aspiration | *Prostatic abscesses frequently require surgical aspiration | ||
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*Admit toxic patients or patients with [[Urinary Retention]] | *Admit toxic patients or patients with [[Urinary Retention]] | ||
*Urology follow up | *Urology follow up | ||
**Should obtain repeat [[Urinalysis]] and urine culture in 7 days | |||
**Ensure follow up to tailor therapy to urine culture and sensitivities | |||
**Counsel patients on importance of adhering to full course of prolonged therapy | |||
==References== | ==References== | ||
Latest revision as of 09:42, 2 May 2020
Background
- E. coli involved in 80% of cases
- Other: Pseudomonas, Klebsiella, Enterobacter, Serratia, Staph
Risk Factors
- Urinary Tract Obstruction
- Epididymitis
- Urethritis
- Unprotected rectal intercourse
- Phimosis
- Indwelling urethral catheter
Genitourinary infection
"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.
- Renal/perirenal
- Ureteral
- Infected urolithiasis
- Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
- Urethra/periurethra
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
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Evaluation
Work-Up
- Urinalysis, urine culture
Diagnosis
- Clinical diagnosis (UA and Urine culture may be normal)
Management
Antibiotics
Associated with STD
Target organisms are E. coli, and STDs (GC)
- Doxycycline 100mg PO q12 hrs x14 days + Ceftriaxone 500mg IM x1
- Ciprofloxacin no longer recommended to treat gonorrhea in US
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
- Gentamycin 7mg/kg IV daily + Ceftriaxone 1g IV q12hrs
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
- Admit toxic patients or patients with Urinary Retention
- Urology follow up
- Should obtain repeat Urinalysis and urine culture in 7 days
- Ensure follow up to tailor therapy to urine culture and sensitivities
- Counsel patients on importance of adhering to full course of prolonged therapy
References
- ↑ Deem SG et al. Acute Bacterial Prostatitis. eMedicine. Dec 9, 2015. http://emedicine.medscape.com/article/2002872-treatment