Prostatitis: Difference between revisions

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==Background==
==Background==
#Infection of the prostate caused by gram negative organisms, 80% E. coli.
[[File:Prostatelead.jpg|thumb|Prostate anatomy]]
*[[E. coli]] involved in 80% of cases
*Other: [[Pseudomonas]], [[Klebsiella]], [[Enterobacter]], [[Serratia]], [[Staph]]


===Acute Prostatitis===
===Risk Factors===
#Symptoms: dysuria/urgency/frequency, perineal pain, low back pain, fever, chills
*[[Urinary Tract Obstruction]]
#Rectal exam (mandatory in men with symptoms of cystitis): exquisitely tender and boggy prostate, warm to touch
*[[Epididymitis]]
*[[Urethritis]]
*Unprotected rectal intercourse
*[[Phimosis]]
*Indwelling urethral catheter


===Chronic Prostatitis===
{{UTI types}}
#Relapsing UTI caused by the same organism, may have history of acute prostatitis
#Symptoms: same as acute with exception of fever/chills
#Rectal exam: often unremarkable


==Diagnosis==
==Clinical Features==
#UA: typically accompanied by cystitis
===Acute===
#Urine Culture: reveals responsible bacteria
*[[Dysuria]]/urgency/frequency, perineal pain/low back pain, pain with ejaculation, fever
#rectal exam: tender prostate gland (acute)
*Rectal exam: Exquisitely tender and boggy prostate


==Work-Up==
===Chronic===
#UA, Urine culture
*Similar to acute prostatitis with exception of fever/chills
#Prostate exam
*Rectal exam is often unremarkable
#Chemistry for renal function


==DDx==
==Differential Diagnosis==
#cystitis
{{Dysuria DDX}}
#pyelonephritis
#chronic bacterial prostatitis 


==Treatment==
==Evaluation==
#Antibiotics: 4-6 week course
===Work-Up===
##Cipro 500mg PO BID
*[[Urinalysis]], urine culture
##OR Bactrim DS 1 tab PO BID
 
#IV antibiotics (toxic prostatitis)
===Diagnosis===
##Cipro 400mg IV q12 OR Levofloxacin 500mg IV q24
*Clinical diagnosis (UA and Urine culture may be normal)
##OR Ceftriaxone 2g IV q24 +/- Gentamycin 3-5mg/kg/day
 
==Management==
===[[Antibiotics]]===
{{Prostatitis antibiotics}}
===Supportive Measures<ref>Deem SG et al. Acute Bacterial Prostatitis. eMedicine. Dec 9, 2015. http://emedicine.medscape.com/article/2002872-treatment</ref>===
*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==
==Disposition==
# Admit toxic patients or patients with urinary retention
*Admit toxic patients or patients with [[Urinary Retention]]
# Urology follow, chronic prostatitis may require 16 weeks of therapy
*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


==Source==
==References==
Adapted from Rosens 7th Edition
<references/>


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

Latest revision as of 09:42, 2 May 2020

Background

Prostate anatomy

Risk Factors

Genitourinary infection

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.

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

  • 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

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