Prostatitis

Background

• E. coli involved in 80% of cases

Risk Factors

• Urinary Tract Obstruction
• Epididymitis
• Urethritis
• Unprotected rectal intercourse
• Phimosis
• Indwelling urethral catheter

Diagnosis

Acute Prostatitis

• Clinical diagnosis (UA and Ucx may be normal)
  • Dysuria/urgency/frequency, perineal pain/low back pain, fever
  • Rectal exam: Exquisitely tender and boggy prostate

Chronic Prostatitis

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

Work-Up

• UA, Ucx

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

Treatment

Antibiotics

• 4-6 wk course
• PO
  • Cipro 500mg PO BID OR
  • Bactrim DS 1 tab PO BID (less expensive but also less efficacious)
• IV
  • Cipro 400mg IV q12 OR levofloxacin 500mg IV q24
  • OR ceftriaxone 2g IV q24 +/- gentamycin 3-5mg/kg/day

Disposition

• Admit toxic pts or pts with Urinary Retention
• Urology f/u

Source

Rosens, Tintinalli