Prostatitis: Difference between revisions

Revision as of 20:34, 17 August 2011

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

DDx

Cystitis
Pelonephritis

Treatment

Abx
1. 4-6 wk course
2. Cipro 500mg PO BID OR
3. Bactrim DS 1 tab PO BID (less expensive but also less efficacious)
IV antibiotics
1. Cipro 400mg IV q12 OR Levofloxacin 500mg IV q24
2. 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

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-#Infection of the prostate caused by gram negative organisms, 80% E. coli.
+*E. coli involved in 80% of cases
+*Risk factors:
+#Urinary tract obstruction
+#Epididymitis
+#Urethritis
+#Unprotected rectal intercourse
+#Phimosis
+#Indwelling urethral catheter
+==Diagnosis==
 ===Acute Prostatitis===
-#Symptoms: dysuria/urgency/frequency, perineal pain, low back pain, fever, chills
+*Clinical diagnosis (UA and Ucx may be normal)
-#Rectal exam (mandatory in men with symptoms of cystitis): exquisitely tender and boggy prostate, warm to touch
+**Dysuria/urgency/frequency, perineal pain/low back pain, fever
+**Rectal exam: Exquisitely tender and boggy prostate
 ===Chronic Prostatitis===
-#Relapsing UTI caused by the same organism, may have history of acute prostatitis
+*Similar to acute prostatitis with exception of fever/chills
-#Symptoms: same as acute with exception of fever/chills
+*Rectal exam is often unremarkable
-#Rectal exam: often unremarkable
-==Diagnosis==
-#UA: typically accompanied by cystitis
-#Urine Culture: reveals responsible bacteria
-#rectal exam: tender prostate gland (acute)
-==Work-Up==
+===Work-Up===
-#UA, Urine culture
+*UA, Ucx
-#Prostate exam
-#Chemistry for renal function
 ==DDx==
-#cystitis
+#Cystitis
-#pyelonephritis
+#Pelonephritis
-#chronic bacterial prostatitis
 ==Treatment==
-#Antibiotics: 4-6 week course
+#Abx
-##Cipro 500mg PO BID
+##4-6 wk course
-##OR Bactrim DS 1 tab PO BID
+##Cipro 500mg PO BID OR
-#IV antibiotics (toxic prostatitis)
+##Bactrim DS 1 tab PO BID (less expensive but also less efficacious)
+#IV antibiotics
 ##Cipro 400mg IV q12 OR Levofloxacin 500mg IV q24
 ##OR Ceftriaxone 2g IV q24 +/- Gentamycin 3-5mg/kg/day
 ==Disposition==
-# Admit toxic patients or patients with urinary retention
+#Admit toxic pts or pts with urinary retention
-# Urology follow, chronic prostatitis may require 16 weeks of therapy
+#Urology f/u
 ==Source==
-Adapted from Rosens 7th Edition
+Rosens, Tintinalli
 [[Category:GU]]