Prostatitis

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Background

  • E. coli involved in 80% of cases

Risk Factors

Evaluation

Acute Prostatitis

  • Clinical diagnosis (UA and Urine culture 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

Differential Diagnosis

Dysuria

Management

Antibiotics

Target organisms are E.coli, and STDs (GC)

Associated with STD

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 alpha-blocker for outflow obstruction and urinary reflux
    • Terazosin 5mg/d PO for 4 wks 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