Acute prostatitis

Last reviewed: 9 Nov 2022
Last updated: 25 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever, chills, malaise
  • tender prostate
More key diagnostic factors

Other diagnostic factors

  • age <50 years
  • urinary frequency
  • dysuria
  • diminished urinary stream
  • perineal pain
  • warm or soft, boggy gland
  • indwelling urinary catheter
  • recent transrectal prostate biopsy
  • recent transurethral surgery
Other diagnostic factors

Risk factors

  • urinary tract infection (UTI)
  • benign prostatic enlargement
  • urinary tract instrumentation/manipulation
  • poor general health/immunosuppression
  • smoking and alcohol consumption
  • genetics
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine culture
  • blood cultures
More 1st investigations to order

Investigations to consider

  • transrectal ultrasound
  • 4-glass or 2-glass test
More investigations to consider

Emerging tests

  • urine cytology
  • cystoscopy
  • prostatic biopsy

Treatment algorithm

ACUTE

signs of sepsis

without signs of sepsis

Contributors

Authors

Christopher Chapple, BSc, MD, FRCS (Urol), FEBU

Honorary Senior Lecturer of Urology

University of Sheffield

Consultant Urological Surgeon

Department of Urology

Royal Hallamshire Hospital

Sheffield

UK

Disclosures

CC is a consultant for Astellas, Contura, Ferring, Symimetic, Takeda, and Urovant Sciences. He is an author for Astellas and Ferring. He is an investigator for Allergan, Astellas, Ferring, Poesis Medical, and Bayer. He is a co-patent holder for Symimetic. He is a speaker for Allergan and Astellas.

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol)

Consultant Urologist

Department of Urology

Royal Hallamshire Hospital

Sheffield

UK

Disclosures

AM declares that he has no competing interests.

Acknowledgements

Dr Christopher Chapple and Dr Altaf Mangera would like to gratefully acknowledge the contribution of Robyn Webber MB, ChB, MD, FRCSEd (Urol) to this topic. Not disclosed.

Peer reviewers

Hans Hedelin, MD

Department of Urology and Centre for Research and Development

Karnsjukhuset

Skovde

Sweden

Disclosures

HH declares that he has no competing interests.

Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP

Professor of Medicine

University of Washington

VA Puget Sound Health Care System

Seattle

WA

Disclosures

BAL has received research funding from, and been a consultant to, several pharmaceutical companies that make antibiotic agents that might be used for treating bacterial prostatitis.

  • Differentials

    • Benign prostatic hyperplasia (BPH)
    • Prostate cancer
    • Urinary tract infection (UTI)
    More Differentials
  • Guidelines

    • Urological infections
    • Prostatitis (acute): antimicrobial prescribing
    More Guidelines
  • Patient leaflets

    Prostatitis

    More Patient leaflets
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