Acute prostatitis is the most frequent urologic diagnosis in men <50 years old.
Commonly caused by Escherichia coli bacteria.
Can cause extreme lower abdominal, ejaculatory, rectal, and perineal pain.
May be successfully treated with antibiotics, but a prolonged course is frequently required if chronic prostatitis follows the acute occurrence.
Acute prostatitis is a painful inflammation within the prostate that is usually accompanied by evidence of recent or ongoing bacterial infection. Its hallmark is the acute onset of lower urinary tract symptoms (e.g., dysuria, urinary frequency, perineal discomfort) accompanied by variable systemic signs of fever, chills, and malaise. Acute prostatitis may cause referred pain into the genitalia, perineum, and lower back or suprapubic areas. It stands in contradistinction to chronic prostatitis, a condition of prolonged prostatic irritation lasting ≥3 months that may be bacterial or abacterial in nature. Chronic prostatitis is characterized by persistent prostatitis or recurrent urinary tract infections. Chronic pelvic pain originating in the prostate, or prostatodynia, completes the clinical presentations associated with the symptom complex.
History and exam
Key diagnostic factors
- fever, chills, malaise
- tender prostate
Other diagnostic factors
- age <50 years
- urinary frequency
- diminished urinary stream
- perineal pain
- warm or soft, boggy gland
- indwelling urinary catheter
- recent transrectal prostate biopsy
- recent transurethral surgery
- urinary tract infection (UTI)
- benign prostatic enlargement
- urinary tract instrumentation/manipulation
- poor general health/immunosuppression
- smoking and alcohol consumption
1st investigations to order
- urine culture
- blood cultures
Investigations to consider
- transrectal ultrasound
- 4-glass or 2-glass test
- urine cytology
- prostatic biopsy
signs of sepsis
without signs of sepsis
- Benign prostatic hyperplasia (BPH)
- Prostate cancer
- Urinary tract infection (UTI)
- Urological infections
- Acute bacterial prostatitis: diagnosis and management
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