Updated: 1/9/2018

Prostatitis

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Snapshot
  • A 60-year-old man presents to his urologist for a 4-month history of pelvic pain. He denies fevers or chills and any recent sexual activity. His physical exam reveals a mildly tender prostate on digital rectal exam. His urinalysis is unremarkable. He is started on tamsulosin and ciprofloxacin.
Introduction
  • Clinical definition
    • infectious or non-infectious inflammation of the prostate
    • acute prostatitis
      • typically infectious
      • < 35 years of age
        • most commonly C. trachomatis and N. gonorrhoeae
      • > 35 years of age
        • most commonly E. coli, P. aeruginosa, K. pneumoniae
    • chronic prostatitis
      • can be due to recurrent infections lasting > 3 months (10% of chronic prostatitis)
      • can be due to chronic pelvic pain (90% of chronic prostatitis)
        • > 3 months of pain in the absence of other identifiable causes
        • noninfectious etiology but often unknown
        • can be due to trauma, psychological stress, and increased prostate tissue pressure
  • Epidemiology
    • incidence
      • 10-15% men have it once in their lifetime
    • risk factors
      • catheterization
      • benign prostatic hypertrophy
Presentation
  • Symptoms
    • dysuria
    • urinary frequency
    • urinary urgency
    • straining with urination or interrupted stream (obstruction)
    • lower back pain
  • Physical exam
    • fever
    • chills
    • digital rectal exam
      • enlarged prostate
      • very tender on exam may indicate acute prostatitis
      • less tender on exam may indicate chronic prostatitis
Studies
  • Urine studies for bacterial infection
    • urinalysis
      • pyuria
      • hematuria
    • urine culture
Differential
  • Urinary tract infection
  • Urethritis
Treatment
  • Medical
    • antibiotics
      • indications
        • acute or chronic bacterial infection
      • drugs chosen empirically based on local resistance patterns
        • uropathogens
          • trimethoprim and sulfamethoxazole
          • fluoroquinolone
        • sexually transmitted pathogens
          • ceftriaxone
          • azithromycin
    • α-blockers
      • indications
        • chronic pelvic pain syndrome or noninfectious chronic pain
        • typically given alongside a fluoroquinolone for initial therapy
      • drugs
        • tamsulosin
Complications
  • Prostatic abscess

 

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Questions (1)

(M2.RL.17.4684) A 68-year-old man presents to his primary care physician with complaints of intermittent dysuria, pain with ejaculation, mild lower abdominal pain, and difficulty voiding for the last four months. There is no weight loss or change in stools. He has no known family history of cancer. His past medical history is notable for irritable bowel syndrome and hypertension. On examination, he is well-appearing but mildly uncomfortable. There are no abdominal or rectal masses appreciated; the prostate is mildly tender to palpation, but with normal size, texture, and contour. Urinalysis reveals trace leukocyte esterase and negative nitrite, negative blood, and no bacteria on microscopy. Which of the following is the most appropriate treatment? Tested Concept

QID: 107337
1

Tamsulosin

8%

(1/12)

2

Ciprofloxacin

33%

(4/12)

3

Tamsulosin and ciprofloxacin

42%

(5/12)

4

Finasteride

0%

(0/12)

5

Duloxetine

8%

(1/12)

M 6 C

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