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
QUESTIONS 1 of 1 1 Previous Next (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 Type & Select Correct Answer 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 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept