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Updated: Dec 2 2021

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
  • Etiology
    • Pathogenesis
  • 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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