ACUTE BACTERIAL PROSTATITIS

Causative organism

E. coli,

Pseudomonas

Enterococcus.

Clinical features

Perineal pain

Dysuria.

Varying degree of urinary obstruction or retention due to swelling of the prostate.

Fever

Urinary frequency

Urinary urgency

Painful ejaculation

Hematospermia

Tender prostate on per rectal examination.  (Prostatic massage is contraindicated in acute prostatitis.)

Investigations

• FBE: leukocytosis with predominant neutrophils.

• Urinalysis: Pyuria,  and hematuria.

• Urine culture and sensitivity may demonstrate the causative organisms.

. Chlamydia and Gonorrhea PCR

. Transrectal U/S

. CT

Treatment

Mild or moderate disease while awaiting culture

Trimethoprim 300 mg orally daily for 14 days,

or

Cephalexin 500 mg orally twice daily for 14 days,

or

Amoxicillin and clavulanic acid 500 mg + 125 mg orally twice daily for 14 days

If septic or unable to tolerate oral therapy

Admit to hospital,

Parenteral therapy with ampicillin and gentamycin or ceftriaxone

If the patient fails to improve with antibiotics, a prostatic abscess should be suspected, particularly in men who are immunocompromised, have diabetes mellitus or who have had recent instrumentation of the urinary tract.

Both computed tomography (CT) and transrectal ultrasound may be used to detect a prostate abscess.

Complications 

Acute urinary retention –

(Suprapubic tap should be performed to alleviate retention as urethral catheterisation may worsen the infection and is contraindicated )

Prostatic abscess,

Sepsis

Chronic bacterial prostatitis,

Fistula formation

Spread of infection to the spine or sacroiliac joints.