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Prostatitis - acute


Definition

Acute prostatitis is an inflammation of the prostate gland that develops suddenly.

Causes, incidence, and risk factors

Acute prostatitis is usually caused by a bacterial infection of the prostate gland. Any organism capable of causing an urinary tract infection (UTI) is also capable of causing acute bacterial prostatitis, including enterococci, Escherichia coli , Klebsiella pneumonia , Proteus mirabilis , Pseudomonas aeruginosa , and Staphylococcus aureus .

Some sexually transmitted diseases (STDs) can cause acute prostatitis, typically seen in men younger than 35. These include gonorrhea , chlamydia , urealyticum, and trichomonas. Prostatitis from an STD typically closely follows sexual contact with an infected partner.

In men older than 35, E. coli and other common bacteria are more often the cause of prostatitis. E. coli prostatitis may follow urinary tract infections , urethritis , or epididymitis .

Acute prostatis may also develop as a result of procedures involving the urethra, such as catheterization or cystoscope; trauma; bladder outlet obstruction ; or an infection elsewhere in the body.

Prostatitis is rare in young boys.

Prostatitis is diagnosed in approximately 2 of every 10,000 outpatient visits. Men between the ages of 20 and 35 who have multiple sexual partners are at an increased risk, as are those who engage in high-risk sexual behaviors such as lack of condom use, particularly for anal intercourse.

Men age 50 or older who have an enlarged prostate ( benign prostatic hyperplasia ), are at increased risk for prostatitis due to their risk of urinary tract infection.

Symptoms

Acute prostatitis often begins with chills and fever, lower abdominal discomfort, perineal pain, and burning with urination. Symptoms of more advanced prostatitis include a diminished urine stream and difficulty urinating.

Prostatitis may occur in conjunction with epididymitis or orchitis, especially if caused by an STD, in which case symptoms of the accompanying condition may also be present.

Symptoms of acute prostatitis include the following:

  • Fever
  • Chills
  • Low back pain
  • Abdominal pain (above the pubic bone)
  • Perineal pain (pelvic floor)
  • Pain/burning with urination ( dysuria )
  • Urinary retention (inability to completely empty bladder)
  • Pain with ejaculation
  • Pain with bowel movement
Additional symptoms that may be associated with this condition:
  • Blood in the urine
  • Urinary frequency/urgency, increased
  • Difficulty urinating
  • Decreased force of urinary stream
  • Testicle pain
  • Blood in the semen
  • Foul-smelling urine

Signs and tests

Your health care provider may perform a physical examination to assess the prostate (warm, soft, swollen, or tender), the inguinal (groin) lymph nodes (enlarged or tender), the scrotum ( swollen or tender), and the urethra (discharge).

Triple-void urine specimens may be collected for urinalysis and urine culture :

  • #1 initial stream
  • #2 mid-stream
  • #3 after prostatic massage by examiner

Note: Your health care provider may choose not to perform prostatic massage if the prostate is obviously swollen and tender, because massage may potentially spread the infection and cause bacteremia or sepsis . These are potentially life-threatening infections in which bacteria are present in the bloodstream, rather than localized to one part of the body.

Urinalysis may reveal increased white blood cells (WBCs) and bacterial growth. Examination of prostatic secretions may also show increased levels of WBCs and concentrated bacterial growth upon culture.

Acute prostatitis may also alter the results of the following tests:

  • CBC
  • Urine analysis
  • PSA
  • Semen analysis

Treatment

Most cases of acute prostatitis clear up completely with medication and slight modification of diet and behaviors.

MEDICATIONS:
Prostatitis is treated with antibiotics, most often trimethoprim-sulfamethoxazole (Bactrim), fluoroquinolones (Floxin or Cipro), and tetracycline derivatives.

For men with prostatitis caused by an STD, a 250 mg shot of ceftriaxone followed by a 10-day course of doxycycline or ofloxacin. For other bacterial causes, a standard course of treatment consists of Bactrim, Cipro, or Floxin for at least 4 weeks.

Because recurrence is common, some health care providers recommend even longer therapies -- 6 to 8 weeks -- to eliminate the infection. In severe cases, hospitalization and intravenous (IV) antibiotics may be required .

Stool softeners may reduce the discomfort associated with bowel movements.

SURGERY:
Surgery or urethral instrumentation (urinary catheterization or cystoscopy ) are not recommended for patients with acute prostatitis.

OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary frequency and urgency.

If the swollen prostate restricts the urethra, the bladder may be unable to empty and insertion of a suprapubic catheter , which allows the bladder to drain through the abdomen, may be necessary.

Warm baths may provide some relief of the perineal and lower back pain associated with acute prostatitis.

DIET:
Avoid substances that irritate the bladder, such as alcohol, caffeinated food and beverages, and citrus juices, and hot or spicy foods.

Increasing the intake of fluids (64 to 128 ounces per day) encourages frequent urination that will help flush the bacteria from the bladder.

MONITORING:
Follow-up should include an examination at completion of antibiotic therapy to ensure that infection is no longer present.

Expectations (prognosis)

The majority of men who are accurately diagnosed with acute prostatitis become symptom-free after treatment.

Patients who have had acute prostatitis are prone to recurrence and are likely to develop chronic prostatitis .

Complications

Chronic prostatitis can develop. Urinary retention may occur as a result of the swollen prostate occluding the urethra. Scarring of the prostate and urethra may result in permanent strictures (narrowing) of the urethra.

Calling your health care provider

Call your health care provider if symptoms of prostatitis occur.

Prevention

Not all types of prostatitis are preventable. Good hand washing after a bowel movement and prior to handling the penis may prevent the transfer of bacteria from the rectal area to the genitourinary tract.

Infections that are associated with STDs can be prevented by practicing safer sex behaviors.

Update Date: 5/25/2002

Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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