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Updated: Nov 24 2018


  • Snapshot
    • A 60-year-old man with a history of benign prostatic hyperplasia presents to his primary care physician for a 3-day period of fever, chills, and pain with urination. He was recently catheterized during an admission in the hospital. Physical exam reveals a tender and enlarged prostate on digital rectal exam. Urinalysis reveals pyuria and hematuria. He is started on empiric antibiotics.
  • Introduction
    • Clinical definition
      • infectious or non-infectious inflammation of 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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