Prostatitis

Question 1

What is prostatitis?

Answer 1

• Inflammation of prostate gland
• Most common urological problem in men <50

Question 2

5 types of prostatitis

Answer 2

• Acute bacterial
• Chronic bacterial
• Non-bacterial
• Prostatodynia

NICE - I, II, IIIA, IIIB and IV

Question 3

Pathophys of acute bacterial prostatitis

Answer 3

• Ascending urethral infection usually
• Occasionally is direct or lymphatic spread from rectum or bacterial sepsis

Question 4

Causative organisms for prostatitis

Answer 4

• Escherichia coli
• Enterobacter
• Serratia
• Pseudomonas
• Proteus mirabilis
• STI - Chlamydia, Gonorrhoea - rarer

Question 5

Pathophys of chronic prostatitis

Answer 5

• Chronic bacterial infection
• +/- prostatitis symptoms
• Thought to be sequalae of inadequately treated acute prostatitis

Question 6

RF for acute bacterial prostatitis

Answer 6

• Indwelling catheter
• Phimosis
• Urethral stricture
• Recent surgery inc cystoscopy, TRUS biopsy
• Immunocompromised

Question 7

RF for chronic prostatitis

Answer 7

• Intraprostatic ductal reflux
• Neuroendocrine dysfunction
• Dysfunctional bladder

Question 8

Symptoms of prostatitis

Answer 8

• LUTS
• Systemic infection - pyrexia
• Perineal or suprapubic pain
• Urethral discharge

Question 9

DRE and exam for prostatitis

Answer 9

• Tender
• Boggy prostate
• Inguinal lymphadenopathy

Question 10

When should chronic prostatitis be suspected?

Answer 10

• Men who complain of pelvic pain or discomfort for at least 3 months (prostatodynia), alongside LUTS
• Perineum most common site for pain - but can occur suprapubic, lower back or rectum

Question 11

Bedside and bloods for ?prostatitis

Answer 11

• Urine culture - guide abx
• STI screen
• Routine bloods - FBC, CRP, U&E

Don’t usually do PSA as will be raised from infection

Question 12

Investigations for patient with prostatits not responding to abx

Answer 12

Need to rule out prostate abscess using transrectal prostatic US or CT imaging

Question 13

Management prostatitis

Answer 13

• Prolonged abx treatment - typically quinolone due to good penetration to prostate (but Trimethoprim also on Micro)
• Analgesia - paracetamol + NSAIDs
• Alpha blockers or 5 alpha reductase inhibitors 2nd line, esp if chronic

New MHRA guidance on fluroquinolones - only prescribe when others inappr

Question 14

When to admit for prostatitis?

Answer 14

• Severely unwell
• Unable to tolerate oral abx

Question 15

When to refer to urology for prostatitis?

Answer 15

• Pre-existing urological condition eg BPH following treatment of acute infection
• Discuss further management

Question 16

Managing chronic prostatitis

Answer 16

• Cause not always fully understood - difficult to treat
• Treatment focused on symptom control - eg oral analgesia with stool softners if painful defecation
• Manage LUTS - alpha blocker
• 6 week course of abx if symptoms present <6 months

Question 17

Management for chronic prostatitis if symptoms persist following urological treatment and management

Answer 17

• Consider referral to chronic pain specialist
• Psychological therapies can be offered by them
• MDT approach