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Acute Prostatitis

Acute prostatitis, defined as an infection of the prostate, is one of the types of urinary tract infections in males. Dysuria, increased urinary frequency, and pain in the pelvic region are main symptoms, whereas fever and systemic manifestations can be reported in more severe forms. Clinical findings, together with a complete laboratory workup, particularly urinalysis and urine cultures, are necessary to make the diagnosis.


Presentation

Acute prostatitis is a term describing an infection of the prostate, arising due to reflux of urine contaminated by various bacterial pathogens [1] [2] [3] [4]. Enterobacteriaceae (E. coli, klebsiella spp., pseudomonas aeruginosa, proteus mirabilis), as well as E. faecalis and staphylococcus aureus, are the main causative agents [3] [4] [5]. The presence of indwelling catheters is perhaps the greatest risk factor for a urinary tract infection (UTI) of any kind, including prostatitis, while invasive procedures (cystoscopy, transrectal prostate biopsy) can significantly increase the risk of prostatitis [1] [3] [4]. In addition, immunosuppression and diabetes mellitus are also depicted as potential risk factors [3] [4]. The clinical presentation includes an abrupt onset of lower urinary tract symptoms (dysuria, increased urgency to urinate, increased frequency, incomplete voiding and a weak urine stream), painful ejaculation (even hematospermia), and perineal, rectal, or pelvic pain [1] [4] [5] [6]. In addition, prostatitis often causes systemic symptoms - fever, chills, and malaise [1] [4] [5]. In cases when the prostate becomes enlarged, urinary tract obstruction might occur [5] [6]. Many reports have emphasized the serious nature of prostatitis, as it may cause acute urinary retention, potential progression to a chronic infection, but also systemic dissemination and even sepsis, which could be life-threatening in the absence of appropriate therapy [1] [3] [4] [6].

Fever
  • Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization.[ncbi.nlm.nih.gov]
  • Fever duration, length of hospitalization, use of an antibiotic combination, duration of antibiotic use, and urine bacterial titers increased when BC were positive.[ncbi.nlm.nih.gov]
  • Dysuria, increased urinary frequency, and pain in the pelvic region are main symptoms, whereas fever and systemic manifestations can be reported in more severe forms.[symptoma.com]
  • Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis.[en.wikipedia.org]
  • The patient had pyuria and mild fever during admission. Laboratory findings showed elevation of the serum prostate specific antigen (95.69 ng/ml). Blood culture yielded Klebsiella pneumoniae.[ncbi.nlm.nih.gov]
Chills
  • Clinical findings Pain at the base of the penis, perineal and perianal, urgency, burning with urination, fever, malaise, penile discharge; other findings include chills, painful defecation and ejaculation.[medical-dictionary.thefreedictionary.com]
  • Some symptoms are unique to each condition: the acute version may involve high fever and chills, while this does not usually happen in the chronic case.[sharecare.com]
  • In addition, prostatitis often causes systemic symptoms - fever, chills, and malaise. In cases when the prostate becomes enlarged, urinary tract obstruction might occur.[symptoma.com]
  • Men with acute prostatitis often have chills, fever, fatigue, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced[prostatitisradicalcure.com]
  • Men with acute prostatitis often have chills, fever, pain in the lower back, perineum, or genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced[en.wikipedia.org]
Perineal Pain
  • pain, burning with urination, difficulty urinating, painful defecation and ejaculation Associations Epididymitis, orchitis, men age 20 to 35 yrs old, multiple sexual partners, high-risk sexual behaviors[medical-dictionary.thefreedictionary.com]
  • In one report, of 600 men diagnosed with prostatitis, 5% had bacterial prostatitis, 64% had nonbacterial prostatitis, and 31% had pelvic-perineal pain syndrome or prostatodynia.[emedicine.com]
  • Perineal pain and anal sphincter spasm may complicate the digital rectal examination. The development of bilateral lower back back pain usually signals involvement by the Seminal Vesicles.[fertilitysolution.com]
  • Genitourinary Radiology Male Pelvis Prostate & Seminal Vesicles Prostatitis Prostatitis Prostatitis, an inflammation of the prostate gland, manifests as pelvic or perineal pain, or irritation with micturition or ejaculation.[med-ed.virginia.edu]
Malaise
  • In addition, prostatitis often causes systemic symptoms - fever, chills, and malaise. In cases when the prostate becomes enlarged, urinary tract obstruction might occur.[symptoma.com]
  • Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis.[en.wikipedia.org]
  • Clinical findings Pain at the base of the penis, perineal and perianal, urgency, burning with urination, fever, malaise, penile discharge; other findings include chills, painful defecation and ejaculation.[medical-dictionary.thefreedictionary.com]
  • Acute bacterial prostatitis symptoms may include: Chills Fever Nausea Vomiting Malaise (generally feeling run-down) Strong urge to urinate immediately Painful urination Difficulty urinating, including trouble starting urination and maintaining urinary[prostatitis.net]
  • High fever, chills, aches and malaise (you feel yourself down and really sick) Urinary symptoms in the form of pain when you pass urine, passing urine frequently, an urgent desire to pass urine, foul-smelling urine, difficulty emptying your bladder, weak[gmcdhcc.com]
Recurrent Urinary Tract Infection
  • urinary tract infection and/or chronic infection of the prostate) Category III – Chronic abacterial prostatitis/chronic pelvic pain syndrome (ie, discomfort or pain in the pelvic region for at least 3 mo with variable voiding and sexual symptoms and[emedicine.com]
  • urinary tract infections with no history of catheterizing their bladders.[uofmhealth.org]
  • Some men probably require long-term antibiotic suppression to prevent recurrent urinary tract infections.[aafp.org]
  • The presentation of chronic bacterial prostatitis and CPPS is more subtle, including symptoms of chronic or recurrent urinary tract infections and genitourinary pain.[amboss.com]
Abdominal Pain
  • pain Back pain, especially pain in lower back Extreme pain Rectal or perineum pain (area between the anus and scrotum) Blood in the semen Painful ejaculation Cloudy urine Your acute bacterial prostatitis treatment can be successful if you start treatment[prostatitis.net]
  • A healthy 37-year-old man visited the emergency room due to recently developed fever, lower abdominal pain, dysuria, frequency, and perineal pain.[synapse.koreamed.org]
  • Critical Essential Core Tested Community Questions (1) (M2.RL.4684) A 68-year-old man presents to his primary care physician with complaints of intermittent dysuria, pain with ejaculation, mild lower abdominal pain, and difficulty voiding for the last[medbullets.com]
  • Other symptoms include frequent urination, feeling of a need to urinate urgently, low back pain, burning in the penis with or without urination, pain in the rectum and scrotal area, lower abdominal pain, pain with ejaculation and fever or chills.[washington.edu]
  • pain pain when ejaculating Blood in the urine, increased need to urinate, pain in the testicles and blood in semen are also possible symptoms.[health24.com]
Suprapubic Pain
  • The present study reports the case of a 67-year-old man who was admitted to our transplant unit 3.5 months post transplantation with fever, dysuria, suprapubic pain, symptoms and signs of acute prostatitis, and elevated markers of inflammation and prostate-specific[ncbi.nlm.nih.gov]
  • He presents with concern for dysuria, increased urinary frequency, and suprapubic pain over the past week. Upon digital rectal examination, the patient’s prostate is tender and enlarged.[consultant360.com]
  • Symptoms (sudden onset) Systemic symptoms Fever and chills Malaise Joint Pain ( Arthralgia ) Muscle pain (myalgia) Nausea or Vomiting Referred pain Low Back Pain Perineal pain or Rectal Pain Suprapubic Pain Irritative urinary symptoms Dysuria Urinary[fpnotebook.com]
  • Lower abdominal tenderness or suprapubic pain may be present if there is concomitant bladder infection or obstruction. Costovertebral tenderness should be sought.[clinicaladvisor.com]
Rectal Pain
  • Symptoms (sudden onset) Systemic symptoms Fever and chills Malaise Joint Pain ( Arthralgia ) Muscle pain (myalgia) Nausea or Vomiting Referred pain Low Back Pain Perineal pain or Rectal Pain Suprapubic Pain Irritative urinary symptoms Dysuria Urinary[fpnotebook.com]
Back Pain
  • pain revealed a destructive bone lesion in the lumbar spine.[ncbi.nlm.nih.gov]
  • He has back pain and difficulty passing urine. His GP has told him he has an infection of the prostate. The patient’s medication records show that he is also taking prednisolone, 10mg daily for temporal arteritis, and Didronel PMO, one tablet daily.[pharmaceutical-journal.com]
  • pain, especially pain in lower back Extreme pain Rectal or perineum pain (area between the anus and scrotum) Blood in the semen Painful ejaculation Cloudy urine Your acute bacterial prostatitis treatment can be successful if you start treatment soon[prostatitis.net]
  • Signs and symptoms include fever, lower back pain, urinary frequency, and painful urination. The urinalysis reveals the presence of white cells.[fpnotebook.com]
  • You may also feel the pain at the base of your male genital organ, around your anus, just above your pubic bone and sometimes even you feel it in your lower back. Pain may spread to the testicles.[gmcdhcc.com]
Low Back Pain
  • Symptoms (sudden onset) Systemic symptoms Fever and chills Malaise Joint Pain ( Arthralgia ) Muscle pain (myalgia) Nausea or Vomiting Referred pain Low Back Pain Perineal pain or Rectal Pain Suprapubic Pain Irritative urinary symptoms Dysuria Urinary[fpnotebook.com]
  • Other symptoms include frequent urination, feeling of a need to urinate urgently, low back pain, burning in the penis with or without urination, pain in the rectum and scrotal area, lower abdominal pain, pain with ejaculation and fever or chills.[washington.edu]
  • They may complain of low back pain, rectal or perineal pain, or even pain along the inner aspects of the thighs. They often have irritative or obstructive urinary symptoms and decreased libido or impotence.[aafp.org]
Cognitive Disorder
  • In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements.[ncbi.nlm.nih.gov]
Pelvic Pain
  • pain syndrome (ie, white blood cells in semen and/or expressed prostatic secretions and/or third midstream bladder specimen) Category IIIB – Noninflammatory chronic pelvic pain syndrome (ie, no white blood cells in semen and/or expressed prostatic secretions[emedicine.com]
  • The most common form is category III, or Chronic Pelvic Pain Syndrome.[books.google.de]
  • The identification of prostatic or pelvic pain becomes a requirement for the diagnosis of CP-CPPS.[ncbi.nlm.nih.gov]
Dysuria
  • Dysuria, increased urinary frequency, and pain in the pelvic region are main symptoms, whereas fever and systemic manifestations can be reported in more severe forms.[symptoma.com]
  • The present study reports the case of a 67-year-old man who was admitted to our transplant unit 3.5 months post transplantation with fever, dysuria, suprapubic pain, symptoms and signs of acute prostatitis, and elevated markers of inflammation and prostate-specific[ncbi.nlm.nih.gov]
  • […] following: Chills Fever Frequent urination Incomplete emptying of bladder Joint pain (arthralgia) Lower back pain Muscle pain (myalgia) Pain in penis, testicles, and area between the scrotum and the rectum (perineum) Painful ejaculation Painful urination (dysuria[healthcommunities.com]
  • He presents with concern for dysuria, increased urinary frequency, and suprapubic pain over the past week. Upon digital rectal examination, the patient’s prostate is tender and enlarged.[consultant360.com]
  • Critical Essential Core Tested Community Questions (1) (M2.RL.4684) A 68-year-old man presents to his primary care physician with complaints of intermittent dysuria, pain with ejaculation, mild lower abdominal pain, and difficulty voiding for the last[medbullets.com]
Urinary Retention
  • Abstract Abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. Our patient is the first case to be reported.[ncbi.nlm.nih.gov]
  • Prostatitis was associated with epididymo-orchitis (3 cases), acute urinary retention (4 cases) and infective endocarditis (1 case).[ncbi.nlm.nih.gov]
  • Many reports have emphasized the serious nature of prostatitis, as it may cause acute urinary retention, potential progression to a chronic infection, but also systemic dissemination and even sepsis, which could be life-threatening in the absence of appropriate[symptoma.com]
  • Complications of acute prostatitis include: acute urinary retention secondary to prostatic oedema, chronic prostatitis, prostatic abscess, bacteraemia, epididymitis and pyelonephritis Notes: in England, resistance of E. coli (the main causative organism[gpnotebook.co.uk]
  • Men with acute prostatitis complicated by urinary retention are best managed with a suprapubic catheter or intermittent catheterization.[en.wikipedia.org]
Painful Ejaculation
  • The clinical presentation includes an abrupt onset of lower urinary tract symptoms (dysuria, increased urgency to urinate, increased frequency, incomplete voiding and a weak urine stream), painful ejaculation (even hematospermia), and perineal, rectal[symptoma.com]
  • ejaculation Cloudy urine Your acute bacterial prostatitis treatment can be successful if you start treatment soon after symptoms appear and you complete the treatment course you are prescribed.[prostatitis.net]
  • ejaculation blood in your semen discomfort during bowel movements pain above your pubic bone pain in your genitals, testicles, or rectum Any bacteria that causes UTIs can cause prostatitis.[healthline.com]
  • They include the following: Chills Fever Frequent urination Incomplete emptying of bladder Joint pain (arthralgia) Lower back pain Muscle pain (myalgia) Pain in penis, testicles, and area between the scrotum and the rectum (perineum) Painful ejaculation[healthcommunities.com]
  • ejaculation Flu-like signs and symptoms (with bacterial prostatitis) When to see a doctor If you have pelvic pain, difficult or painful urination, or painful ejaculation, see your doctor.[mayoclinic.org]
Nocturia
  • They can include: Pain or burning sensation when urinating (dysuria) Difficulty urinating, such as dribbling or hesitant urination Frequent urination, particularly at night (nocturia) Urgent need to urinate Cloudy urine Blood in the urine Pain in the[mayoclinic.org]
  • UTI Prostatic abscess Acute urine retention Pyelonephritis Epididymitis Sepsis Renal damage Sudden fever, chills Abdominal, groin, perineal, or lower back pain Perineal fullness Arthralgia, myalgia Urinary urgency and frequency Dysuria, nocturia Transient[quizlet.com]
  • Painful urination: specifically a burning sensation Urinary urgency: experiencing an urge to urinate immediately Urinary hesitancy: dribbling or difficulty starting the urine stream Urinary frequency: needing to urinate more often than usual Nocturia:[verywell.com]
  • Irritation is manifested by frequency and urgency, obstruction, a sensation of incomplete bladder emptying, a need to void again shortly after voiding, or nocturia.[msdmanuals.com]
  • Excessive urinating at night (nocturia). A sensation of not completely emptying the bladder. Pain or discomfort in the lower back, in the area between the testicles and anus, in the lower abdomen or upper thighs, or above the pubic area.[northshore.org]

Workup

A thorough clinical workup by the physician can provide sufficient clues to make an initial diagnosis. Firstly, a detailed patient history, including the onset of symptoms, their characteristics, as well as the assessment of risk factors (catheterization, immunosuppression), should be obtained [1] [2]. More specific findings of prostatitis, however, are identified during the physical examination. A properly conducted digital rectal exam will reveal an enlarged prostate that is tender on palpation, one of the key features of prostatitis [2] [5] [6]. Physicians must be careful when performing a prostate exam, as prostate massage is contraindicated in the case of acute prostatitis due to an increased risk of subsequent bacteremia and sepsis [1] [2]. As soon as clinical criteria suggest an infection of the urinary tract, laboratory studies (a complete blood count with basic biochemical parameters and serum inflammatory markers), together with urinalysis, urine cultures (of midstream urine), and blood cultures if systemic signs are present, are the next step [1] [2] [3] [5]. If the diagnosis remains inconclusive, or if patients do not respond to antibiotic therapy, imaging studies such as transrectal prostatic ultrasonography (TRUS), pelvic ultrasonography or computed tomography (CT) can be implemented [2]. The use of prostate-specific antigen (PSA) is not recommended, as it is often elevated due to the inflammatory changes in the prostate [2], which could mislead the physicians toward other diagnoses.

Pyuria
  • The patient had pyuria and mild fever during admission. Laboratory findings showed elevation of the serum prostate specific antigen (95.69 ng/ml). Blood culture yielded Klebsiella pneumoniae.[ncbi.nlm.nih.gov]
  • Acute prostatitis was defined as a fever greater than 38 C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility.[ncbi.nlm.nih.gov]
  • A urinalysis is performed, the results of which reveal pyuria and the presence of nitrite-positive bacteria. Based on these findings, you make a diagnosis of acute bacterial prostatitis, and you would like to initiate antibiotic therapy.[consultant360.com]
  • […] 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[medbullets.com]
  • Benign prostatic hypertrophy and overactive bladder may also present with lower urinary tract symptoms, but are generally without signs of infection like fever or pyuria. D. Physical Examination Findings.[clinicaladvisor.com]
Clostridium Perfringens
  • Bacterial identification was possible in fourteen cases: E. coli (nine cases), Proteus mirabilis (one case), Klebsiella pneumoniae (one case), Enterococcus faecalis (one case), Staphylococcus Spp (one case), Clostridium perfringens (one case).[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).[ncbi.nlm.nih.gov]
  • The patients reported improvement significantly more often after metacycline than after placebo treatment.[ncbi.nlm.nih.gov]
  • Pre- and post-treatment scintigraphies were performed. Before treatment, all patients with prostatitis showed uptake of ILLs in the prostate area.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The prompt initiation of effective treatment is essential to decrease morbidity and mortality. Empirical treatment would be a second or third generation cephalosporins, or carbapenems according to clinical severity of patients.[ncbi.nlm.nih.gov]
  • […] week treatment duration.[consultant360.com]

Prognosis

  • Prognosis : generally good - may recur, become chronic Prostate disease or form abscesses Prostate: abscessation. NB : Brucella canis Brucella canis has been isolated (rare) from prostatic infections.[vetstream.com]
  • With appropriate treatment, the prognosis of acute prostatitis with and without abscess would not differ.” The investigators noted that prostatic abscesses often are found in patients who do not improve with initial therapy.[renalandurologynews.com]
  • Pain killers and Paracetamol for the fever are prescribed as supportive treatment Is the prognosis good? Most cases of acute prostatitis respond promptly and well to treatment. Your treating Urologist may recommend a prolonged course of antibiotics.[gmcdhcc.com]
  • Acute prostatitis T1: peripheral zone iso- or hypointense to transition zone T2: hyperintense T1 C (Gd) diffusely enhancing 6 Treatment and prognosis Antibiotics are the mainstay of treatment for bacterial prostatitis.[radiopaedia.org]
  • Prognosis and Patient Counseling. The development of acute to chronic bacterial prostatitis is not well understood. Those patients who take a shorter course of antibiotics may be at risk for higher failure rates.[clinicaladvisor.com]

Etiology

  • The potential role of asymptomatic category IV chronic prostatitis in the etiology of prostate cancer may be delineated further with future research.[ncbi.nlm.nih.gov]
  • […] prostatitis and chronic pelvic pain syndrome, evidence behind individual therapies and ancillary topics such as erectile dysfunction, infertility, the link between chronic prostatitis and prostate cancer, male interstitial cystitis and the potential etiologic[books.google.de]
  • Pathogenesis Etiology Bacteria, eg Escherischii coli Escherichia coli - most common. Fungal - rare. Predisposing factors General Bacterial urinary tract infection. Urinary catheterization (high urinary bacterial numbers). Immunodeficiency.[vetstream.com]
  • Etiology Pathogenesis Bacterial prostatitis : Gram-negative bacteria, particularly E. coli and other Enterobacteriaceae Enterococci and other gram-positive cocci Mycobacterial or viral infections are rare.[amboss.com]
  • The term prostatitis describes a wide spectrum of conditions with variable etiologies, prognoses and treatments.[aafp.org]

Epidemiology

  • […] ie, no white blood cells in semen and/or expressed prostatic secretions) Category IV – Asymptomatic inflammatory prostatitis (ie, evidence of inflammation in biopsy samples, semen and/or expressed prostatic secretions, but no symptoms) Historical and epidemiologic[emedicine.com]
  • ) : primarily affects men 40–60 years of age References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology Uncommon type of Prostatitis , accounting for only 10% of cases Peak onset age 20-40 years old, and over age 70 years old III.[fpnotebook.com]
  • Epidemiology and treatment of acute prostatitis after prostatic biopsy. Prog. Urol. 17, 960–963 (2007). 49. Kanjanawongdeengam, P., Viseshsindh, W., Santanirand, P., Prathombutr, P. & Nilkulwattana, S.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Future research into using inflammatory markers (eg, tumor necrosis factor-alpha, interleukin-2) and using PCR to identify the presence of bacteria may further refine the pathophysiology of prostatitis.[ncbi.nlm.nih.gov]
  • Pathophysiology Ascending bacterial infection from urinary tract - most common. Ascending infection from gonadal infection - less common. Blood borne.[vetstream.com]
  • Pathophysiology: Mechanisms Ascending infection from infected Urethra or intraprostatic reflux (most cases) Instrumentation (transrectal Prostate biopsy, Urinary Catheterization , cystoscopy) Direct or lymphatic spread from Rectum Hematogenous spread[fpnotebook.com]

Prevention

  • However, prompt treatment with selected antibiotics along with dietary and lifestyle changes usually eliminates the infection and can help prevent it from returning.[prostatitis.net]
  • Diagnosis This article is available in full to registered subscribers Sign up now to purchase a 30 day trial, or Login Treatment This article is available in full to registered subscribers Sign up now to purchase a 30 day trial, or Login Prevention This[vetstream.com]
  • Not all types of prostatitis can be prevented. Practice safe sex behaviors. Chronic prostatitis - bacterial; Acute prostatitis Ferri FF. Prostatitis. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2018:1077-1077.[nlm.nih.gov]
  • Prevention You may be able to prevent prostatitis. Practice good hygiene, and keep your penis clean. Drink enough fluids to cause regular urination. Seek early treatment of a possible urinary tract infection .[northshore.org]
  • Prevention You may be able to prevent prostatitis. Practice good hygiene, and keep your penis clean. Drink enough fluids to cause regular urination. Seek early treatment of a possible urinary tract infection.[healthlinkbc.ca]

References

Article

  1. Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician. 2016;93(2):114-20.
  2. Nickel JC. Prostatitis. Can Urol Assoc J. 2011;5(5):306-315.
  3. Grabe M, Bartoletti R, Bjerklund-Johansen TE, et al. Guidelines on Urological Infections. European Association of Urology. 2015.
  4. Dickson G. Prostatitis--diagnosis and treatment. Aust Fam Physician. 2013;42(4):216-219.
  5. Videčnik Zorman J, Matičič M, Jeverica S, Smrkolj T. Diagnosis and treatment of bacterial prostatitis. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24(2):25-29.
  6. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236.

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Last updated: 2018-06-22 06:59