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Prostatitis

Prostatitis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Acute (bacterial) prostatitis:
    • Acute febrile illness
    • Systemic symptoms may appear days before localizing urinary symptoms appear.
    • Patients may appear toxic and usually have a concurrent cystitis.
  • Prostatic abscess:
    • Once common after acute prostatitis, now rare except in immunocompromised patients
    • Fever, rectal pain, and leukocytosis despite treatment
    • Fluctuant mass on rectal exam
  • Chronic bacterial prostatitis:
    • ∼10% of cases of prostatitis
    • Most common cause of recurrent UTI in men
    • WBC and bacteria may be present in expressed prostatic secretions (EPS).
  • Chronic nonbacterial prostatitis (also called prostatosis):
    • Same symptoms as chronic bacterial prostatitis but unable to culture organisms from urine or EPS
  • Chronic pelvic pain syndrome (CPPS):
    • Symptoms referable to the prostate
    • No inflammatory cells are found
    • No bacteria cultured from the urine or EPS

Etiology

  • Usually a single-organism bacterial infection of the prostate
  • Acute prostatitis:
    • Age <35 yr:
      • Neisseria gonorrhoeae and Chlamydia trachomatis are usual etiologies.
    • Age ≥35 yr:
      • Enterobacteriaceae or Escherichia coli (usual), Klebsiella, Pseudomonas, Enterococcus, and Proteus also seen
    • Rarely may be caused by Salmonella, Clostridia, tuberculosis, or fungi.
    • Cryptococcus neoformans in AIDS patients
  • Chronic bacterial prostatitis:
    • Enterobacteriaceae (80%), Enterococcus (15%), and Pseudomonas aeruginosa
  • Chronic nonbacterial prostatitis:
    • Possible role for Chlamydia, Ureaplasma urealyticum, Trichomonas vaginalis, and Mycoplasma hominis

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Citation

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TY - ELEC T1 - Prostatitis ID - 307269 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307269/all/Prostatitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -