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Acute Bacterial Prostatitis

Usually a febrile disease with intense symptoms. The prostate gland is typically very tender to palpation.

Disturbances in emptying of the bladder may predispose to infections.
- A urinary tract pathogen that causes an abscess in the prostate.
- Benign prostatic hyperplasia
- Functional disturbance in opening of the urethra

Increased urinary frequency, burning sensation in lower abdomen = symptoms of urinary tract infection
Voiding difficulties, painful voiding
The patient often has fever and feels ill.

Urinary tract infection (pyelonephritis, urosepsis) http://www.dynamed.com/condition/acute-bacterial-prostatitis#URINE_STUDIES
- Always order CRP assay (usually elevated) and urinary bacterial culture.
- A large amount of leucocytes, mucus and bacteria are usually found in the urine specimen.
- Blood culture http://www.dynamed.com/condition/acute-bacterial-prostatitis#BLOOD_TESTS
Sexually transmitted diseases (chlamydia, gonorrhoea)
- Primarily investigated with nucleic acid testing
Chronic bacterial prostatitis; see Chronic Prostatitis

Oral fluoroquinolone or sulpha-trimethoprim in normal (UTI) doses is usually sufficient. Of the fluoroquinolones, ciprofloxacin and norfloxacin yield the highest concentrations. The duration of treatment is 10-14 days at the shortest, but depending on the severity of the disease up to 4-6 weeks.
In septic disease, antimicrobial therapy may also be started intravenously (piperacillin-tazobactam or fluoroquinolone), as required.
Massage of the prostate is contraindicated.
Suprapubic cystostomy may occasionally be necessary to secure the emptying of the bladder. Do not catheterize.
A prostatic abscess should be emptied surgically in a hospital.

Bonkat G, Bartoletti RR, Bruyère F, et al; European Association of Urology. Guidelines on urological infections. EAU 2023 http://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2023.pdf
Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician 2016;93(2):114-20[PubMed]