Acute prostatitis
Acute bacterial prostatitis is a sudden bacterial infection of the prostate presenting with local urinary symptoms plus fever, chills, and a tender boggy prostate on exam. Diagnosis is clinical, confirmed by urinalysis and culture, and treatment is empiric antibiotics chosen by patient age and risk, continued for 2-4 weeks.
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What this article covers
- Overview
Acute bacterial infection of the prostate: acute bacterial prostatitis presents with sudden-onset local urinary symptoms (dysuria, frequency, urgency, suprapubic or perineal pain) plus systemic…
- Epidemiology
Increasing incidence with age: benign prostatic hyperplasia causing urinary obstruction and altered urine flow is the most common reason for increased urinary tract infection incidence, including prostatitis, in men older than 60 years.
- Risk factors
Benign prostatic hyperplasia: urinary obstruction and altered urine flow are the leading risk factor in men older than 60 years.
- Pathophysiology
Ascending infection from the urethra is the dominant route: bacteria ascend the urethra into the prostatic ducts, often facilitated by urinary reflux during voiding or by instrumentation.
- Clinical features
Acute onset of local urinary symptoms: dysuria, urinary frequency and urgency, and suprapubic and/or perineal pain; pain may also be testicular, penile, or in the lower back.
- Differential diagnosis
Cystitis: dysuria and frequency without the systemic symptoms or the tender boggy prostate that define acute prostatitis.
- Diagnosis
First, establish the diagnosis clinically by the combination of systemic infectious symptoms and an exquisitely tender, boggy prostate on digital rectal examination; this clinical picture alone is diagnostic.
- Management
First, obtain urine for analysis and culture, then start empiric antibiotics without delay, selected by age, STI risk, and illness severity, and refine based on culture results.
- Complications
Bacteremia and sepsis: occur in approximately 25% of patients and are the most immediately life-threatening complication.
- Prognosis
Most patients recover fully with prompt, appropriate antibiotic therapy, particularly when treatment is started early and matched to culture susceptibilities.
- Prevention
Minimize unnecessary genitourinary instrumentation, including transrectal prostate biopsy, urethral catheterization, and other urologic procedures, since instrumentation is a recognized risk factor for acute bacterial prostatitis.
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Orchitis is inflammation of the testis, most commonly viral (mumps) with isolated testicular involvement or bacterial as a contiguous extension of epididymitis (epididymo-orchitis), presenting as testicular pain and swelling that must be distinguished from the surgical emergency of testicular torsion. Diagnosis is clinical, guided by exposure history and preserved cremasteric reflex, with mumps orchitis managed supportively and bacterial epididymo-orchitis treated with the same age- and risk-stratified antibiotics used for epididymitis.