Acute prostatitis (inflammation of the prostate gland) is quite common, but often goes undiagnosed. It is caused by bacterial infection due to organisms like Escherichia coli, Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae, Chlamydia. The infection may be blood-borne or secondary to urinary infection.
Signs And Symptoms of Acute Prostatitis
General symptoms may predominate over local. The patient has influenza-like symptoms such as feeling ill, shivers and rigor (a sudden attack of shivering along with a cold feeling or the chills, usually accompanied by high fever), body aches, pain in the back.
The temperature may go up to 39 degrees centigrade. Pain on micturition (passing of urine) is common, but need not always be present. The urine should be cultured as it contains threads. Heaviness in perineum, irritation in rectum, and pain on defecation (passage of stools) can be present, and rarely urethral discharge.
Frequency of micturition is increased when the infection spreads to the bladder. Examination of the rectum reveals a tender (painful to touch) prostate, with the lobes unequally swollen. Seminal vesicles may be involved. Infection may spread to epididymis and testes.
A fluctuant (movable and compressible) abscess is uncommonly present. When the abscess occurs in the prostate, the temperature rises sharply with rigors, masked if antibiotics are being used.
It could be mistaken for an anorectal abscess, but a rectal examination reveals an enlarged, hot, tender and possibly fluctuant prostate. If retention of urine occurs, suprapubic (above the pubic bone) catheterization is indicated.
Typical symptoms as above suggest the diagnosis. Rectal examination reveals a swollen, extremely tender, enlarged prostate gland, which is warm, firm and may be irregular. Blood examination shows leucocytosis (an increase in white blood cells).
Blood cultures are positive if sepsis has occurred, usually in immunocompromised (low immunity) patients. Urine culture shows the presence of bacteria. C-reactive protein is mostly elevated. Prostatic biopsy is usually not indicated.
If biopsy is done, the histological picture is one of neutrophilic infiltration. Prostate specific antigen is elevated briefly, and its testing is indicated only in complicated cases.
Acute Prostatitis Treatment
Rigorous and prolonged treatment with antibiotics is indicated to ensure infection is eradicated and recurrence is prevented. Antibiotics such as trimethoprim or ciprofloxacin, which penetrate into the prostate, are indicated. In addition, bed rest, stool softeners, analgesics and fluids are prescribed.
If the infection is not responding to antibiotics, prostatic abscess should be suspected, which can be confirmed by transrectal ultrasound. If abscess is present, it should be drained as soon as possible by (1) Preurethral resection – deroofing the whole cavity; (2) Perineal route if periprostatic spread is present.
In some patients it may be a medical emergency; they may need to be hospitalized and intravenous antibiotics administered. If the acute prostatitis is not treated adequately, it can become chronic. In such a case, antibiotics as above are indicated.
Other antibiotics that could be used are metronidazole in case of Trichomonas infection, and doxycycline in case of infection with Chlamydia. Prostatic massage is of doubtful value in eradication of infection.
If acute prostatitis is treated adequately, complete recovery without any sequelae is the norm.
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