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Review literature: (Benway and Moon, 2008).
Acute bacterial prostatitis is characterized by sudden fever, perineal and suprapubic pain and voiding symptoms. The urine analysis reveals a urinary tract infection.
Acute prostatitis is a bacterial infection of the prostate, caused by ascension of bacteria from the urinary tract, please see section urinary tract infection. Risk factors for acute bacterial prostatitis: intraprostatic reflux, phimosis, anal sex, urinary tract infections, epididymitis, bladder catheterization, prostate biopsy or transurethral resections.
Painful prostate exam: prostate of soft consistency, possibly with fluctuation as a sign of a prostate abscess.
Urine culture usually identifies the pathogen and is mandatory before antibiotic treatment.
Blood culture can identify the pathogen, if a high fever or signs of urosepsis are present.
Urinary retention or residual urine?
After initiating the antibiotic treatment, transrectal imaging can be safely performed and may reveal an abscess of the prostate [fig. prostatic abscess]. Alternative imaging: computed tomography.
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Prostatic abscess (left): hypoechoic area in transrectal ultrasound (TRUS). Center and right: transperineal puncture, advancing a guide wire and drainage of the prostatic abscess |
Until the results of urine culture and blood culture are available, treatment is started with e.g. ofloxacin 200–400 mg p.o. 1-0-1 or ciprofloxacin 500 mg p.o. 1-0-1.
In severe cases, intravenous treatment is started with ampicillin/clavulanic acid 2.2 g 1-1-1 i.v. or cephalosporin i.v. combined with gentamicin 3 mg/kg i.v. 1-0-0.
Antibiotic treatment is given parenterally for 3–7 days. Afterwards, treatment is switched to a full-dose oral antibiotic treatment for 2–4 weeks. Prospective studies of acute prostatitis are lacking.
Prostatitis Definitionen | Index | Prostate diseases |
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Deutsche Version: Akute bakterielle Prostatitis
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© Dr. med. Dirk Manski
man...@urologielehrbuch.de