Suprapubic tap should be performed to alleviate retention as urethral catheterisation may worsen infection and is contraindicated. 12Īcute urinary retention may develop as a complication of ABP. 12 However, if surgical debridement of the abscess is planned, a CT scan may be more helpful to define borders of the abscess, plan the surgical approach and to investigate for other abnormalities in the genitourinary system. 11 If perineal puncture of the abscess is planned, ultrasound may guide the procedure. 10 Both computed tomography (CT) and transrectal ultrasound may be used to detect a prostate abscess. If the patient fails to improve with antibiotics, a prostatic abscess should be suspected, particularly in men who are immunocompromised, have diabetes mellitus or who have had recent instrumentation of the urinary tract. Urine culture 48 hours post-treatment is useful combined with review after 7 days of antibiotic treatment to assess clinical response to treatment. In addition to antibiotic therapy, non-steroidal anti-inflammatory drugs (NSAIDs) may offer both analgesia and more rapid healing through liquefaction of prostatic secretions. Contact tracing, notification and treatment is also important in these cases. If gonorrhoea is suspected, ceftriaxone 500 mg intramuscularly and azithromycin 1 g orally is indicated. If chlamydia is thought to be the causative agent, azithromycin 1 g orally stat or doxycycline 100 mg orally twice daily for 7 days is appropriate. While ABP is usually caused by urinary pathogens, sexually transmissible infections such as chlamydia and gonorrhoea should be considered, particularly in young men. Table 1 outlines the Australian Therapeutic Guidelines current treatment recommendations. Imaging is only indicated when prostatic abscess is suspected in a patient with ABP who is failing to improve with treatment.Īntibiotic therapy for ABP should be based on the acuity of the patient and the known or suspected causative organism. Prostate specific antigen elevations are common in the setting of infection and may take up to 1 month postinfection to resolve. ![]() While blood cultures and C-reactive protein may prove useful, a prostate specific antigen (PSA) test is not indicated. 9Īcute bacterial prostatitis can be diagnosed clinically, although both urine Gram stain and urine culture are recommended to identify causative organisms and guide treatment. While gentle palpation of the prostate gland on physical examination will often reveal a pathognomonic finding of an exquisitely tender, boggy prostate gland, care should be taken to avoid vigorous prostate massage as this may precipitate bacteremia and sepsis. ![]() 6 Classic symptoms include:Īcute bacterial prostatitis should be considered in the differential diagnosis of any male presenting with urinary tract symptoms. The clinical presentation of ABP may be highly variable with symptoms ranging from mild to severe. 6,7 There is no evidence that perineal trauma from bicycle or horseback riding, dehydration or sexual abstinence are risk factors for ABP. 5,6 Men with chronic indwelling catheters, diabetes mellitus, immunosuppression, or who intermittently perform self-catheterisation, are at higher risk of developing ABP due to their increased risk of bacterial colonisation of the urethra. Acute bacterial prostatitis results from proliferation of bacteria within the prostate gland following intraprostatic reflux of urine infected with organisms such as Escherichia coli, Enterococcus and Proteus species. 1 Although rare, ABP requires prompt recognition and treatment as it may result in sepsis. 4Īcute bacterial prostatitis (ABP) accounts for approximately 5% of cases of prostatitis cases. ![]() ![]() asymptomatic inflammatory prostatitis.chronic prostatitis/chronic pelvic pain syndrome.Prostatitis encompasses four distinct clinical entities, which can be described using the National Institutes of Health International Prostatitis Collaborative Network classification system.
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