Prostatitis

Question 1

Prostatitis causative organisms

Answer 1

• S. faecalis
• E. coli - most common
• Chlamydia

Question 2

Presentation of prostatitis

Answer 2

• Usually >35yrs
• UTI / dysuria
• Perineal or suprapubic pain
- Low backache
-  Pain on ejaculation
•Haematospermia
• Fever and rigors
• Retention
• Malaise

Question 3

Ix of prostatitis

Answer 3

• Blood: FBC, U+E, CRP
• Urine: dip, MC+S
• STI screening
• Failure responce to abx - transrectal prostatic ultrasound (TRUS) or CT imaging

Question 4

Mx of prostatitis

Answer 4

• Analgesia
• Levofloxacin - 28 days
• 2nd line: Alpha blockers or 5a-redictase inhibitors

Question 5

Prostatitis on examination

Answer 5

• Pyrexia
• Swollen / boggy / tender prostate on PR
• Examine testes to exclude epididymo-orchitis

Question 6

Risk factors for prostatitis

Answer 6

• Indwelling catheters
• Phimosis or urethral stricture
• Recent surgery - cystoscopy or transrectal prostate biopsy
• Immunocompromised

Question 7

Chronic prostatitis

Answer 7

Pelvic pain or discomfort for at least 3 months with LUTS

Perineum is the most common site for pain

Question 8

Mx of chronic prostatitis

Answer 8

LUTS - 4-6-week trial of an alpha blocker

6-week course of antibiotics

Chronic pain specialist