Prostatitis
Prostatitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Prostatitis, inflammation of the prostate gland, may be acute or chronic. Acute prostatitis most often results from gram-negative bacteria and is easy to recognize and treat. However, chronic prostatitis, the most common cause of recurrent urinary tract infections (UTIs) in males, is less easy to recognize.
Causes and incidence
About 80% of bacterial prostatitis cases result from infection by Escherichia coli; the rest are due to infection by Klebsiella, Enterobacter, Proteus, Pseudomonas, Streptococcus, or Staphylococcus. These organisms probably spread to the prostate by the bloodstream or from ascending urethral infection, invasion of rectal bacteria via lymphatics, reflux of infected bladder urine into the prostate ducts or, less commonly, infrequent or excessive sexual intercourse or such procedures as cystoscopy or catheterization. Chronic prostatitis usually results from bacterial invasion from the urethra.
It’s estimated that 2 of every 10,000 people who seek outpatient care do so because of prostatitis. As many as 35% of males older than age 50 have chronic prostatitis; about 50% of males will be diagnosed with prostatitis at some point in their lives.
Signs and symptoms
Acute prostatitis begins with fever, chills, low back pain, myalgia, perineal fullness, and arthralgia. Urination is frequent and urgent. Dysuria, nocturia, and urinary obstruction may also occur. The urine may appear cloudy. When palpated rectally, the prostate is tender, indurated, swollen, firm, and warm.
Chronic bacterial prostatitis sometimes produces no symptoms but usually elicits the same urinary symptoms as the acute form but to a lesser degree. UTI is a common complication. Other possible signs include painful ejaculation, hemospermia, persistent urethral discharge, and sexual dysfunction.
Diagnosis
Characteristic rectal examination findings suggest prostatitis. In many cases, a urine culture can identify the causative infectious organism.
CONFIRMING DIAGNOSIS A firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens: one collected when the patient starts voiding (voided bladder one); another midstream; another after the patient stops voiding and the physician massages the prostate to produce secretions (expressed prostate secretions; and a final voided specimen. A significant increase in colony count in the prostatic specimens confirms prostatitis.
Treatment
Systemic antibiotic therapy chosen according to the infecting organism is the treatment of choice for acute prostatitis. If sepsis is likely, I.V. antibiotics may be given until sensitivity test results are known. If test results and clinical response are favorable, parenteral therapy continues for 48 hours to 1 week, after which an oral agent is substituted for 30 days. For infections caused by a sexually transmitted disease, injection of ceftriaxone followed by a 10-day course of doxycycline or floxacin is effective.
Supportive therapy includes bed rest, adequate hydration, and administration of analgesics, antipyretics, sitz baths, and stool softeners as necessary. Diet therapy includes avoiding substances that irritate the bladder, such as alcohol, caffeinated food and beverages, citrus juices, and hot or spicy foods. Increasing the intake of fluids (1,893 to 3,785 ml/day) encourages frequent urination that will help flush the bacteria from the bladder. In symptomatic chronic prostatitis, regular massage of the prostate is most effective. Regular ejaculation may help promote drainage of prostatic secretions. Anticholinergics and analgesics may help relieve nonbacterial prostatitis symptoms.
If drug therapy is unsuccessful, treatment may include transurethral resection of the prostate, which requires removal of all infected tissue. However, this procedure usually isn’t performed on young adults because it may cause retrograde ejaculation and sterility. Total prostatectomy is curative but may cause impotence and incontinence.
Special considerations
Patient care is primarily supportive.
❑ Ensure bed rest and adequate hydration. Provide stool softeners and administer sitz baths, as ordered.
❑ As necessary, prepare to assist with suprapubic needle aspiration of the bladder or a suprapubic cystostomy.
❑ Emphasize the need for strict adherence to the prescribed drug regimen. Instruct the patient to drink at least 8 glasses of water a day. Have him report adverse drug reactions (rash, nausea, vomiting, fever, chills, and GI irritation).
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Prostatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Prostate Abnormality (Field Guide to Bedside Diagnosis)
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