Prostatitis
Adult-Gerontology Acute Care Practice Guidelines
Definition
A.Inflammation of the prostate gland, which can be caused by infection or persistent irritation of the gland.
B.Can be acute or chronic, lasting for more than 3 months.
Incidence
A.Almost 10% of males will have prostatitis over their lifetime.
B.About 90% of these conditions will be related to chronic nonbacterial prostatitis.
Pathogenesis
A.Any bacteria can cause prostatitis, although 80% of pathogens are gram negative. Sexual transmission is very common.
B.Chronic nonbacterial prostatitis is inflammation of the prostate gland from persistent irritation that is nonbacterial.
Predisposing Factors
A.Blockage of urine out of the bladder.
B.Phimosis.
C.Injury to the perineum.
D.Foley catheters.
E.Procedures such as cystoscopy or biopsy of the prostate.
F.Benign prostatic hypertrophy (BPH).
Subjective Data
A.Common complaints/symptoms.
1.Acute bacterial prostatitis: Fever, chills, malaise, dysuria, low abdominal pain, or urethral discharge.
2.Chronic bacterial prostatitis: Intermittent dysuria or recurrent urinary tract infections (UTIs).
B.Common/typical scenario.
1.Possible fever, chills, and malaise.
2.Possible pain with intercourse or defecation.
3.Arthralgias.
4.Nocturia.
C.Family and social history.
1.Ask about number of sexual partners or history of sexually transmitted infections (STIs).
D.Review of systems.
1.Assess patient for discharge, pain, hematuria, back pain, and weight loss.
Physical Examination
A.Check for urethral discharge and inspect the foreskin and penis for any lesions or fluid.
B.Palpate testes and epididymides for inflammation and tenderness.
C.Check for costovertebral angle (CVA) tenderness.
D.Perform rectal examination to evaluate prostate for symmetry, swelling, and tenderness and to determine if the prostate gland is boggy.
E.Avoid massage if acute prostatitis is suspected.
Diagnostic Tests
A.Check for infection.
1.Complete blood count (CBC) with differential.
2.Urinalysis with urine culture.
3.Gram stain and culture-expressed prostatic secretions (EPS).
4.Presence of STI.
B.For chronic prostatitis, check:
1.CBC, serum creatinine, and blood urea nitrogen (BUN).
2.Ultrasound, MRI, or biopsy if necessary to rule out other possibilities.
Differential Diagnosis
A.Anal fistulas.
B.UTI.
C.Epididymitis.
D.Urethritis.
E.Urinary obstruction.
F.Pyelonephritis.
Evaluation and Management Plan
A.General plan.
1.Acute prostatitis may need intravenous (IV) therapy for severe infection or if patient looks toxic.
2.Increase fluid intake.
3.Decrease caffeine and alcohol intake.
B.Patient/family teaching points.
1.Teach patients how the infection is transmitted.
2.Suggest that sexual partners may need treatment.
3.Tell patients to use condoms.
4.Tell patients to urinate when the urge comes.
C.Pharmacotherapy.
1.Acute bacterial prostatitis.
a.Broad-spectrum penicillin, third generation cephalosporins, or fluoroquinolones.
b.Nonsteroidal anti-inflammatory drugs (NSAIDs) for treating discomfort may be considered.
2.Chronic bacterial prostatitis.
a.Fluoroquinolones for 4 to 6 weeks.
b.NSAIDs.
c.Alpha blockers, which reduce bladder outlet syndrome, may be beneficial.
D.Discharge instructions.
1.Prevent infection with good hygiene.
2.Complete the antibiotic treatment as prescribed, which may take up to 1 month.
Follow-Up
A.Evaluate the effectiveness of the treatment plan and resolution of symptoms.
B.Admit patients who appear toxic to the hospital for IV antibiotics.
Consultation/Referral
A.Consult urology for acute recurrent bacterial infections or persistent infections. Cystoscopy may be required.
Special/Geriatric Considerations
A.Prostatitis may lead to sepsis, particularly in patients with diabetes or chronic renal failure, patients on dialysis, immunocompromised patients, and postsurgical patients with urethral instrumentation. There should be a low threshold to hospitalize these patients if there is a concern.
B.Urinary retention association with acute prostatitis may also require hospitalization.
Bibliography
Center for Urology, Rochester, N. Y. (n.d.). Discharge instructions for prostatitis. Retrieved from http://www.cfurochester.com/pdf/discharge-prostatitis.pdf
5 Foods that can cause prostatitis. (n.d.). Retrieved from http://prostate.net/articles/foods-that-cause-prostatitis
Gupta, N., Mandal, A., & Singh, S. (2008). Tuberculosis of the prostate and urethra. Indian Journal of Urology, 24(3), 388–391. doi:10.4103/0970-1591.42623
Luzzi, G. (2007). Editorial letter. Chronic prostatitis. New England Journal of Medicine, 356, 423–424. doi:10.1056/NEJMc063135
Stevermer, J., & Easley, S. (2000, May). Treatment of prostatitis. American Family Physician, 61(10), 3015–3022.
Strauss, A., & Dimitrakov, J. (2010, March). New treatments for chronic prostatitis/chronic pelvic pain syndrome. Nature Reviews Urology, 7(3), 127–135.
Turek, P. J. (2019, December 6). In J. P. Taylor 3rd (Ed.), Medscape. Retrieved from http://emedicine.medscape.com/article/785418-overviewProstatitis
Yavasscaoglu, I., Oktay, B., Simpseck, U., & Ozyurt, M. (1999, March). Role of ejaculation in the treatment of chronic non-bacterial prostatitis. International Journal of Urology, 6(3), 130–134.