Critical Alerts

• Acute bacterial prostatitis is a clinical emergency: Can progress to urosepsis
• Tender, boggy prostate on DRE: Diagnostic
• Avoid vigorous prostatic massage: Risk of bacteremia
• UTI in male should prompt prostatitis evaluation
• Urinary retention common: May require catheterization
• Prostatic abscess if not improving: CT or TRUS for diagnosis

Key Diagnostics

Emergency Treatments

Overview

Acute bacterial prostatitis (ABP) is an acute infection of the prostate gland, typically caused by Gram-negative bacteria. It presents with fever, urinary symptoms, and a tender, swollen prostate. It is a serious infection that can progress to urosepsis. Most cases are treated with prolonged antibiotic courses; prostatic abscess requires drainage.

Classification

NIH Classification of Prostatitis:

Epidemiology

• Incidence: 2-10% of men will experience prostatitis symptoms
• Peak age: 30-50 years
• Most common urologic diagnosis in men <50
• Hospitalization rate: 5-10% of acute cases

Etiology

Common Pathogens:

Risk Factors:

Urosepsis

Prostatic Abscess

Urinary Retention

Other Causes of Similar Symptoms

Clinical Diagnosis

• ABP is primarily a clinical diagnosis: Symptoms + tender prostate on DRE

Laboratory Studies

Imaging

Not Routinely Needed for Uncomplicated ABP

Indications for Imaging:

Discharge Criteria (Outpatient)

• Mild symptoms, well-appearing
• Able to tolerate oral antibiotics
• No signs of sepsis
• Reliable follow-up

Admission Criteria

• Sepsis or severe illness
• Unable to tolerate oral intake
• Urinary retention
• Suspected prostatic abscess
• Immunocompromised
• Failure of outpatient therapy

Referral

Follow-Up

Condition Explanation

• "You have an infection of your prostate gland."
• "This requires a long course of antibiotics (4-6 weeks) to fully treat."
• "If you stop the antibiotics early, the infection can come back or become chronic."

Home Care

• Take all antibiotics as prescribed
• Drink plenty of fluids
• Avoid alcohol and caffeine (can irritate bladder)
• Take NSAIDs for pain relief
• Avoid sexual activity until symptoms resolve

Warning Signs to Return

• High fever or chills
• Inability to urinate
• Worsening pain
• Nausea, vomiting
• Confusion or dizziness

Young Sexually Active Males

• Consider STI organisms (N. gonorrhoeae, C. trachomatis)
• Obtain NAAT for gonorrhea/chlamydia
• Treat empirically if STI suspected (ceftriaxone + doxycycline)

Elderly with BPH

• Higher risk of retention
• May have atypical presentation
• Monitor for chronic prostatitis

Immunocompromised

• Higher risk of abscess and sepsis
• Broader antibiotic coverage
• Lower threshold for admission

Post-Prostate Biopsy

• Common cause of prostatitis
• Often fluoroquinolone-resistant (prophylaxis used)
• Consider broader empiric coverage

Performance Indicators

Documentation Requirements

• DRE findings (tender, boggy prostate)
• Urinalysis results
• Antibiotic prescribed and duration
• Disposition and follow-up plan

Diagnostic Pearls

• Tender, boggy prostate = ABP: DRE is diagnostic
• Avoid vigorous prostatic massage: Risk of bacteremia
• UTI in male → Consider prostatitis: Prostate is often involved
• Pyuria + fever + prostatic tenderness = ABP
• Abscess if not improving: CT or TRUS
• PSA is often elevated: Non-specific, don't use for diagnosis

Treatment Pearls

• Fluoroquinolones are first-line: Excellent prostatic penetration
• Prolonged course (4-6 weeks): Prevents chronic prostatitis
• IV antibiotics for sepsis: Step down when improving
• Suprapubic catheter preferred for retention: Avoids prostatic trauma
• Abscess needs drainage: Antibiotics alone insufficient
• Check STI in young men: Treat empirically if suspected

Disposition Pearls

• Mild cases can be outpatient: If stable and can tolerate PO
• Admit for sepsis, retention, abscess: Close monitoring
• Urology for abscess or recurrence: Drainage or evaluation
• Follow-up essential: Ensure cure, prevent chronicity