Prostatitis
Prostatitis is a term used to describe the inflammation of the prostatic gland. Historically, nonspecific disease-associated prostatic pain also referred as chronic pelvic pain syndrome or prostatic pain syndrome had been equated with chronic prostatitis.
- PDF / 206,430 Bytes
- 4 Pages / 439.37 x 666.14 pts Page_size
- 49 Downloads / 191 Views
46
Iason D. Kyriazis, Ioannis Georgiopoulos, and Evangelos N. Liatsikos
46.1
General Facts
Prostatitis is a term used to describe the inflammation of the prostatic gland. Historically, nonspecific disease-associated prostatic pain also referred as chronic pelvic pain syndrome or prostatic pain syndrome had been equated with chronic prostatitis. Nevertheless, in accordance to the 2012 EAU guidelines on chronic pain syndromes, the former syndrome should be regarded as a distinct clinical entity requiring a multimodal and symptom-directed management [1]. For the purposes of this chapter, only prostatitis of infectious origin (bacterial prostatitis) will be discussed.
46.2
Symptoms and Classification
Based on the duration and the severity of symptoms, prostatitis can be classified as acute or chronic [2]. Acute prostatitis is a serious infection that can progress rapidly to urosepsis if remain untreated, especially in immunocompromised patients such as elderly or diabetic. Thus, upon diagnosis prompt treatment with broad-spectrum antibiotics should be initiated. The diagnosis of acute prostatitis is based on clinical symptomatology. Patient is usually febrile demonstrating high fever with shivering. Pain at various locations including perineum, scrotum, lower abdomen, and back in addition to lower urinary tract symptoms such as frequency and dysuria are the predominant symptoms. Although prostatic massage is strongly contraindicated in
I.D. Kyriazis (*) • I. Georgiopoulos • E.N. Liatsikos Department of Urology, University of Patras, Rion, Patras 26 504, Greece e-mail: [email protected] A.S. Merseburger et al. (eds.), Urology at a Glance, DOI 10.1007/978-3-642-54859-8_46, © Springer-Verlag Berlin Heidelberg 2014
245
246
I.D. Kyriazis et al.
acute prostatitis, in cases of uncertain diagnosis, a digital rectal examination can be performed revealing a swollen, warm, and tender prostatic gland. Laboratory and radiologic investigation should focus on the assessment of patients’ systemic inflammatory response to diagnose urosepsis promptly, the isolation of causative pathogen through midstream urine culture, and the radiologic evaluation of gland if a prostatic abscess is suspected. Chronic prostatitis is defined as the clinical condition in which prostatitis-like symptoms last more than 3 months following an acute infection. The symptoms of chronic prostatitis are milder than acute infection and fever is usually absent. The isolation of the responsible pathogen is of outmost importance in the laboratory investigation of chronic prostatitis. Midstream urine and Stamey-Meares-expressed prostatic secretion cultures should be available in all cases although the causative agent will be identified only in a minority of cases.
46.3
Therapy
Unless or until a specific pathogen has been isolated, antibiotic treatment of prostatitis should be empirically guided based on the most common causative bacteria. Based on their favorable safety profile, fluoroquinolones are considered the gold standard empirical treatment opt
Data Loading...
