1 Republican Vilnius University Hospital
Acute bacterial prostatitis is a bacterial inflammation within a prostate and cause urinary tract symptoms and abdominal pain. Prostatitis is classified in acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis. Acute bacterial prostatitis is most commonly caused by Escherichia coli. Prostatitis include acute irritative (dysuria, urinary frequency) and obstructive (urinary retention, hesitancy to urinate, diminished calibre of urinary stream) signs and symptoms, with the presence of pain in suprapubical area, genitals, perineum, painful ejaculation and defecation, hematospermia.
In patients with suspected acute bacterial prostatitis, urinalysis and urine culture should be requested. Other investigations (computed tomography, magnetic resonance imaging) should be done if prostatic abscess is expected. The choice of treatment is influenced by severity of clinical signs and symptoms, risk factors, local antibiotic resistance. Majority of patients can be treated at home. Criteria for hospitalisation are urinary incontinence, severe cases, signs of sepsis, strong pain in perineum. Less-severe cases are treated with oral antibiotics (ciprofloxacin, levofloxacin, trimetoprim/sulfametoxazole, trimetoprim) at home. Severe cases with signs of sepsis are treated with parenteral antibiotics: piperacillin.tazobactam, cefotaxime, ceftazidime, ciprofloxacin) and switched to oral antibiotics as the patient improves. Non- steroidal anti-inflammation drugs (ibuprofen, diclofenac) are used for pain management. Normally, acute bacterial prostatitis is successfully treated with antibiotic therapy and patients become asymptomatic.
Keywords: acute bacterial prostatitis, prostate, irritative symptoms, obstructive symptoms.