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Prostatitis - acute - Management
How should I diagnose acute prostatitis?

  • Suspect acute prostatitis in a man who presents with:
    • A feverish illness of sudden onset.
    • Irritative urinary voiding symptoms (dysuria, frequency, urgency) or acute urinary retention.
    • Perineal or suprapubic pain (low back pain, pain on ejaculation, and pain during bowel movements can also occur).
    • Exquisitely tender prostate on rectal examination.
    • Urine dipstick test suggesting that there are white blood cells and bacteria in the urine.
  • To make the diagnosis:
    • Confirm urinary infection with a urine culture — do not collect prostatic secretions as prostatic massage could lead to septicaemia or a prostatic abscess, may be very painful, and is not needed for the diagnosis (infection is confirmed with urine culture).
    • Exclude conditions with similar presentations, including:
      • Prostatic abscess — consider this if the prostate is fluctuant on gentle palpation.
      • Chronic prostatitis — consider this if the symptoms have been present for several weeks or months.
      • Cystitis, urethritis, or upper urinary tract infection — consider these if there are no symptoms suggesting that the prostate is affected.
      • Acute unilateral or bilateral epididymo-orchitis — consider these if the scrotum, testis, or epididymis are painful or swollen.
      • Local invasion from cancer of the prostate, bladder, or rectum; or a leaking aortic aneurysm.

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