Acute Prostatitis

Scope

  • Management of Acute Prostatitis (this is a rare diagnosis with an infective history and the patient is systemically unwell often requiring admission)

Please Note: Pre-Choice Triage is currently active for this specialty.

Out of scope

  • Management of male urinary tract infections
  • Management of acute and chronic urinary retention
  • Management of Chronic Pelvic Pain Syndrome (previously known as Chronic Prostatitis)

Assessment

History & Examination

Symptoms characteristic of acute prostatitis include:
  • 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)
Examination
  • A focused physical examination is important so that abnormalities of the abdomen and external genitalia are not missed and left untreated
  • Urine dipstick test suggesting that there are white blood cells and bacteria in the urine
Signs of Acute prostatitis include:
  • Signs localised to the prostate:
    • An extremely tender, swollen and tense, smooth-textured prostate gland which is warm to the touch
    • Digital rectal exam (DRE) may not be possible because of extreme discomfort
Signs of the bacteraemia:
  • Patients with Acute Prostatitis are usually systemically unwell
    • Pyrexia and tachycardia

Differential Diagnoses

Acute Prostatitis is uncommon.

  • Consider Acute Prostatitis as an STI in younger adults
  • Does the patient have symptoms of UTI with signs of prostatism? (see UTI in males pathway)
  • Chronic Pelvic Pain Syndrome / Chronic Prostatitis:
    • Apyrexial, no systemic signs
    • The patient may have a diffusely tender prostate during acute episodes otherwise no objective clinical signs (see Chronic Pelvic Pain Syndrome)

Red Flags

Red Flag/Urgently refer patients if:
  • A suspicion of prostate or bladder cancer see 2WW referral
  • Storage symptoms in a heavy smoker
  • Chronic retention which may present as night time enuresis / over flow incontinence and/ or painless palpable bladder needs renal function checking and refer urgently

Investigations

  • Consider Prostate-Specific Antigen (PSA) as a baseline

Management

Management in primary care

Formulary Chapter 5: Urinary Tract Infections

Reassess after 24-48 hours - review the culture results and ensure that an appropriate antibiotic is being used.

Adequate response to treatment

If sure of diagnosis:

  • Refer all men when they have recovered. Investigation of the urinary tract is required to exclude structural abnormality

Inadequate response to treatment - after appropriate antibiotic treatment:

  • Refer to Urology
  • Discuss with microbiologist
  • Complications such as prostatic abscess should be assessed for, and this may require transrectal ultrasound (TRUS) examination or CT scan of the prostate
  • If present, perineal or transurethral drainage may be necessary

Referral

Referral criteria

Admit to hospital if the patient:
  • is unable to take oral antibiotics − parenteral therapy should be arranged
  • is severely ill
  • shows symptoms of acute urinary retention − suprapubic catheterisation is required (inserting a urethral catheter may spread the infection through the blood)
  • has deteriorating symptoms despite appropriate antibiotic treatment
Refer to Urology urgently:
  • if the patient has pre-existing urological conditions (such as benign prostatic hypertrophy or an indwelling catheter) specialist urological management may be required
  • any patient who is immunocompromised or has diabetes
  • if the infection is not responding adequately to treatment
Refer to Urology routinely:
  • all men when they have recovered. Investigation of the urinary tract is required to exclude structural abnormality

Referral instructions

Referral to Urology:

e-Referrals service selection

  • Specialty: Urology
  • Clinic Type: Not otherwise specified
  • Service: DRSS-Western – Urology – New Devon CCG – 99p

Referral forms

DRSS referral proforma

Supporting Information

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NHS Devon CCG.

Publication date: March 2020

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NHS Devon CCG.

Publication date: March 2020

Last updated: 21-05-2020

 

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