Acute prostatitis

Acute prostatitis
Etiology: is common but under diagnosed.a
The usual microorganism responsible is Eschersia coli. But Staphylococcus aureus, Staphylococcus Albus, streptococcus Faecalis ,Neisseria Gonorrhea or Chlamydia may be responsible.
It may be hematogenous from distinct route or secondary to urinary tract infection.
Clinical features: patients feel ill, shivers. Has aches all over especially in the back and may be easily diagnosed as influenza. Pain on micturition is usual.
Urine contains threads in initial voided sample and should be cultured.
Perineal heaviness, rectal irritation and pain on defecation occur.
DRE: tender prostate, one lobe may be swollen more than the other.
Seminal vesicle s may be involved.
Treatment: must be vigorous and prolonged or the infection will not be eradicated and recurrent attacks may occur, spread to epididymis and testis may occur.
Prolonged treatment with antibiotics with good penetration is indicated (Trimethoprim, ciprofloxacin)
Prostatic abscess
Prostatic abscess is heralded by temp. rising steeply with rigors
Sever un remitted perineal and rectal pain and occasionally tensmus cause the condition to be confused with anorectal abscess
DRE: prostate enlarge, hot, extremely tender and perhaps fluctuation
Retention of urine is likely to occur (suprapubic catheter is the treatment)
Treatment: the abscess should be drained without delay either by peruerthtral resection (unroofing the whole cavity)
The perineal route is rarely indicated unless there is marked preprostatic spread