Ivanova T, Stief CG, Magistro G. Akute Prostatitis: Diese Diagnose wireless weitgehend klinisch gestellt [Acute bacterial prostatitis].

Ivanova T, Stief CG, Magistro G. Akute Prostatitis: Diese Diagnose wireless weitgehend klinisch gestellt [Acute bacterial prostatitis]. MMW Fortschr Med. 2022 Sep;164(15):41-43. German. doi: 10.1007/s15006-022-1815-x. PMID: 36064922.

Acute prostatitis : This diagnosis is mainly made by clinical

A 58-year-old patient said he had problems with urination for 5 days. He had to go to the toilet frequently and his urine flow was extremely weak. He had a feeling that he could not completely empty bladder . The patient further reported that the urine is now also very cloudy. In addition, he felt severe pain in the perineal area, which was particularly noticeable when physically exhausted and sitting for a long time. Since last night, he has a fever (39°C), feeling weak and uncomfortable. The patient has always been healthy and does not take medicine. Prostate swelling and extreme stress pain were also noted in digital rectal examination (DRE). Based on the results obtained, you make a suspected diagnosis of acute prostatitis.

basic information

According to the classification of National Institutes of Health (NIH), prostatitis is divided into 4 categories (Table 1).

Table 1 Classification of prostatitis according to the National Institutes of Health classification

Prostatitis is a common urinary system disease. However, only about 10% of prostatitis-like symptoms are caused by bacterial infection. Acute bacterial prostatitis is manifested as obvious symptoms of perineal pain and urination (empty disorder and storage symptoms), which may be accompanied by signs of systemic infection. The most common uropathogenic agent for acute bacterial prostatitis is E. coli.

Diagnosis

Due to typical symptoms, the diagnosis of acute bacterial prostatitis can be mainly carried out through clinical practice. The steps for confirmatory diagnosis include:

• Clinical examination: the abdomen, renal axis and external genitals should be examined. In DRU, palpation has extremely compressive prostate. In the case of an abscess, fluctuations can be touched. Due to the risk of bacteremia , prostate massage should be avoided. Therefore, DRE should be carried out with caution.

• Urine analysis: urine test strips and urine sediment suggest urinary tract infection ( nitrite , leukocyte urine, bacterial urine). Urine culture should be produced from sterile mid-section urine.

• Laboratory chemical analysis: In the signs of systemic infection, parameters such as C-reactive protein (CRP) and leukocyte count (leukocyte enlargement) are pathologically elevated. Furthermore, in 60% of cases, prostate-specific antigen (PSA) was pathologically elevated. During the treatment process, it falls off again in a therapeutic context with appropriate response. In general, in poor condition and/or fever, blood culture should also be performed.

• Urography: Transabdominal ultrasound examination is used to eliminate or confirm urinary transport disorders (residual urine after urination; hydronephrosis ). Transrectal examination should not be performed as a standard. In unclear circumstances, it is suitable to exclude or confirm the formation of the abscess and then determine the degree.

acute abdominal disease , acute scrotum, acute urinary retention , gastrointestinal causes (sigmoid diverticulosis, inflammatory bowel disease ) and musculoskeletal triggers.

Only about 10% of prostatitis-like symptoms are caused by bacterial infection.

therapy

The treatment of severe course of acute bacterial prostatitis requires immediate antibacterial treatment. This is calculated by intravenous (intravenous) administration of broad-spectrum penicillin, group 3 cephalosporin, or fluoroquinolones.If the initial clinical response is insufficient, aminoglycoside antibiotic may escalate.

With adequate clinical improvement and microbial culture results, antibiotic treatment can be converted to oral administration according to the test. Fluoroquinolones continue to be approved for this indication, and are used as the preferred drug due to their good pharmacological properties. The treatment time is 2-4 weeks. If mild to moderate symptoms are available for outpatient treatment, fluoroquinolones are also recommended as the preferred drug for initial calculation of treatment (cave: local resistance, fluoroquinolones intake in the past 6 months). After receiving the microorganism results, you can adjust it to test it if necessary. The treatment duration is also 2-4 weeks. In 10% of cases, due to obvious symptoms of urination, an increase in residual urine after urination can be detected, which makes it necessary to divert urine. The supraplegic catheter is better than transurethral drainage because the risk of progression to chronic prostatitis is lower here. In the presence of prostate abscess , it should be relieved from the size of 1 cm. This can be done by puncture, drainage, or through urethra intervention (“revealing the roof”). For smaller findings, conservative approaches can also be used. What happened next in

?

urine sediment can confirm urinary tract infection. In laboratory chemistry examination, CRP, leukocyte counts, and PSA values ​​were pathologically elevated. Transabdominal ultrasound demonstrated that the combined upper space required in the bladder requires 400 ml (Figure 1). If the fever is 39.5°C and the general condition is reduced, the patient is hospitalized. Insert the upper bladder catheter of pubic and start the treatment with ciprofloxacin intravenous antibiotics. On day 2, after receiving urinary culture (Escherichia coli) and a good clinical response, ciprofloxacin can be switched to ciprofloxacin according to the test. In ultrasound control, the bladder can be emptied to 40 ml. Therefore, suprapus catheter was also removed. The patient can be discharged from the hospital on the 4th day, his condition has improved significantly, he has no fever, and he will continue to treat antibiotics in the outpatient clinic.

Figure 1 The residual urine increases after urination in the symptom of urination in the background of acute bacterial prostatitis.

Practical Conclusion

1. In acute perineal pain, urination problems and fever, acute bacterial prostatitis should be regarded as a suspected diagnosis.

2. Extremely volatilized prostate, urine diagnosis and in severe cases, laboratory chemical examination and blood culture collection ensure diagnosis.

3. Fluoroquinolones are the first treatment of choice for more than 2-4 weeks (local resistance, fluoroquinolones intake in the past 6 months).