Prostatitis is the inflammation of the prostate that may be caused by infection, chronic pelvic pain syndrome or asymptomatic prostate inflammation.
Prominent features are genitourinary, pelvic or rectal pain and lower urinary tract symptoms, eg urinary frequency, urgency, hesitancy, weak stream and straining on urination, dysuria, pain that increased with urination.
Persistent prostatitis may be managed by another course of antibiotic therapy adjusted according to susceptibility results; course is more prolonged & consists of a higher dosage or different agent
Consider referral to a specialist for evaluation if patient is unresponsive to modified antibiotic therapy or if w/ severe symptoms
Acute Bacterial Prostatitis (ABP)
Assess clinical response on follow-up along with a urine culture collected 7 days after antibiotic therapy
Suspect a prostatic abscess if patient failed to improve with antibiotic therapy
Complications of acute bacterial prostatitis (ABP) include acute urinary retention, prostatic abscess, chronic bacterial prostatitis, fistula formation, sepsis, or spread of infection to spine or sacroiliac joints
May use the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) & InternationalProstate Symptom Score (IPSS) as validated tools for determining improvement of patient’s symptoms or quality of life w/ time or treatment
A 6-point decrease from baseline in the total score of National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) is the threshold for prediction of response to treatment
Patients refractory to treatment may be given the following:
Psychosocial screening, eg history of trauma including emotional, physical, or sexual abuse, for possible referral to mental health services
Consider giving phytotherapy, eg bioflavonoids, pollen extracts, &/or saw palmetto, as a treatment option