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Acute bacterial prostatitis

Definition
Acute bacterial prostatitis is an uncommon infection of the prostate gland due to bacteria, usually with severe presentation.
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Pathophysiology
Acute bacterial prostatitis is an infection of the prostate gland, typically caused by common urinary tract pathogens. The bacteria usually enter the prostate from the urethra, triggering an inflammatory response within the gland. This inflammation can lead to swelling and discomfort in the prostate and surrounding areas.
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Epidemiology
Acute bacterial prostatitis constitutes nearly 10% of prostatitis diagnoses, predominantly affecting individuals aged 20-40 and those > 70 years.
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Disease course
Clinically, patients with acute bacterial prostatitis often present with a range of symptoms. These can include fever, chills, and malaise, as well as urinary symptoms such as dysuria, urinary frequency, and urgency. Some patients may also experience pelvic or perineal pain, and in severe cases, there may be blood in the urine. In some instances, patients may present with symptoms of urosepsis, such as tachycardia, tachypnea, and hypotension.
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Prognosis and risk of recurrence
The prognosis of acute bacterial prostatitis is generally good with appropriate treatment, which typically involves antibiotics.
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Key sources
The following summarized guidelines for the evaluation and management of acute bacterial prostatitis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023) and the Canadian Urological Association (CUA 2011).
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Guidelines

1.Diagnostic investigations

Physical examination: as per EAU 2023 guidelines, do not perform prostatic massage in patients with acute bacterial prostatitis.
D
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  • Urine tests

  • Blood tests

  • Transrectal ultrasound

  • Pelvic imaging

2.Medical management

General principles: treat acute bacterial prostatitis according to the recommendations for complicated UTIs.
A

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  • Setting of care

  • Antibiotic therapy

  • Management of pain

  • Management of voiding symptoms

3.Therapeutic procedures

Urethral catheterization
Perform urethral catheterization with a trial of voiding or short-term small caliber urethral catheterization in patients with severe obstructive voiding symptoms or urinary retention.
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Consider placing a suprapubic tube in patients not tolerating a urethral catheter.
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4.Surgical interventions

Drainage of prostatic abscess: perform incision and drainage of the prostatic abscess, preferably via transurethral route.
B