Complications
Common complication in acute bacterial prostatitis, and in some patients may be the presenting feature. May be caused by the prostate becoming oedematous with the development of infection. Retention of urine is a clinical diagnosis, and impending retention may be recognised in patients who complain of increasing difficulty in passing urine, and who are shown on ultrasound to have a post-voiding residual volume. Treatment of acute retention is by urinary catheter.
Systemic sepsis is recognised clinically in a patient who is obviously unwell on examination, usually with fever, although in some cases a patient may be hypothermic. If this is untreated, hypotension and tachycardia will follow. The condition may be fatal without treatment with appropriate antibiotics.
This rare complication may develop in patients with acute bacterial prostatitis. Aetiology of this condition largely arises from the presence of bacterial infection, with an increased risk of abscess development in patients with an indwelling catheter, instrumentation of the lower urinary tract, and immunocompromise (e.g., diabetes, HIV infection).[50] The patient complains of severe perianal pain and may have difficulty in passing urine. Rectal examination may reveal a fluctuant area in the prostate.
Patients require additional/adjunctive antibiotic therapy and may require surgical intervention. Aspiration of pus with culture and sensitivity will aid choice of agent. Aspiration may be achieved through transrectal or perineal aspiration, which may be performed under ultrasound guidance. Endoscopic intervention using a Collins knife may be used to 'uncap' the abscess. In patients with signs of sepsis, transurethral resection of the prostate and cavity drainage may be necessary.[51]
The development of intractable symptoms of dysuria, urinary frequency, pelvic discomfort, and (sometimes) impotence suggests chronic inflammation and/or infection of the prostate. Laboratory examination is non-productive, with normal urinalysis and negative urine cultures. Digital rectal expression of prostatic secretions may reveal leukocytes in the absence of bacteria on microscopic examination. Treatment for chronic bacterial prostatitis is a prolonged course of oral antibiotics (e.g., trimethoprim/sulfamethoxazole) for 6 weeks, non-steroidal anti-inflammatory drugs (NSAIDs), and supportive care (avoiding caffeine, increasing water intake, and taking warm sitz baths). Chronic abacterial prostatitis is another term for chronic pelvic pain syndrome (CPPS) and can be inflammatory or non-inflammatory.[4] Effective treatment regimens for CPPS remain to be defined, and strategies are based on symptomatic control and anxiety relief.[49][52][53]
[ 
]
Use of this content is subject to our disclaimer