Who You Are:
You are an F2 working in GP clinic.Who the patient is:
Sam Lynch, 52 years old. He has come with some concernsWhat you should do:
Talk to him, discuss management and address his concerns.
Presenting Complaint: Pain down below
History
- Where is the pain?(SOCRATES)
acute, pain/burning while peeing for last 2 days.
- Prostate symptoms:
- Frequency- Do you go to the toilet more frequently than usual?
- Urgency- Do you need to rush to the toilet?
- Hesitancy- Are you finding it difficult to start urinating? do you strain?
- Stream- How is the stream? Weaker than usual
- Leakage- After passing the urine do you have any dribbling or leakage?
- Empty- After passing urine do you feel like you haven’t emptied your bladder very well?
- Nocturia- Do you wake up in the night to go to the toilet?
- STI symptoms
– P: Can I be in a relationship? - UTI symptoms
– Fever
–burning micturition
Examination
- Urine Dipstick
– Positive: Protein, Leucocyte
– Negative: Sugare, Nitrate - DRE: Prostate tender on examination
Diagnosis
- Inflammation of Prostate, it is a male gland lies under the bladder
Management
- Ciprofloxacin for 14 days
- Avoid dehydration
- If anal pain: lactulose
Admit only if Patient has
- Fever
- Rigors/chills
- Vomiting
- Confusion
NICE CKS Summary
- Acute bacterial prostatitis is a severe, potentially life-threatening bacterial infection of the prostate.
- Urinary infection with pathogens may be caused by urethral instrumentation, trauma, bladder outflow obstruction, or dissemination of infection from outside the urinary tract.
- Most men treated appropriately for acute prostatitis will recover completely within 2 weeks.
- Acute prostatitis should be suspected in a man who presents with signs and symptoms of:
- A urinary tract infection (UTI) — dysuria, frequency, urgency.
- Prostatitis — perineal, penile, or rectal pain; acute urinary retention, obstructive voiding symptoms; low back pain, pain on ejaculation; tender, swollen, warm prostate (on gentle rectal examination).
- Bacteraemia — rigors, arthralgia, or myalgia; fever, tachycardia.
- Assessment of men suspected of having bacterial prostatitis includes:
- Collecting a mid-steam urine (MSU) sample to confirm UTI by dipstick, culture and sensitivity.
- Arranging blood cultures and full blood count.
- Conducting a physical examination — this should include the abdomen to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination (DRE).
- Considering screening for sexually transmitted infections (STIs), particularly in men considered to be at risk.
- Considering and excluding other diagnoses.
- Men suspected of having acute bacterial prostatitis should be prescribed an oral antibiotic for 14 days: ciprofloxacin 500 mg twice daily or ofloxacin 200 mg twice daily first line, or if they are unsuitable trimethoprim 200 mg twice daily. Second-line options should include levofloxacin 500 mg once daily, or co-trimoxazole 960 mg twice daily.
- Men should be advised:
- To take paracetamol (with or without a low-dose weak opioid, such as codeine) for pain, or ibuprofen if this is preferred and suitable.
- To drink enough fluids to avoid dehydration.
- About the usual course of acute prostatitis (several weeks).
- About possible adverse effects of the antibiotic.
- To seek medical help if symptoms worsen at any time, symptoms do not start to improve within 48 hours of taking the antibiotic, or they become systemically very unwell.
- Follow up should be arranged after 48 hours to check response to treatment and the urine culture results.
- Antibiotic choice should be reviewed and changed according to susceptibility results if the bacteria are resistant.
- Admission to hospital should be arranged if symptoms have not improved 48 hours after starting antibiotic treatment.
- Urgent referral to to a genito-urinary medicine (GUM) clinic should be arranged if an STI is identified.
- Antibiotic treatment should be reviewed after 14 days.
- Following recovery, men should be referred for investigation to exclude structural abnormality of the urinary tract.
- Admission to hospital should be arranged if the man:
- Is unable to take oral antibiotics.
- Has severe symptoms.
- Has signs or symptoms of a more serious condition (for example sepsis, acute urinary retention or prostatic abscess).
- Urgent referral should be considered for any man who:
- Is immunocompromised or has diabetes mellitus.
- Has a pre-existing urological condition (such as benign prostatic hypertrophy or an indwelling catheter) — specialist urological management may be required.