Prostatitis acuta

thumb|right|150px|Akutní prostatitida – histologie Acute prostatitis most often occurs in young men. It usually occurs as a result of reduced immunity, colds, transmission of infection after sexual intercourse or urinary tract infection.

Etiology
Most often acute prostatitis is caused by bacterial infection, currently the main pathogens are Chlamydia spec., Trichomonas vaginalis or Ureoplasma. Other uropathogens are common (E. coli, Klebsiella sp., Proteus). However, it can also be abacterial.

Symptomatology
Acute prostatitis usually manifests itself as a sudden febrile illness. At the forefront are severe pains in the suprapubic and perineal region, which are accentuated during micturition and during defecation. The patient complains of dysuric discomfort. Hematuria or hemospermia is often present. The seminal vesicles are affected at the same time as the prostate, so we can talk about prostatovesiculitis. The disease is accompanied by general symptoms (fever, weakness, shivering, nausea, vomiting), the temperature may fluctuate and rise to septic values. The whole organism is altered, the patient may be breathless, have tachycardia, tachypnea, hypotension. The disease may progress to sepsis.

The abdomen is palpably painful in the suprapubic region. On per rectum examination, the prostate is very painful to the palpation and markedly oozing, irregular in shape.

Diagnostics
Diagnosis is based on clinical picture, physical examination, microscopic picture and culture of urine or prostatic fluid. This is obtained by massage of the prostate gland, which relaxes the glandular ducts. We find massive leukocytic infiltration.

Treatment
Acute stages with alteration of the general condition are treated during hospitalization by parenteral administration of bactericidal antibiotics that penetrate into the prostate tissue (combination of aminoglycosides, broad-spectrum penicillins or cephalosporins of II-III generation or fluoroquinolones of III and IV generation). We then switch to oral fluoroquinolones or cotrimoxazole. In less severe cases, outpatient treatment for 4-6 weeks is sufficient. Simultaneously we administer spasmolytics and analgesics (NSAIDs specific to COX II, alpha-adrenoceptor blockers). We help drain the inflammatory infiltrate from the glands with massage.

CAVE! Prostate massage is contraindicated in the acute course! There is a risk of spreading infection and bacteremia.

Antibiotics are given for at least 30 days to minimize the risk of progression to chronic prostatitis.

Complications
When febrile peaks persist with adequate antibiotic therapy, we must think about the possibility of an abscess, which we diagnose with TRUS or CT of the pelvis. Other complications include the development of urosepsis, epididymitis or pyelonephritis, or the transition to chronic or granulomatous prostatitis.

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