Prostatitis

Diagnosis

200

Acute bacterial prostatitis  symptoms 

Urinary: straining, urgency, dysuria, hesitancy, frequency, obstruction, irritationSystemic: fever, malaise, arthralgia, myalgia, intense suprapubic pain, mildly to acutely ill appearance, chills, nausea, emesis, and signs of sepsis (tachycardia and hypotension)

300

Chronic bacterial prostatitis  symptoms

Irritative voiding symptoms; testicular, low back, or perineal pain; recurrent urinary tract infection; urethritis; epididymitis; distal penile pain

400

Acute prostatitis ddx

Acute cystitis, prostatic abscess

500

Chronic bacterial prostatitis DDx

Benign prostatic hyperplasia, stones or foreign body within the urinary tract, bladder cancer, prostatic abscess, enterovesical fistula

Treatment

200

Duration of antibiotics used outpatient

6 weeks

400

antibiotic to use inpatient 

amp + gent

500

Doses, length, and frequency of 2 most commonly used antibiotics outpatient

Cipro 500 BID or TMP/SMZ  160/800 BID
Both for 6 weeks

Physical Exam

100

what type of physical exam exam manuver is contraindicated in acute bacterial  prostatitis 

prostatic massage contraindicated

200

Under what circumstances do you do prostate massage? 

Chronic Bacterial Prostatitis

Meares-Stamey 4-glass tests

300

 Acute bacterial prostatitis physical exam finding (particularly the prostate)

Tender, boggy, enlarged prostate on digital rectal examination; distended bladder;

400

Chronic bacterial prostatitis prostate exam

prostate can be normal, tender, or boggy on digital rectal examination

500

Describe the procedure for collecting the Meares-Stamey 4 glass tests AND under what circumstances would it be appropriate to collect

The traditional four-glass urine collection technique, includes examination of four urine specimens. The collection procedure is as follows:

1. The first specimen is voided bladder–1 (VB1), which is the first 10 mL of urine and represents the urethral specimen.
2. The patient then voids another 100-150 mL of urine.
3. The second specimen, voided bladder–2 (VB2), is collected, which is another 10 mL of urine and represents the bladder specimen.
4. The third specimen is the expressed prostatic specimen (EPS), which is the fluid collected during prostatic massage.
5. The fourth specimen, voided bladder–3 (VB3), consists of the first 10 mL of urine collected after EPS; it contains any EPS trapped in the prostatic urethra.

Labs

200

Acute bacterial prostatitis labs to order

Urine culture, postvoid residual

300

Chronic bacterial sinusitus labs to order

pre- and post-prostatic massage test, postvoid residual