H. kongestiver Prostatitis

Prostatitis

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Articles in the December issue discuss various h. kongestiver Prostatitis issues affecting school-aged children, including acne, eczema and growth disorders. Volume 42, No. Prostatitis is a spectrum of disorders that impacts a significant number of men. Acute bacterial prostatitis may be a life-threatening event requiring prompt recognition and treatment with antibiotic therapy. Chronic bacterial prostatitis has a more indolent course and also requires antibiotic therapy for h.

kongestiver Prostatitis. Asymptomatic inflammatory prostatitis is an incidental finding of unclear significance. Understanding the diagnostic and management strategies for each of these entities is critical for general practitioners in caring for their male patients.

Prostatitis encompasses four distinct clinical entities, which can be described using the National Institutes of Health International Prostatitis Collaborative Network classification system. The four categories of prostatitis are:. Acute bacterial prostatitis results from proliferation of bacteria within the prostate gland following intraprostatic reflux of urine infected with organisms such as Escherichia coliEnterococcus and Proteus species. The clinical presentation of ABP may be highly variable with symptoms ranging from mild to severe.

Acute bacterial prostatitis should h. kongestiver Prostatitis considered in h. kongestiver Prostatitis differential diagnosis of any male presenting with urinary tract symptoms.

While gentle palpation of the prostate gland on physical examination will often reveal a pathognomonic finding of an exquisitely tender, boggy prostate gland, care should be taken to avoid vigorous prostate massage as this may precipitate bacteremia and sepsis.

Acute bacterial prostatitis can be diagnosed clinically, although both urine Gram stain and urine culture are recommended to identify causative organisms and guide treatment. While blood cultures and H. kongestiver Prostatitis protein may prove useful, a prostate specific antigen PSA test is not indicated.

Prostate specific antigen elevations are common in the setting of infection and may take up to 1 month postinfection to resolve. Imaging is only indicated when prostatic abscess is suspected in a patient with ABP who is failing to improve with treatment. Antibiotic therapy for ABP should be based on the acuity of h.

kongestiver Prostatitis patient and the known or suspected causative organism. Table 1 outlines the Australian Therapeutic Guidelines current treatment recommendations. While ABP is usually caused by urinary pathogens, sexually transmissible infections such as chlamydia and gonorrhoea should be considered, particularly in young men. If chlamydia is thought to be the causative agent, azithromycin 1 g orally stat or doxycycline mg orally twice daily for 7 days is appropriate.

If gonorrhoea is suspected, ceftriaxone mg intramuscularly and azithromycin 1 g orally is indicated. Contact tracing, notification and treatment is also important in these cases. In addition to antibiotic therapy, non-steroidal anti-inflammatory drugs NSAIDs may offer both analgesia and more rapid healing through liquefaction of prostatic secretions. Urine culture 48 hours post-treatment is useful combined with review after 7 days of antibiotic treatment to assess clinical response to treatment.

If the patient fails to improve with antibiotics, a prostatic abscess should be suspected, particularly in men who are immunocompromised, have diabetes mellitus h. kongestiver Prostatitis who have had recent instrumentation of the urinary tract. Acute urinary retention may develop as a complication of ABP. Suprapubic tap should be performed to alleviate retention as urethral catheterisation may worsen infection and is contraindicated. In addition to acute urinary retention and prostatic abscess, ABP can lead to sepsis, h.

kongestiver Prostatitis bacterial prostatitis, fistula formation or spread of infection to the spine or sacroiliac joints. Chronic bacterial prostatitis CBP may result from ascending urethral infection, lymphogenous spread of rectal bacteria, hematogenous spread of bacteria from a remote source, undertreated acute bacterial prostatitis or recurrent urinary tract infection with prostatic reflux.

Recognising CBP can be difficult, as the history and examination are highly variable. All patients note some degree of genitourinary pain or discomfort. H. kongestiver Prostatitis presentations include recurrent urinary tract infections with no history of bladder instrumentation, dysuria and frequency with h.

kongestiver Prostatitis other signs of ABP or new onset sexual dysfunction without other aetiology. Often the physical examination, including prostate examination, is normal. Prostate examination should be performed to document any abnormalities such as prostatic calculi, which can serve as a reservoir of infection.

Prostate stones may be difficult to palpate, h. kongestiver Prostatitis if found, may impact management decisions. Although the Meares-Stamey four glass test is the gold standard to diagnose CBP, it is rarely used in practice due to time constraints and the difficulty obtaining samples. More than 20 leucocytes per high powered field on the post-massage urine sample is diagnostic of CBP. Occasionally, Mycoplasma genitalium is found in prostatic secretions, although its role in prostatitis is unclear.

If these tests are also negative, an alternative diagnosis should be considered. Limited comparative trials exist to guide antibiotic regimens for CBP.

Table 1 lists current recommendations. Patients should be warned about the common side effects of extended duration of antibiotic use, such as Achilles tendon rupture with fluoroquinolones. Alpha-blockers may diminish urinary obstruction and reduce future occurrences. If prostatic stones h. kongestiver Prostatitis present, prostatectomy h. kongestiver Prostatitis eliminate the nidus of infection. With the current evidence available, tailoring treatment to individual patient symptom complexes may h.

kongestiver Prostatitis more beneficial than attempting to use one treatment as a curative agent in all individuals. Of the treatments that have been h. kongestiver Prostatitis, alpha-adrenergic receptor blockers and antibiotics used alone or in combination appear to have the greatest improvement in symptom scores when compared with placebo.

Additional studies are needed to determine the role of 5 alpha-reductase inhibitors, glycosaminoglycans, saw palmetto, acupuncture, physical therapy, and pelvic floor training using biofeedback as part of treatment. Other treatments that have proven useful in small studies for targeted symptoms include: phosphodiesterase five inhibitors for sexual dysfunction, 36 cernilton or pollen extract for urinary symptoms, 37 quercetin mg orally twice daily for 30 days for pelvic floor muscle spasm, 38 and fluoxetine 20 mg orally daily h.

kongestiver Prostatitis depression and improved quality of life. Asymptomatic inflammatory prostatitis is, by definition, asymptomatic. It is often diagnosed incidentally during the evaluation of infertility or prostate cancer. Limited research exists to guide the diagnosis and management of these entities, making prostatitis a challenging condition to manage.

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