Materiały źródłowe

• #1 Prostatitis Diagnosis and treatment

  https://www.racgp.org.au/afp/2013/april/prostatitis

  Prostatitis is a spectrum of disorders that impacts a significant number of men. Understanding the diagnostic and management strategies for each of these entities is critical for general practitioners in caring for their male patients. […] Acute bacterial prostatitis should be considered in the differential diagnosis of any male presenting with urinary tract symptoms. […] Acute bacterial prostatitis can be diagnosed clinically, although both urine Gram stain and urine culture are recommended to identify causative organisms and guide treatment. […] 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. […] Diagnosis requires the patient to have had pelvic pain or urinary symptoms for more than three of the previous 6 months with no evidence of ABP or urinary tract infection in that time.

• #1 Prostatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/prostatitis?lang=us

  Prostatitis refers to an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. Prostatitis is a clinical diagnosis and imaging is useful to evaluate abscess formation. […] The National Institutes of Health (NIH) have classified prostatitis into four distinct syndromes: I: acute bacterial prostatitis, II: chronic bacterial prostatitis, III: chronic prostatitis and chronic pelvic pain syndrome (CPPS) further subclassified as inflammatory or non-inflammatory, IV: asymptomatic inflammatory prostatitis. […] Antibiotics are the mainstay of treatment for bacterial prostatitis. In cases of chronic non-bacterial prostatitis, diuretics and anti-inflammatory medications may be needed instead.

• #1 Prostatitis: Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/prostatitis

  „It is necessary to perform the necessary diagnostic tests to confirm this disease with certainty”. […] „The diagnosis of prostatitis will be made on the basis of medical history, examination, fractionated urine culture, semen culture, ultrasound, blood test (elevated PSA in acute prostatitis) and prostate biopsy in some cases of chronic prostatitis.” […] „Clinically, several prostate syndromes are distinguished that have been grouped into a classification by the US National Institute of Health (NIH Classification) in” […] „Acute Bacterial Prostatitis: Acute infection of the prostate gland.” […] „Chronic Bacterial Prostatitis: Recurrent urinary tract infection. Chronic prostatic infection.” […] „Chronic Bacterial Prostatitis/Chronic Pelvic Pain syndrome: Perineal or pelvic pain (3 months minimum) with variable urinary or sexual symptoms without demonstrated infection.”

• #1 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. […] Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. […] Most cases can be diagnosed with a convincing history and physical examination. […] A convincing history and physical examination are typically sufficient to diagnose acute bacterial prostatitis. […] Physicians should obtain a urinalysis and midstream urine culture to support the clinical diagnosis before administering antibiotics. […] Blood cultures should be collected before initiating antibiotics in patients with a body temperature greater than 101.1F (38.4C), a possible hematogenous source of infection (e.g., endocarditis with Staphylococcus aureus), complicated infections (e.g., sepsis), or who are immunocompromised.

• #1 Prostatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/prostatitis/diagnosis-treatment/drc-20355771

  Imaging tests can show something that isn’t usual in the prostate and growths or other issues in the pelvic region that may be causing pain. […] Your healthcare professional will review your symptoms and medical history with you. Be ready to answer the following questions: […] Have you been diagnosed with bacterial prostatitis or a urinary tract infection in the past? When? […] Did you take all the pills for that infection?

• #1 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Although blood and urine cultures can aid in diagnosis and management, up to 35% of urine cultures in patients with acute prostatitis will fail to grow an organism. […] In men younger than 35 years who are sexually active, and in men older than 35 years who engage in high-risk sexual behavior, a Gram stain of urethral swabs, a culture of urethral discharge, or a DNA amplification test should be obtained to evaluate for N. gonorrhoeae and C. trachomatis. […] The physical examination should include an abdominal examination to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination. […] In a patient with acute bacterial prostatitis, the prostate will often be tender, enlarged, or boggy. […] If there is concern for obstructed voiding, postvoid residual urine volumes should be measured using ultrasonography.

• #1 Prostatitis Workup: Approach Considerations, Urine Studies, Blood Studies

  https://emedicine.medscape.com/article/785418-workup

  Prostate inflammation can lead to elevation of serum prostate-specific antigen (PSA). PSA is used primarily as a cancer screening tool and should not be routinely used for the diagnosis of prostatitis. […] On transrectal ultrasonography, characteristic features of prostatitis are capsular thickening and prostatic calculi. A hypoechoic halo in the periurethral region, a heterogeneous echo pattern, and enlargement and thickening of the septa of the seminal vesicles may be seen. […] Interpretation of transrectal ultrasound is highly subjective and therefore not very reliable for the diagnosis of prostatitis. This study is not routinely indicated in patients with prostatitis, except when prostatic abscess is suspected.

• #1 Prostatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0815/p397.html

  Prostatitis ranges from a straightforward clinical entity in its acute form to a complex, debilitating condition when chronic. […] Diagnosis of acute and chronic bacterial prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage. […] The diagnosis of acute bacterial prostatitis is often based on symptoms alone. […] The diagnosis is based on history and physical examination, a voiding test such as the 2-glass pre- and post-prostatic massage test, and a positive urine culture. […] Evaluation and diagnosis of chronic prostatitis/chronic pelvic pain syndrome can be confusing and challenging for the treating physician. […] In a patient thought to have chronic prostatitis/chronic pelvic pain syndrome, referral to a urologist for diagnosis is warranted. […] The NIH Chronic Prostatitis Symptom Index explores symptoms to establish the diagnosis and determine treatment effect.

• #1 Prostatitis Workup: Approach Considerations, Urine Studies, Blood Studies

  https://emedicine.medscape.com/article/785418-workup

  Urinalysis and urine culture can confirm the presence of infection and identify pathogens. Fractional urine studies (urethral and bladder urine) and cytology of expressed prostatic secretions can help differentiate prostatitis from urethritis and cystitis. Further studies may be indicated in patients with possible complications (eg, urinary tract obstruction). There is no gold-standard diagnostic test for chronic abacterial prostatitis. […] A urine culture can be used to identify the causative organism, if any. Escherichia coli is the pathogen most often identified on positive cultures. […] Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture. […] The use of fractional urine specimens may be useful in the diagnosis of prostatitis. […] Chronic bacterial prostatitis can be diagnosed if the culture of the EPS and V3 samples produce the same bacteria as the first-voided specimen and the colony count of the 2 cultures is at least 10 times as great as the first-void specimen.

• #1 Acute Bacterial Prostatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459257/

  At a minimum, once ABP is suspected based on history and physical examination, the patient should be evaluated with midstream urinalysis and urine culture. […] Diagnosis of chronic prostatitis is best performed by a specialist utilizing either the Meares and Stamey four-glass test or the simpler two-glass pre-massage and post-massage test and possibly semen sample with culture and urodynamic studies. […] Management of acute bacterial prostatitis (ABP) involves both choosing appropriate spectrum antibiotics that have good prostate tissue penetration and managing the complications and sequelae of the disease. […] Treatment of CBP should be guided by culture results and should be done with antibiotics that achieve therapeutic prostate concentrates, as initiating antibiotic treatment emergently is not warranted and can wait on culture results.

• #1 Prostate Infection Symptoms, Causes, Treatment & Signs

  https://www.emedicinehealth.com/prostate_infections/article_em.htm

  One of two tests are sometimes performed to help with the diagnosis: […] The classic test is a Meares-Stamey 3-glass test. […] Men with recurrent urinary tract infections should have ultrasound imaging of their upper urinary tract and a plain abdominal X-ray or an intravenous urography (IVU) to exclude a possible structural problem or a kidney stone. […] The role of antibiotics is unclear in chronic bacterial prostatitis, but because prostate infections often go unnoticed, doctors may often try antibiotics to help stop the infection. […] Follow-up is very important to make sure the infection has cleared up. […] The prognosis for acute bacterial prostatic infections is usually good if treated appropriately with effective antibiotics. The prognosis for chronic bacterial prostatic infections is less or only fair because the recurrent disease is difficult to cure, and the cure rate is less than the acute type.

• #1

  https://bpac.org.nz/2023/prostatitis.aspx

  Symptoms include pelvic, perineal and genitourinary pain, lower urinary tract symptoms and sexual dysfunction; diagnostic criteria require symptoms to be present for at least three of the previous six months, in the absence of infection. […] Diagnosing chronic bacterial prostatitis can be challenging. […] The presence and severity of symptoms varies, although they are often milder than seen in acute bacterial prostatitis, and people can be asymptomatic between episodes. […] Making the diagnosis: Consider CP/CPPS in a patient if pelvic or genitourinary pain has been present for at least three of the past six months and urine culture results are negative (ruling out chronic bacterial prostatitis).

• #1 Chronic pelvic pain and prostatitis: symptoms, diagnosis and treatment | Nursing Times

  https://www.nursingtimes.net/pain-management/chronic-pelvic-pain-and-prostatitis-symptoms-diagnosis-and-treatment-18-04-2017/

  Chronic pelvic pain syndrome and chronic prostatitis are long-term conditions in men. […] This article gives an overview of these two related and overlapping conditions, explains how to assess patients and diagnose, and presents the various treatment approaches. […] Clinical diagnosis of CPPS and/or chronic prostatitis relies on patient history and physical examination. Various investigations are conducted to detect signs and exclude other pathologies. […] Patients are normally assessed using the Chronic Prostatitis Symptom Index of the US National Institutes of Health, which scores issues relating to pain, voiding and quality of life. […] If CPPS and/or chronic prostatitis is suspected, examination of the abdomen and external genitalia and a digital rectal examination should be performed.

• #1 Prostatitis Diagnosis and treatment

  https://www.racgp.org.au/afp/2013/april/prostatitis

  Chronic prostatitis/chronic pelvic pain syndrome is a diagnosis of exclusion and laboratory or imaging studies are indicated to rule out other potential causes of symptoms. […] A diagnosis of prostatitis encompasses a spectrum of disease: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic prostatitis have varying clinical significance, causative agents, treatment strategies and long-term prognosis. […] Limited research exists to guide the diagnosis and management of these entities, making prostatitis a challenging condition to manage.

• #1 Prostatitis – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/prostatitis

  For patients with types II, III, and IV (nonacute prostatitis) disease, additional tests that can be considered are cystoscopy and urine cytology (if hematuria is also present) and urodynamic measurements (if there is suspicion of neurologic abnormalities or detrusor-sphincter dyssynergia). […] Hospitalize patients who have acute bacterial prostatitis and systemic symptoms that suggest sepsis and give broad-spectrum antibiotics such as ampicillin plus gentamicin. […] For men with chronic prostatitis or chronic pelvic pain syndrome, follow algorithms for chronic pelvic pain, which include anxiolytics (eg, SSRIs, benzodiazepines), sacral nerve stimulation, biofeedback, pelvic floor physical therapy, pain management with gabapentin or amitriptyline, prostatic massage, and minimally invasive prostatic procedures (eg, microwave thermotherapy).

• #1 Prostatitis laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Prostatitis_laboratory_findings

  Laboratory tests used in the diagnosis of prostatitis may include a CBC, urinalysis, serum PSA (prostate-specific antigen) level, urine culture, postvoid residual volume levels, 2-glass pre- and post-prostatic massage test, Stamey-Meares four-glass test, and a semen analysis. […] Laboratory findings consistent with the diagnosis of acute prostatitis include increased leukocytes on CBC, bacteria seen on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels. […] Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include negative pre-massage urine culture results, more than 10 to 20 leukocytes per high-power field in both the pre- and the postmassage urine specimen, bacteriuria in the postmassage urine specimen, and lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions.

• #1 Prostatitis tests | Prostate Cancer UK

  https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/other-prostate-problems/prostatitis-tests

  They may also do some further tests ask your doctor for more information about these. […] It is usually picked up by chance when you’re having tests for other conditions, such as enlarged prostate. […] You might be offered a PSA blood test if your GP is checking for other possible prostate problems, such as an enlarged prostate or prostate cancer. […] A raised PSA level can be a sign of a problem with your prostate, such as an enlarged prostate, prostate cancer, or prostatitis. […] If your GP thinks you may have another prostate problem they will avoid testing your PSA while you have prostatitis symptoms. […] There is some research to suggest that men with inflammation in their prostate might be more likely to get prostate cancer. […] If you have prostatitis and youre worried about getting prostate cancer, talk to your GP or hospital doctor or speak to our Specialist Nurses.

• #1 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Prostate-specific antigen (PSA) levels are not indicated in the workup of acute bacterial prostatitis. […] The duration of antibiotic therapy for mild infections is typically 10 to 14 days (with a two-week extension if the patient remains symptomatic), or four weeks for severe infections. […] Repeat urine cultures should be obtained one week after cessation of antibiotics to ensure bacterial clearance.

• #1 Prostatitis Differential Diagnoses

  https://emedicine.medscape.com/article/785418-differential

  The differential diagnosis of prostatitis is based on the history, physical examination findings, and, frequently, analysis of expressed prostatic secretions. […] Absence of systemic symptoms and persistence of pain for at least 3 months indicate chronic prostatitis rather than acute disease. […] Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.

• #1 Prostatitis tests | Prostate Cancer UK

  https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/other-prostate-problems/prostatitis-tests

  There are a number of tests that can be used to find out whether you have prostatitis. It can take some time to get a diagnosis – the symptoms of prostatitis can be similar to other problems such as urine infections, which can make it difficult to diagnose. […] This booklet describes the causes, symptoms, diagnosis and treatment of prostatitis. […] Your doctor will need to rule out other possible causes of your symptoms before they make a diagnosis. This can take some time. […] Youll need to have a urine test to make sure you dont have a urine infection or a sexually transmitted disease. […] You might also need a blood test. […] You might also be offered an MRI (magnetic resonance imaging) scan or an ultrasound scan to check if you have a prostate abscess. […] They will then try to rule out other problems that could be causing your symptoms.

• #1 A Better Path to Diagnosing Prostatitis – Sperling Prostate Center

  https://sperlingprostatecenter.com/new-hope-diagnosing-treating-prostatitis/

  Diagnosing Prostatitis at Sperling Prostate CenterDiagnosing Prostatitis at Sperling Prostate Center […] Prostatitis can defy accurate diagnosis. It overlaps with other prostate conditions. One of the most common tests, a basic urinalysis, fails to detect 85% of bacteria strains that can cause prostatitis. […] If results are inconclusive, a diagnosis of Chronic Pelvic Pain Syndrome (CPPS) is often assigned, especially if pain or urinary symptoms have been present for 3 of the previous 6 months. […] It is the most difficult to diagnose accurately. Antibiotic treatment is not effective. […] A targeted in-bore mpMRI-guided biopsy using minimal needles can be done to rule out prostate cancer. […] When standard tests fail to determine a specific source of infection, the Sperling Prostate Center offers a new advanced urine test that picks up organisms missed by other tests.

• #1 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  Clinicians should consider the diagnosis of CP/CPPS in patients who experience chronic perineal pain, bilateral scrotal content pain, penile pain, suprapubic pain, dysuria, or pain with ejaculation. (Expert Opinion) […] Clinicians should consider the diagnosis of CSCP in patients who experienced unilateral chronic scrotal pain in the absence of other pelvic sites of pain or urinary symptoms. (Expert Opinion) […] Clinicians may utilize cystoscopy, urodynamics, and/or imaging when the diagnosis is unclear. (Clinical Principle) […] Clinicians should periodically reassess efficacy of treatment and discontinue ineffective treatments. The clinical diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. (Clinical Principle) […] Treatment decisions should be made based on shared decision-making between the patient and clinician, with the patient informed of the risks, potential benefits, and treatment alternatives. Initial treatment should typically be nonsurgical. (Clinical Principle)

• #1 Chronic Prostatitis: Diagnosis and Treatment Unclearlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/jw200009260000001/2000/09/26/chronic-prostatitis-diagnosis-and-treatment

  Chronic bacterial and abacterial prostatitis, benign prostatic hypertrophy, and pelvic pain syndrome in men are difficult to diagnose and easily can be confused with one another. […] Yet, selecting successful treatments for these conditions — for example, antibiotics or agents to relieve bladder outlet obstruction — depends at least in part on accurate diagnosis. […] In general, the 19 diagnosis studies and 14 treatment studies identified were small and of low methodologic quality. […] No reference standard for clinical testing could be identified, although the use of pre- and post-prostatic massage urine specimens was 91 percent sensitive and specific for prostatitis when compared with the commonly used 4-sample test (initial, midstream, and post-massage urine specimens plus a post-massage prostatic secretion sample). […] However, neither these features nor ultrasonography were adequate to diagnose abacterial prostatitis. […] Clearly, high-quality research is needed for physicians to better understand diagnosis and treatment of chronic abacterial prostatitis.

• #1 Get Prostatitis Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/prostatitis-treatment

  Your first visit with us begins with a conversation. […] Your provider will also test your urine and do a blood test to check for PSA, a protein the prostate gland makes. […] Youll also have a prostate exam, where your provider will check for swelling and pain. […] We may also do some other tests to confirm a prostatitis diagnosis, like: […] If you choose Cleveland Clinic for prostatitis diagnosis and treatment, youll benefit from our team approach to care. […] Well use your test results and the type of prostatitis you have to craft your personalized treatment plan. […] Treatments for prostatitis may include: […] Prostatitis shouldnt derail your life. […] Its a common problem thats treatable. […] But since there are different types of prostatitis, it can be confusing and challenging to diagnose and treat. […] Finding healthcare providers who understand how to diagnose and treat all of the prostatitis conditions is key. […] Cleveland Clinic providers know there isnt a one-size-fits-all solution.

• #2 Prostatitis Diagnosis & Treatment – NYC | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/urology/our-services/urinary-disorders/conditions-we-treat/prostatitis

  Prostatitis, an inflammation or infection of the prostate gland, is a common and usually painful condition that can affect men of all ages. […] Prostatitis is the most common condition urologists deal with in men under 50 years of age, but it is one of the most challenging conditions to diagnose and manage. […] As part of the evaluation, patients undergo a history and physical exam, including a digital rectal exam, and blood and urine tests. Doctors may examine the bladder and prostate with a cystoscope (a long flexible telescope that is inserted through the urethra), and use radiographic tests such as ultrasound, CT, and MRI to rule out other causes of pain. […] A complete evaluation can rule out other problems with similar symptoms.

• #2

  https://bpac.org.nz/2023/prostatitis.aspx

  Prostatitis can be categorised into four distinct conditions: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis. […] Acute bacterial prostatitis is characterised by the rapid onset of pelvic or genitourinary pain and lower urinary tract symptoms; prompt recognition and antibiotic treatment is essential to avoid complications, e.g. sepsis. […] Chronic bacterial prostatitis is characterised by persistent infection causing intermittent genitourinary pain and ongoing lower urinary tract symptoms lasting for three months or longer, with evidence of bacterial infection. […] CP/CPPS is the most prevalent form of prostatitis, and is diagnosed by excluding other genitourinary conditions.

• #2 Prostatitis: Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/prostatitis

  „Chronic inflammatory pelvic pain syndrome (leukocytes in semen, post-massage prostatic secretion or post-massage urination)” […] „Non-inflammatory chronic pelvic pain syndrome (no white blood cells in semen, post-massage prostatic secretion or post-massage urination).” […] „Asymptomatic inflammatory prostatitis: Evidence of inflammation in biopsy, semen, post-massage prostatic secretion or post-massage urination in the absence of symptoms.”

• #2 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. […] Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. […] Most cases can be diagnosed with a convincing history and physical examination. […] A convincing history and physical examination are typically sufficient to diagnose acute bacterial prostatitis. […] Physicians should obtain a urinalysis and midstream urine culture to support the clinical diagnosis before administering antibiotics. […] Blood cultures should be collected before initiating antibiotics in patients with a body temperature greater than 101.1F (38.4C), a possible hematogenous source of infection (e.g., endocarditis with Staphylococcus aureus), complicated infections (e.g., sepsis), or who are immunocompromised.

• #2 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Although blood and urine cultures can aid in diagnosis and management, up to 35% of urine cultures in patients with acute prostatitis will fail to grow an organism. […] In men younger than 35 years who are sexually active, and in men older than 35 years who engage in high-risk sexual behavior, a Gram stain of urethral swabs, a culture of urethral discharge, or a DNA amplification test should be obtained to evaluate for N. gonorrhoeae and C. trachomatis. […] The physical examination should include an abdominal examination to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination. […] In a patient with acute bacterial prostatitis, the prostate will often be tender, enlarged, or boggy. […] If there is concern for obstructed voiding, postvoid residual urine volumes should be measured using ultrasonography.

• #2 Acute Bacterial Prostatitis: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/26926407/

  Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. […] Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. […] Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern.

• #2 Prostatitis: ED Presentation, Evaluation, Management, and Complications – emDocs

  https://www.emdocs.net/prostatitis-ed-presentation-evaluation-management-and-complications/

  Although not definitely needed to clinch the diagnosis, patients may have leukocytosis and elevated inflammatory markers such as ESR or CRP. No quantitative studies currently exist evaluating their role in diagnosing acute bacterial prostatitis. Urinalysis may be remarkable for bacteria and pyuria. Mid-stream urine culture results along with gram stain are also helpful to determine the responsible microbe. […] Bottom Line: Prostatitis is a clinical diagnosis! UA and urine culture may be negative, so be sure to consider the bigger clinical picture. […] Imaging studies are not typically needed unless there is a high suspicion for prostatic abscess or the patient is high risk, with ultrasound and CT being potential imaging modalities. Transrectal ultrasound is recommended first-line as a common and inexpensive imaging modality compared to other imaging alternatives, with a sensitivity of 80-100% for prostatic abscesses. […] Prostatitis can be tricky to diagnosis, but complete a focused but thorough history and exam. The key to diagnosis is considering the disease. Tenderness on DRE helps to make the definitive diagnosis of prostatitis.

• #2 Prostatitis Diagnosis and treatment

  https://www.racgp.org.au/afp/2013/april/prostatitis

  Prostatitis is a spectrum of disorders that impacts a significant number of men. Understanding the diagnostic and management strategies for each of these entities is critical for general practitioners in caring for their male patients. […] Acute bacterial prostatitis should be considered in the differential diagnosis of any male presenting with urinary tract symptoms. […] Acute bacterial prostatitis can be diagnosed clinically, although both urine Gram stain and urine culture are recommended to identify causative organisms and guide treatment. […] 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. […] Diagnosis requires the patient to have had pelvic pain or urinary symptoms for more than three of the previous 6 months with no evidence of ABP or urinary tract infection in that time.

• #2 Prostatitis: etiology and diagnosis – Culture; Identification; Molecular diagnosis (PCR). – IVAMI

  https://www.ivami.com/en/clinical-microbiology/2998-prostatitis-etiology-and-diagnosis-crops-id-molecular-diagnosis-pcr

  Chronic bacterial prostatitis is diagnosed if the cultivation of EPS samples and M3 are the same bacteria as the first voided urine (M1), and counting colonies of the two crops (EPS and M3) is at least 10 times the first voided urine (M1). […] Urinalysis and culture can confirm the presence of infection and identify pathogens. […] Fractionated samples of urine, may be useful for the diagnosis of prostatitis. […] The bacteria found in the sample of the prostate expression (EPS) and (M3) represent the microbiological characteristics of the prostate gland. […] In acute bacterial prostatitis, with signs of severe disease, sepsis evidence, or both, require hospitalization for intravenous antibiotics as broad – spectrum penicillins, third generation cephalosporins, aminoglycosides with or without, or fluoroquinolones. […] When no signs of gravity, outpatient therapy can be made 14 to 28 days of oral treatment generally fluoroquinolone or trimethoprim-sulfamethoxazole, for good proststica diffusion both fluoroquinolones such as trimethoprim or doxycycline or erythromycin for 2 to 3 weeks.

• #2 Prostatitis (Types, Diagnosis, and Treatment)

  https://patient.info/doctor/prostatitis

  Prostatitis investigations: If the patient is toxic and septicaemia is possible then FBC, UE and creatinine are required along with blood cultures. […] In acute bacterial prostatitis, diagnosis is made on urine culture. There is also microscopy for white blood cell count and bacterial count along with presence of oval fat bodies and lipid-laden macrophages. […] Diagnostic criteria for this condition include: Symptoms suggestive of prostatitis (eg, pelvic discomfort or pain) lasting for more than three months. […] Negative cultures of urine and prostatic fluid. […] In the inflammatory type, leukocytes are present in prostatic fluid. […] In the non-inflammatory type, no leukocytes are present in prostatic fluid.

• #2 Prostatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0815/p397.html

  Prostatitis ranges from a straightforward clinical entity in its acute form to a complex, debilitating condition when chronic. […] Diagnosis of acute and chronic bacterial prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage. […] The diagnosis of acute bacterial prostatitis is often based on symptoms alone. […] The diagnosis is based on history and physical examination, a voiding test such as the 2-glass pre- and post-prostatic massage test, and a positive urine culture. […] Evaluation and diagnosis of chronic prostatitis/chronic pelvic pain syndrome can be confusing and challenging for the treating physician. […] In a patient thought to have chronic prostatitis/chronic pelvic pain syndrome, referral to a urologist for diagnosis is warranted. […] The NIH Chronic Prostatitis Symptom Index explores symptoms to establish the diagnosis and determine treatment effect.

• #2 Chronic prostatitis: A diagnosis of exclusion – Uroweb

  https://uroweb.org/news/chronic-prostatitis-a-diagnosis-of-exclusion

  This guideline advises the use of the term Primary prostatic pain syndrome (PPPS) as a pain syndrome that can be triggered regularly and recurrently, among other things, by palpation of the prostate. […] In essence, PPPS is a diagnosis of exclusion. Therefore, other curable causes such as bacterial infections, BPS or a tumour must be excluded during the diagnostic process. […] First, it is important to take a detailed medical history. […] The diagnostic process can then be adapted to the individual patient. […] The EAU guidelines recommend antibiotics for patients in the first year of the disease. […] The main purpose of the diagnosis is to rule out causally treatable diseases.

• #2 Prostatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/prostatitis/

  Bacterial prostatitis is a clinical diagnosis based on history and physical examination, including digital rectal examination (DRE). […] Obtain urine studies to support the diagnosis and identify the causative pathogen. […] Consult urology as needed for specific diagnostic tests (e.g., fractional urine examination). […] Urinalysis (midstream urine); may show characteristic urinalysis findings of UTI (e.g., WBC). […] Urine culture: E. coli is most common pathogen (approx. 80% of cases). […] CPPS is a diagnosis of exclusion. […] Evaluate for bacterial prostatitis. […] Consult urology for further testing, e.g.: CPPS-specific assessments, imaging (e.g., transrectal ultrasound, pelvic CT and/or MRI), semen culture and analysis, urodynamic studies, cystoscopy.

• #2 Acute prostatitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/172

  Acute prostatitis is the most frequent urologic diagnosis in men 50 years old. […] Acute prostatitis is a painful inflammation within the prostate that is usually accompanied by evidence of recent or ongoing bacterial infection. Its hallmark is the acute onset of lower urinary tract symptoms (e.g., dysuria, urinary frequency, perineal discomfort) accompanied by variable systemic signs of fever, chills, and malaise. […] Key diagnostic factors include fever, chills, malaise and tender prostate. […] Other diagnostic factors include age 50 years, urinary frequency, dysuria, diminished urinary stream, perineal pain, warm or soft, boggy gland, indwelling urinary catheter, recent transrectal prostate biopsy, and recent transurethral surgery. […] 1st investigations to order include urinalysis, urine culture, and blood cultures. […] Investigations to avoid include prostatic biopsy and serum prostate-specific antigen (PSA). […] Investigations to consider include transrectal ultrasound and 4-glass or 2-glass test.

• #2 Prostatitis Differential Diagnoses

  https://emedicine.medscape.com/article/785418-differential

  The differential diagnosis of prostatitis is based on the history, physical examination findings, and, frequently, analysis of expressed prostatic secretions. […] Absence of systemic symptoms and persistence of pain for at least 3 months indicate chronic prostatitis rather than acute disease. […] Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.

• #2 A Better Path to Diagnosing Prostatitis – Sperling Prostate Center

  https://sperlingprostatecenter.com/new-hope-diagnosing-treating-prostatitis/

  CPPS is short for Chronic Pelvic Pain Syndrome. Prostatitis is often associated with CPPS, even though prostatitis may not be the culprit. […] In an effort to arrive at better diagnostic precision, researchers have developed a 6-category system that covers all possible bases. […] We strongly recommend a baseline multiparametric MRI (mpMRI) as soon as possible to visually identify and characterize the prostate and surrounding tissues. […] Our unparalleled imaging and expert readers can detect even subtle tissue changes that indicate prostatitis-related inflammation, making it a superior diagnostic tool for those who may be suffering from prostatitis.

• #2 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  Clinicians may utilize a multimodal and multidisciplinary approach to pain management. If pain control is inadequate, referral to pain management should be discussed. (Clinical Principle) […] Clinicians should encourage patients expressing significant distress secondary to chronic pelvic pain to seek treatment for mental health needs and discuss family, spousal, and/or local support systems. (Clinical Principle) […] In patients with CP/CPPS, clinicians may offer cognitive behavioral therapy as an adjunct to other therapeutic interventions. (Conditional Recommendation; Evidence Level: Grade C) […] In patients with CP/CPPS, clinicians should discuss lifestyle modification, including dietary changes and aerobic exercise. (Conditional Recommendation; Evidence Level: Grade C) […] In patients with CP/CPPS and voiding symptoms, clinicians should offer treatment with an alpha-blocker. (Moderate Recommendation; Evidence Level: Grade B)

• #3 Acute prostatitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/172

  Acute prostatitis is the most frequent urological diagnosis in men 50 years old. […] Commonly caused by Escherichia coli bacteria. […] Can cause extreme lower abdominal, ejaculatory, rectal, and perineal pain. […] May be successfully treated with antibiotics, but a prolonged course is frequently required if chronic prostatitis follows the acute occurrence. […] Acute prostatitis is a painful inflammation within the prostate that is usually accompanied by evidence of recent or ongoing bacterial infection. […] Its hallmark is the acute onset of lower urinary tract symptoms (e.g., dysuria, urinary frequency, perineal discomfort) accompanied by variable systemic signs of fever, chills, and malaise. […] Key diagnostic factors include presence of risk factors, fever, chills, malaise, and tender prostate.

• #3 Diagnosis and Tests for Prostate Diseases | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/prostate-diseases/tests

  A healthcare provider will diagnose prostatitis by asking about symptoms and medical history. Tests the provider may do include: […] A urine sample can show a possible urinary tract infection. […] Blood tests may be done to check for other signs of infection or prostate disease. […] The healthcare provider inserts a finger into the rectum to see if the prostate is swollen or tender. However, this test can be harmful if a man does have prostatitis. It can cause bacteremia (a serious blood infection). […] A CT or ultrasound scan may be done to see the prostate.

• #3 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. […] Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. […] Most cases can be diagnosed with a convincing history and physical examination. […] A convincing history and physical examination are typically sufficient to diagnose acute bacterial prostatitis. […] Physicians should obtain a urinalysis and midstream urine culture to support the clinical diagnosis before administering antibiotics. […] Blood cultures should be collected before initiating antibiotics in patients with a body temperature greater than 101.1F (38.4C), a possible hematogenous source of infection (e.g., endocarditis with Staphylococcus aureus), complicated infections (e.g., sepsis), or who are immunocompromised.

• #3

  https://bpac.org.nz/2023/prostatitis.aspx

  Prostatitis can be categorised into four distinct conditions: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis. […] Acute bacterial prostatitis is characterised by the rapid onset of pelvic or genitourinary pain and lower urinary tract symptoms; prompt recognition and antibiotic treatment is essential to avoid complications, e.g. sepsis. […] Chronic bacterial prostatitis is characterised by persistent infection causing intermittent genitourinary pain and ongoing lower urinary tract symptoms lasting for three months or longer, with evidence of bacterial infection. […] CP/CPPS is the most prevalent form of prostatitis, and is diagnosed by excluding other genitourinary conditions.

• #3 Prostatitis (Types, Diagnosis, and Treatment)

  https://patient.info/doctor/prostatitis

  Prostatitis investigations: If the patient is toxic and septicaemia is possible then FBC, UE and creatinine are required along with blood cultures. […] In acute bacterial prostatitis, diagnosis is made on urine culture. There is also microscopy for white blood cell count and bacterial count along with presence of oval fat bodies and lipid-laden macrophages. […] Diagnostic criteria for this condition include: Symptoms suggestive of prostatitis (eg, pelvic discomfort or pain) lasting for more than three months. […] Negative cultures of urine and prostatic fluid. […] In the inflammatory type, leukocytes are present in prostatic fluid. […] In the non-inflammatory type, no leukocytes are present in prostatic fluid.

• #3 Prostatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0815/p397.html

  Prostatitis ranges from a straightforward clinical entity in its acute form to a complex, debilitating condition when chronic. […] Diagnosis of acute and chronic bacterial prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage. […] The diagnosis of acute bacterial prostatitis is often based on symptoms alone. […] The diagnosis is based on history and physical examination, a voiding test such as the 2-glass pre- and post-prostatic massage test, and a positive urine culture. […] Evaluation and diagnosis of chronic prostatitis/chronic pelvic pain syndrome can be confusing and challenging for the treating physician. […] In a patient thought to have chronic prostatitis/chronic pelvic pain syndrome, referral to a urologist for diagnosis is warranted. […] The NIH Chronic Prostatitis Symptom Index explores symptoms to establish the diagnosis and determine treatment effect.

• #3 Prostatitis Diagnosis & Treatment – NYC | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/urology/our-services/urinary-disorders/conditions-we-treat/prostatitis

  Prostatitis, an inflammation or infection of the prostate gland, is a common and usually painful condition that can affect men of all ages. […] Prostatitis is the most common condition urologists deal with in men under 50 years of age, but it is one of the most challenging conditions to diagnose and manage. […] As part of the evaluation, patients undergo a history and physical exam, including a digital rectal exam, and blood and urine tests. Doctors may examine the bladder and prostate with a cystoscope (a long flexible telescope that is inserted through the urethra), and use radiographic tests such as ultrasound, CT, and MRI to rule out other causes of pain. […] A complete evaluation can rule out other problems with similar symptoms.

• #3 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  Clinicians may utilize a multimodal and multidisciplinary approach to pain management. If pain control is inadequate, referral to pain management should be discussed. (Clinical Principle) […] Clinicians should encourage patients expressing significant distress secondary to chronic pelvic pain to seek treatment for mental health needs and discuss family, spousal, and/or local support systems. (Clinical Principle) […] In patients with CP/CPPS, clinicians may offer cognitive behavioral therapy as an adjunct to other therapeutic interventions. (Conditional Recommendation; Evidence Level: Grade C) […] In patients with CP/CPPS, clinicians should discuss lifestyle modification, including dietary changes and aerobic exercise. (Conditional Recommendation; Evidence Level: Grade C) […] In patients with CP/CPPS and voiding symptoms, clinicians should offer treatment with an alpha-blocker. (Moderate Recommendation; Evidence Level: Grade B)

• #4 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Although blood and urine cultures can aid in diagnosis and management, up to 35% of urine cultures in patients with acute prostatitis will fail to grow an organism. […] In men younger than 35 years who are sexually active, and in men older than 35 years who engage in high-risk sexual behavior, a Gram stain of urethral swabs, a culture of urethral discharge, or a DNA amplification test should be obtained to evaluate for N. gonorrhoeae and C. trachomatis. […] The physical examination should include an abdominal examination to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination. […] In a patient with acute bacterial prostatitis, the prostate will often be tender, enlarged, or boggy. […] If there is concern for obstructed voiding, postvoid residual urine volumes should be measured using ultrasonography.

• #4

  https://bpac.org.nz/2023/prostatitis.aspx

  Prostatitis can be categorised into four distinct conditions: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis. […] Acute bacterial prostatitis is characterised by the rapid onset of pelvic or genitourinary pain and lower urinary tract symptoms; prompt recognition and antibiotic treatment is essential to avoid complications, e.g. sepsis. […] Chronic bacterial prostatitis is characterised by persistent infection causing intermittent genitourinary pain and ongoing lower urinary tract symptoms lasting for three months or longer, with evidence of bacterial infection. […] CP/CPPS is the most prevalent form of prostatitis, and is diagnosed by excluding other genitourinary conditions.

• #4 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  Clinicians may prescribe 5-alpha reductase inhibitors to patients with CP/CPPS who also have voiding symptoms from BPH or enlarged prostate as determined by imaging or PSA level. (Expert Opinion) […] Clinicians may prescribe anti-inflammatory agents as part of a multi-modal pain management strategy for treatment of pain in patients with CP/CPPS. (Conditional Recommendation; Evidence Level: Grade B) […] Clinicians may prescribe daily tadalafil for treatment of prostatitis symptoms in patients with CP/CPPS with or without concomitant erectile dysfunction. (Conditional Recommendation; Evidence Level: Grade B) […] Clinicians may offer transcutaneous electrical nerve stimulation for pain control in patients with CP/CPPS. (Conditional Recommendation; Evidence Level: Grade B) […] Clinicians may offer acupuncture to patients with CP/CPPS. (Conditional Recommendation; Evidence Level: Grade B)

• #5 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Although blood and urine cultures can aid in diagnosis and management, up to 35% of urine cultures in patients with acute prostatitis will fail to grow an organism. […] In men younger than 35 years who are sexually active, and in men older than 35 years who engage in high-risk sexual behavior, a Gram stain of urethral swabs, a culture of urethral discharge, or a DNA amplification test should be obtained to evaluate for N. gonorrhoeae and C. trachomatis. […] The physical examination should include an abdominal examination to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination. […] In a patient with acute bacterial prostatitis, the prostate will often be tender, enlarged, or boggy. […] If there is concern for obstructed voiding, postvoid residual urine volumes should be measured using ultrasonography.

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