CC January 2015 Chronic bacterial prostatitis

echoecho's version from 2015-05-14 06:10


Question Answer
Define chronic bacterial prostatitis?a bacterial infection of the prostate that is present for 3 or more months
How may patients present?1. hx of recurrent UTIs 2. fatigue complaints of pain in the groin, testicles or low back pain
Is fever often present?no
Why is urinalysis often negative?because infection is confined to the prostate and may not involve the urine without prostatic manipulation
*** When chronic bacterial prostatitis is suspected, pre- and post-prostatic massage microscopy of the urine should be obtained to determine the presence of what?leukocytes
What 2 types of pre and post prostatic exams are there?2 or 4 glass evaluation
Why is the 4 glass test not frequently done?it is cumbersome, minimally improves diagnostic accuracy
Describe how the 2-glass test is done?pt gives a mid-stream urine sample, stops urinating, undergoes prostatic massage then provides a post-massage urine sample
What is the result in the post-massage urine sample that is highly suggestive of chronic bacterial prostatitis?more than 10 leukocytes per high-power field
Why is urine culture necessary to make the diagnosis?chronic bacterial prostatitis requires the identification of an infecting organism
List 2 common causative baceria?E. coli, Enterococcus
What is the preferred treatment?oral fluoroquinolone x 4-6 weeks when culture confirms active infection
List the second line treatment?oral Bactrim
List the third-line therapy?tetracyclines and macrolides
Why are tetracyclines and macrolides considered third-line therapy?they may not cover common bacterial infections and may not achieve high prostatic tissue penetration, however, if chlamydial or ureaplasmal infection is known, then they are appropriate
In a pt w/ prolonged s/s of pelvic discomfort and a tender prostate, the presence of WBCs in either urine or semen WITH a ___________ (positive vs. negative) culture is indicative of chronic prostatitis / chronic pelvic pain syndrome?negative
Chronic bacterial prostatis can be made in the absence of prostatic WBCs but dx is then often based on what?excluding other chronic pelvic pain etiologies
Does a PSA level help confirm the dx of chronic bacterial prostatitis?no
What imaging test can help confirm the dx of epididymitis?US of testicles, however the pain is often ore localized to the testis and the symptoms are more commonly acute and not chronic
Cystoscopy and CT should be reserved for evaluation of what?chronic lower abdominal and pelvic pain when the search for other disorders has been unsuccessful