eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Prostatitis, Bacterial: Follow-up

Author: Joe D Mobley III, MD, MPH, Chief Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center
Coauthor(s): Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Contributor Information and Disclosures

Updated: Oct 8, 2009

Follow-up

Further Outpatient Care

  • After completion of a 4-week course of a fluoroquinolone or TMP-SMZ, repeating a culture is advisable. The recurrent and persistent nature of chronic bacterial prostatitis encourages efforts for eradication confirmed by negative results on bacterial cultures.
  • Persistent bacterial growth should be treated with another 4-week trial of antibiotics. Repeat susceptibility testing is necessary.
  • A final option for chronic bacterial prostatitis that is recalcitrant to the above therapies is long-term antibiotic suppression in an effort to prevent recurrent cystitis.

Complications

A recent retrospective study has suggested a relationship between the severity of chronic prostatitis symptoms and erectile dysfunction frequency. Whether this relationship is mediated through organic or psychologic mechanisms remains unclear, and further studies to investigate this relationship would be helpful.13

Prognosis

  • A 4- to 6-week course of TMP-SMZ results in 33-50% bacteriologic cure rates.
  • A 4- to 6-week course of fluoroquinolone therapy is equally successful as, if not more successful than, TMP-SMX. Weidner et al (1991) reported a 63% durable response rate at 30 months after treatment.14

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Acute bacterial prostatitis is an uncommon, but potentially life-threatening, type of prostatitis. It is characterized by high fever, chills, malaise, and myalgias, in addition to voiding symptoms. EPS should not be obtained in acute bacterial prostatitis because of the risk of potentiating bacteremia. Acute bacterial prostatitis represents a potentially lethal process if untreated.
 


More on Prostatitis, Bacterial

Overview: Prostatitis, Bacterial
Differential Diagnoses & Workup: Prostatitis, Bacterial
Treatment & Medication: Prostatitis, Bacterial
Follow-up: Prostatitis, Bacterial
Multimedia: Prostatitis, Bacterial
References
Further Reading
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References

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  2. Wood HM, Shoskes DA. The role of nanobacteria in urologic disease. World J Urol. Feb 2006;24(1):51-4. [Medline].

  3. NIH Summary Statement. NIDDK Workshop on Chronic Prostatitis, Bethesda, Md. December 1995.

  4. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. Mar 1968;5(5):492-518. [Medline].

  5. Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications. Asian J Androl. Jul 2009;11(4):461-77. [Medline].

  6. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. Mar 1998;159(3):883-7. [Medline].

  7. Paulson DF, White RD. Trimethoprium-sulfamethoxazole and minocycline- hydrochloride in the treatment of culture-proved bacterial prostatitis. J Urol. Aug 1978;120(2):184-5. [Medline].

  8. Sohn DW, Han CH, Jung YS, Kim SI, Kim SW, Cho YH. Anti-inflammatory and antimicrobial effects of garlic and synergistic effect between garlic and ciprofloxacin in a chronic bacterial prostatitis rat model. Int J Antimicrob Agents. Sep 2009;34(3):215-9. [Medline].

  9. Meares ET. Chronic bacterial prostatitis: role of transurethral prostatectomy (TURP) in therapy. In: Schmiedt E, Alken JE, Bauer HW, eds. Therapy of prostatitis. Munich, Germany: Zuckerschwerdt Verlag; 1986:193-197.

  10. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84. [Medline].

  11. Plomp TA, Baert L, Maes RA. Treatment of recurrent chronic bacterial prostatitis by local injection of thiamphenicol into prostate. Urology. Jun 1980;15(6):542-7. [Medline].

  12. Jiménez-Cruz JF, Tormo FB, Gómez JG. Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control. J Urol. May 1988;139(5):967-70. [Medline].

  13. Magri V, Perletti G, Montanari E, Marras E, Chiaffarino F, Parazzini F. Chronic prostatitis and erectile dysfunction: results from a cross-sectional study. Arch Ital Urol Androl. Dec 2008;80(4):172-5. [Medline].

  14. Weidner W, Schiefer HG, Brahler E. Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median followup of 30 months. J Urol. Aug 1991;146(2):350-2. [Medline].

  15. Bjerklund Johansen TE, Grüneberg RN, Guibert J, Hofstetter A, Lobel B, Naber KG, et al. The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol. Dec 1998;34(6):457-66. [Medline].

  16. Budía A, Luis Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. 2006;40(4):326-31. [Medline].

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  26. Pansadoro V, Emiliozzi P, Defidio L, Scarpone P, Sabatini G, Brisciani A, et al. Prostate-specific antigen and prostatitis in men under fifty. Eur Urol. 1996;30(1):24-7. [Medline].

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  28. Shoskes DA, Katz E. Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. Jul 2005;6(4):296-9. [Medline].

  29. Shoskes DA, Thomas KD, Gomez E. Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol. Feb 2005;173(2):474-7. [Medline].

  30. Stamey TA, Meares EM Jr, Winningham DG. Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol. Feb 1970;103(2):187-94. [Medline].

  31. Wagenlehner FM, Naber KG. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Urol Rep. Aug 2004;5(4):309-16. [Medline].

  32. Wiygul RD. Prostatitis: epidemiology of inflammation. Curr Urol Rep. Jul 2005;6(4):282-9. [Medline].

  33. Wright ET, Chmiel JS, Grayhack JT, Schaeffer AJ. Prostatic fluid inflammation in prostatitis. J Urol. Dec 1994;152(6 Pt 2):2300-3. [Medline].

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Further Reading

For additional information, see Medscape’s Prostatitis Resource Center.

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Keywords

chronic urinary tract infections, UTI, acute bacterial prostatitis, chronic bacterial prostatitis, chronic abacterial prostatitis, asymptomatic inflammatory prostatitis, nonbacterial prostatitis, chronic pelvic pain syndrome, CPPS, prostatodynia, asymptomatic bacteriuria, dysuria, ascending urethral infection, gonococcal prostatitis, intraprostatic urinary reflux

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Contributor Information and Disclosures

Author

Joe D Mobley III, MD, MPH, Chief Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center
Joe D Mobley III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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