eMedicine Specialties > Emergency Medicine > Infectious Diseases

Prostatitis: Follow-up

Author: Tarlan Hedayati, MD, Instructor of Clinical Emergency Medicine, Director of Observation Unit, Director of Chest Pain Unit, Department of Emergency Medicine, Los Angeles County/University of Southern California Medical Center
Coauthor(s): Molly Keegan, MD, Resident Physician, Department of Emergency Medicine, Los Angeles County and USC Medical Center
Contributor Information and Disclosures

Updated: Jul 29, 2009

Follow-up

Further Inpatient Care

  • Carefully treat associated septicemia in acutely ill patients.
  • Carefully monitor for bladder outlet obstruction and renal failure.

Further Outpatient Care

  • After primary management and stabilization, care of the patient is appropriately transferred to a urologist, as aggressive treatment of acute prostatitis can lessen the chance of developing chronic prostatitis.
  • After initial improvement with parental antibiotics, acute bacterial prostatitis may be managed with outpatient care with a 2- to 4-week course of oral antibiotics and urologic follow-up.
  • Management strategies for category II prostatitis, chronic bacterial prostatitis, include intraprostatic antibiotic injection, transurethral resection of the prostate (TURP), and long-term antimicrobial suppression.
  • Additional therapeutic modalities studied for category III prostatitis include anti-inflammatories, phytotherapy, biofeedback, thermal therapy, and pelvic floor exercises.
  • Although no clear connection between elevated PSA level in prostatitis and cancer have been established, patients found to have elevated PSA levels should be followed up by their primary care-physicians, urologists, or both.

Deterrence/Prevention

  • Protection against STDs also provides protection against many of the organisms associated with acute bacterial prostatitis, development of chronic prostatitis, and suspected causes of nonbacterial prostatitis.
  • Psychological stress has been associated with men who report symptoms of chronic prostatitis. Recognition of underlying psychosomatic disease in chronic cases and appropriate psychiatric referral and treatment lessens the recurrence rate.

Complications

  • Chronic prostatitis - Approximately one third of patients with chronic bacterial prostatitis experience recurrence following initial treatment.
  • Bladder outlet obstruction/urinary retention
  • Abscess - Typically in immunocompromised patients
  • Infertility due to scarring of the urethra
  • Recurrent cystitis
  • Pyelonephritis
  • Renal damage
  • Sepsis

Prognosis

  • The prognosis of the first occurrence of acute bacterial prostatitis is good with aggressive antibiotic therapy and good patient compliance.
  • In cases of recurrent chronic prostatitis that may present with acute exacerbations, causative underlying factors must be determined to affect outcome.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider diagnosis in sexually active adolescents
  • Performing prostatic massage in patients with acute bacterial prostatitis
  • Failure to recognize acute urinary retention

Special Concerns

  • Acute bacterial prostatitis is a recognized complication after sclerotherapy for rectal prolapse.
  • Nursing home patients with indwelling urethral catheters may be at increased risk.
  • Patients with an elevated PSA value must be referred to their primary care physician or a urologist for PSA recheck and follow-up.
  • Chronic prostatitis and asymptomatic inflammatory prostatitis have not been scientifically linked to prostate cancer.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, David S Kwon, MD, to the development and writing of this article.



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References
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Further Reading

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Keywords

prostatitis, acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, prostatodynia, prostate gland, bacterial prostatitis, chronic pelvic pain syndrome, CPPS, asymptomatic inflammatory prostatitis, prostatic inflammation

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Contributor Information and Disclosures

Author

Tarlan Hedayati, MD, Instructor of Clinical Emergency Medicine, Director of Observation Unit, Director of Chest Pain Unit, Department of Emergency Medicine, Los Angeles County/University of Southern California Medical Center
Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Molly Keegan, MD, Resident Physician, Department of Emergency Medicine, Los Angeles County and USC Medical Center
Disclosure: Nothing to disclose.

Medical Editor

David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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