[Management of acute prostatitis: experience with 84 patients]

Abstract

Objectives: The present study analyzed the symptoms, etiology, utility of complementary diagnostic procedures, treatment and subsequent course of patients with acute prostatitis in our setting.

Methods: We reviewed the clinical records of patients admitted to our department from 1988 to 1992 with the diagnosis of acute prostatitis. The present study comprised 84 patients for a total of 114 cases including reinfections.

Results: Acute prostatitis with irritative voiding symptoms was observed in 81% of the cases and was associated with fever (60%), pain (38%), systemic involvement (23%), urinary obstructive symptoms (11.5%) and hematuria (11%). It is more prevalent in middle aged men (mean 53 years); reinfection and persistence of infection are not uncommon (18% and 21%, respectively). A painful (72%) and enlarged (87%) prostate are the most important features and are detected by digital rectal examination (DRE). Leukocytosis with a left shift can also be observed. The most common pathogen in the first episode and subsequent reinfections was E. coli (64%), followed by abacterial (12%), enterococcus (7%), Pseudomonas (6%) and other gram-negative rods (12%). The antibiotic profile showed a sensitivity greater than 95% to imipenem, aminoglycosides, most of the cephalosporins and ciprofloxacin, and 83% sensitivity to trimethoprim-sulfamethoxazole. Ultrasonography did not provide more information than that already obtained from the symptoms and DRE. No correlation was found with previous urologic history or subsequent course of the disease.

Conclusions: Acute prostatitis is an infection with a tendency to persist or recur. To avoid the persistence or recurrence of this condition, an accurate diagnosis must be made based on the symptoms and DRE findings, early and prolonged therapy is required, as well as subsequent follow up with Stamey's test, semen and urine analyses.