Question

Clinical features of acute prostatitis and prostatic abscess.

Hint:

In acute prostatitis, fever, perineal pain, and urinary symptoms are key features, while a prostatic abscess is often associated with more severe pain and systemic infection.

Answer 1

Step 1: Acute Prostatitis:
Acute prostatitis is an infection of the prostate gland, typically caused by bacteria. The clinical features include:
- Fever and Chills: A common presentation due to systemic infection. Fever is typically high and associated with chills.
- Perineal Pain: Pain in the perineal area, often described as aching or discomfort. This pain may radiate to the lower abdomen or lower back.
- Urinary Symptoms: These may include dysuria, frequency, urgency, and a feeling of incomplete voiding. Hematuria may also be present in severe cases.
- General Malaise and Fatigue: Patients often feel unwell, with fatigue, lethargy, and a general sense of being ill.
- Painful Ejaculation: This can occur as a result of inflammation and swelling of the prostate gland.

Step 2: Prostatic Abscess:
Prostatic abscess is a localized collection of pus in the prostate, which can arise from acute prostatitis. The clinical features of a prostatic abscess include:
- Severe Perineal or Rectal Pain: Patients often complain of more intense, localized pain in the perineal or rectal region.
- Fever and Sepsis: Similar to acute prostatitis, fever is present, but in prostatic abscess, it is often associated with more severe systemic symptoms, such as tachycardia and hypotension.
- Difficulty Urinating: Symptoms like obstructive voiding, retention, and dysuria are common. The bladder may feel full, and there may be difficulty emptying it completely.
- Tenderness on Rectal Exam: On digital rectal examination (DRE), there is often marked tenderness in the prostate, and in severe cases, a fluctuant mass may be palpable.