Question

Management of acute prostatitis and prostatic abscess.

Hint:

Prompt initiation of antibiotics and drainage (if necessary) are critical in managing acute prostatitis and prostatic abscess, to prevent complications like sepsis.

Answer 1

Step 1: Management of Acute Prostatitis:
The primary goal in treating acute prostatitis is to control the infection and alleviate symptoms. The management includes:
- Antibiotic Therapy: Empiric broad-spectrum antibiotics (e.g., ciprofloxacin, trimethoprim-sulfamethoxazole) should be initiated to cover likely pathogens, including Gram-negative bacteria like E. coli. Antibiotics should be continued for 4-6 weeks, depending on the severity.
- Pain Management: Analgesics such as acetaminophen or NSAIDs can help relieve pain and fever.
- Supportive Care: Hydration and bed rest are important to assist the body’s recovery. Additionally, a short course of alpha-blockers may help relieve urinary symptoms.
- Hospitalization: Severe cases with high fever, dehydration, or sepsis may require hospitalization for IV antibiotics and supportive care.

Step 2: Management of Prostatic Abscess:
Prostatic abscesses often require more aggressive treatment, including:
- Antibiotics: Broad-spectrum IV antibiotics are started, and once cultures are available, the treatment is adjusted based on susceptibility.
- Drainage: Percutaneous or transrectal drainage is often necessary for larger abscesses to remove pus and alleviate symptoms. In some cases, surgical drainage may be required.
- Post-Drainage Care: After drainage, the patient may require continued antibiotics and close follow-up to monitor for recurrence.
- Monitoring for Complications: Sepsis, hemorrhage, and urinary retention are potential complications. Monitoring for these, especially in the initial post-drainage period, is essential.