Differential diagnosis and treatment of acute bacterial prostatitis

Differential diagnosis and treatment of acute bacterial prostatitis.  After treatment, patients should pay attention to their diet, eat more fresh fruits and vegetables, drink plenty of water, drink alcohol and eat irritating foods, and develop good living habits to prevent the recurrence of prostatitis.

The patient was a 68-year-old male with frequent urination, urgency, painful urination and fever for more than 3 days, and his body temperature was as high as 38.5C. After B-ultrasound examination, the size of the prostate was about 5.3 × 4.4 × 4.3 cm, with a full appearance and strong echoes inside. Normal male vulva, urethral orifice is slightly red and swollen, no obvious abnormal secretions and masses are seen. Digital rectal examination revealed a full prostate and positive tenderness.

The patient has typical symptoms of frequent urination, urgency, and painful urination, and a positive digital rectal examination can be preliminarily diagnosed as acute prostatitis. But how to diagnose acute bacterial prostatitis?

Acute bacterial prostatitis is an acute inflammation of the prostate tissue caused by bacteria, which can be further diagnosed by PSA, urine routine, blood routine examination, etc. The patient’s PSA (group item): total PSA: 42.18ng/mL↑, free PSA: 11.69ng/mL↑, FPSA/PSA: 0.28 venous blood routine + CRP: WBC: 20.50×10^9/L↑, RBC: 4.43×10^12/L, HGB: 132.00g/L, C-reactive protein: 199.10mg/L↑. Through further examination, it can be diagnosed as acute bacterial prostatitis.

Acute bacterial prostatitis often comes on suddenly, and some patients may have symptoms of systemic infection and poisoning, such as fever, chills, and general malaise, and some may also experience nausea and vomiting. Local pain in the lumbosacral and perineum will be accompanied by symptoms such as frequent urination and urgency, and usually accompanied by varying degrees of cystitis. Physical examination can find suprapubic tenderness, urinary retention can touch the inflated bladder, digital rectal examination can find prostate enlargement, tenderness, irregular shape, etc., remember to prohibit prostate massage. Routine urinalysis and urinary sediment examination can reveal turbid urine, even a large amount of flocculent deposits, and a large number of white blood cells as a result of microscopic examination. Routine blood examination can find that the number of white blood cells is increased, the proportion of neutrophils is greater than 70%, and even left. Bacteriological examination can reveal a positive urine or blood culture.

However, there are many kinds of acute diseases that can occur in the prostate. How can it be diagnosed differently from other diseases and accurately diagnosed as acute bacterial prostatitis?

Other diseases that need attention are the following:

First, prostate discharge.

Also known as aseptic prostatitis, prostate leakage or chronic prostate congestion. Milky white secretions flow out from the urethra during stool or at the end of urination, often accompanied by psychiatric symptoms. Microscopic examination of the prostate fluid and secretion was normal, and the bacterial culture of the lower urinary tract was negative. On digital rectal examination, the prostate was normal in size, soft in texture, and non-tender.

Second, non-specific granulomatous prostatitis.

Pathological diagnosis can be divided into two types: non-eosinophilic granulomatous prostatitis and eosinophilic granulomatous prostatitis. It may be accompanied by fever, frequent urination, dysuria, pyuria, perineal pain and discomfort, but the symptoms progress quickly and urinary retention can occur quickly. The digital rectal examination examines the prostate enlargement, induration, such as fixed cancer, which is different in hardness, mountain-like protrusions, and elasticity. In the short term, the induration grows faster, and a granulomatous reaction can be found by perineal prostate biopsy. Using hormones, Chinese medicine and other experimental treatments, induration can gradually shrink

Third, non-bacterial prostatitis.

Clinical symptoms are difficult to distinguish from chronic prostatitis, usually with perineal pain, urination symptoms and sexual dysfunction. There are a lot of lecithin bodies in the prostatic fluid, and there are more white blood cells, but there is no bacterial growth in the smear and bacterial culture.

Fourth, prostate pain, that is, spasm of the pelvic floor muscles.

Symptoms of frequent urination, urgency, dysuria, dysuria, white discharge in urine, hematuria, etc., accompanied by pain and discomfort in perineum, perianal, lower abdomen, lumbosacral, groin, pubic bone, scrotum, penis, etc. It has nothing to do with urination, the symptoms can be improved after massage treatment, but the maintenance time is not long. On digital rectal examination, the muscles around the anus and prostate were tender or uncomfortable, while the prostate was normal. Prostatic fluid microscopic examination was normal, and there was no bacterial growth in prostatic fluid and urine culture. Cystoscopy showed mild to moderate bladder neck obstruction, with obstructive changes in the bladder. Urodynamic examination revealed that most patients had spasmodic dysfunction of the bladder neck and prostate urethra.

Fifth, prostate tumors:

Symptoms such as frequent urination, painful urination, and dysuria appear in the late stage, and systemic symptoms such as weight loss and fatigue are obvious. The morphology of the digital rectal examination changes, showing irregular enlargement. The internal echo is uneven, local echo or strong echo, and the edges are not neat. Both CT and MRI showed space-occupying lesions in the prostate and invading the surgical envelope, which can be confirmed by a biopsy of the prostate.

Sixth, prostate tuberculosis. The symptoms are similar to chronic prostatitis.

Perineum, lumbosacral dull pain and frequent urination, urgency, dysuria, urethral secretions, etc., but a history of tuberculosis in the urinary tract and other tuberculosis lesions. The main symptoms are blood sperm, decreased semen, painful ejaculation, and urination Difficult, the prostate showed irregular nodules on digital rectal examination, the epididymis was enlarged and hardened, the vas deferens had beaded induration, and the direct smear of prostatic fluid was positive for Mycobacterium tuberculosis, and the diagnosis rate by PCR technology was higher.

After the diagnosis of acute bacterial prostatitis, the first treatment is antibiotic treatment, while paying attention to the changes in vital signs and blood indicators. If the patient’s symptoms are obvious and the body temperature is high, antibiotics can be injected intravenously, and antibiotics should be continued after a week. Broad-spectrum antibiotics, third-generation cephalosporins, etc. are recommended. If the patient’s symptoms are not obvious, oral medication can be used for at least one month. Antibiotics should choose drugs that can enter the prostate and can be treated quickly to prevent the treatment from becoming chronic prostatitis in time. If acute bacterial prostatitis has formed a prostate cyst, incision and drainage should be performed in time through the rectum or perineum.

After treatment, patients should pay attention to their diet, eat more fresh fruits and vegetables, drink plenty of water, drink alcohol and eat irritating foods, and develop good living habits to prevent the recurrence of prostatitis.

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