Objective:
To improve the diagnosis and treatment of acute prostatitis.
Methods:
We retrospectively analyzed the results of 35 cases of acute prostatitis from January 2001 to March 2004, which were treated with anti-infection, symptomatic management and support. 2 cases with prostatic abscess were treated with surgical drainage, and 3 cases with acute urinary retention were treated with indwelling urinary catheters.
Results:
All patients had normal body temperature in 3-5 days of treatment, blood and urine routine, urine culture and ultrasound examination returned to normal in 1-2 weeks, and the maximum urinary flow rate improved in those with difficulty in urination.
Conclusion:
Patients with acute prostatitis should be treated with early, adequate and long course of sensitive antibiotics after diagnosis, and given appropriate symptomatic treatment, and surgical drainage should be performed in those with abscess formation.
From January 2001 to March 2004, 35 cases of acute prostatitis were treated in our hospital with good results. The results are reported below.
1. Information and methods
1.1 Clinical data The 35 patients in this group, aged 23-82 years old, average 56 years old. All of them were seen for acute chills, fever, urinary frequency, urinary urgency, painful urination and difficulty in urination. Some patients had pain in the lower abdomen, perineum, lumbosacral area, swelling and rectal irritation. The history ranged from 1 to 7 d, with an average of 3 d. The body temperature ranged from 38.7 to 40.0°C, with an average of 39.4°C. Rectal examination (DRE): tenderness in 7 cases, high surface temperature of the prostate, and fluctuating sensation in 2 cases. Laboratory examinations: routine blood leukocytes (8.3~23.1)×109/L, including >10×109/L in 33 cases, neutrophils 0.82~0.93; routine urine leukocytes +~+++; 21 cases with positive mid-stage urine culture, including 15 cases of Escherichia coli, 4 cases of Pseudomonas aeruginosa and 2 cases of Enterococcus; transrectal ultrasonography (TRUS) in 30 cases, prostate volume 18 The volume of the prostate was 18.5~67.4(36.3±15.2) m. In 18 cases, there were 24 hypoechoic areas, 13 cases had abundant blood flow in the prostate, and 2 cases had liquid dark areas (unilateral); the urine flow rate was examined in 18 cases, and the maximum urine flow rate (Qmax) was <15 ml/s in 12 cases, with an average of 10.2 ml/s.
1.2 Treatment After admission, quinolones or cephalosporins were firstly administered intravenously: levofloxacin 300 mg 1 time/d; ciprofloxacin 200 mg 2 times/d or ceftriaxone sodium 2.0 g 1 time/d (adjusted according to the results of drug sensitivity test); treatment was given for 1 week. Then change to oral levofloxacin 200 mg 2 times/d or cefaclor 500 mg 2 times/d for 3~4 weeks. Two cases of TRUS with fluid dark areas in the prostate were treated with ultrasound-guided puncture drainage, and 2.5 and 4.3 ml of purulent fluid was drained respectively. The two cases with fluid dark areas in the TRUS prostate were drained by ultrasound-guided puncture, and 2.5 and 4.3 ml of purulent fluid were drained respectively.
2. Results
In 35 patients, the body temperature returned to normal (<37.0℃) 3~5 (average 3.5) d after treatment.
The blood count was normal in 4 cases with leukocytes >10×109/L and neutrophils >0.7 in 18 cases; urine routine: leukocytes + in 2 cases with prostate abscess. The urine culture was still abnormal in 2 cases after 1 week, both of them were Escherichia coli, and the reexamination showed negative after 2 weeks. 2 cases of prostate abscess disappeared after 2 weeks of reexamination of ultrasound liquid dark area, 18 cases of difficult urination reexamination of urine flow rate, Qmax 11~22 ml/s, average 16. 5 ml/s.
3. Discussion
The latest classification was proposed by the International Prostate Collaborative Network (IPCN) in 1998 and is divided into 4 major categories: acute bacterial prostatitis, chronic bacterial prostatitis, chronic non-bacterial prostatitis/chronic pelvic pain syndrome and asymptomatic prostatitis, in which acute bacterial prostatitis and chronic bacterial The most important thing is that you can get a good idea of what you are doing. The route of infection can be:
(1) Upstream infection caused by urethritis;
(2) The reflux of infected urine into the prostatic ducts;
(3) Inflammation of neighboring organs, such as the rectum, colon, and lower urinary tract, can cause prostatitis through the lymphatic system;
The prostatitis is caused by the bloodstream, such as the respiratory tract, skin and soft tissue infections through the bloodstream. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
The typical clinical manifestations of acute prostatitis are: chills, fever with bladder irritation, pain in the lower abdomen, pelvis and perineum, difficulty in urination, enlarged DRE prostate, tenderness or fluctuating sensation, and increased anal temperature. The blood count and neutrophil count are elevated. Urine routine can find a large number of pus cells, especially in the initial or end-stage urine.
Kravchick et al. performed culture of urine and blood specimens from 28 patients with acute prostatitis who had persistent high fever after 48 h of oral antibiotics (before taking antibiotics), and the positive rate was 89% and 25%, respectively, with Escherichia coli accounting for 68% and Pseudomonas aeruginosa for 20% and Enterococcus for 12%. The group of patients with positive urine culture 21 cases, including 15 cases of Escherichia coli, 4 cases of Pseudomonas and 2 cases of Enterococcus.
The diagnosis of acute prostatitis is not difficult, mainly through history, physical examination, blood, urine routine and urine culture, but in elderly patients with poor responsiveness, clinical symptoms are not obvious or combined with respiratory tract infection, the diagnosis is often missed or misdiagnosed and the condition is delayed. The diagnosis of acute prostatitis was delayed. The first thing you need to do is to differentiate acute prostatitis from acute upper urinary tract infections.
The most common is in women, and the clinical manifestations are fever, back pain, and positive urine culture, but often without symptoms of urinary difficulty. In addition, do not perform prostate massage at the time of diagnosis, so as not to cause the spread of infection and aggravate the condition. When BPH is associated with lower urinary tract infection, it often manifests as urinary frequency, urgency, painful urination, hematuria, difficulty in urination and urinary retention, but it is not accompanied by chills and fever, and the DRE does not have prostate fluctuation or increased anal temperature. In this group, 15 patients had a history of BPH without previous acute urinary retention; 7 patients had a history of chronic prostatitis.
The anti-infective treatment of acute prostatitis is safe and effective for most patients, and is the preferred treatment, and most cases can reduce fever in 36-48 hours. The actual fact is that there is no unified program for anti-infection treatment: a mid-phase urine culture and drug sensitivity test is performed prior to the use of drugs to select drugs that can easily enter the prostate tissue and prostate fluid. Fluoroquinolone has a great advantage in this regard because it is an amphoteric drug and can enter the prostate tissue in high concentrations. Ofloxacin and ciprofloxacin are preferred, while tetracyclines and macrolides are suitable for suspected mycoplasma and chlamydia infections.
Mears [3] recommended: ciprofloxacin 200 mg/d, norfloxacin 400 mg/d, enoxacin 400 mg/d, all divided into two daily doses, 30 d for a course of treatment; ofloxacin 300 mg/d, 6 weeks for a course of treatment. However, because of the increased permeability of prostate tissue and blood vessels during the acute prostatitis attack, the choice of drugs is relatively loose. We suggest that the new quinolones or cephalosporins can be used in the initial stage of treatment, and if the efficacy is not good, then the medication can be adjusted according to the results of drug sensitivity tests. The course of antibiotic therapy is uncertain, for clear acute bacterial.
The course of treatment for patients with prostatitis should be long rather than short. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. In the case of acute prostatitis with poor anti-infective therapy, the possibility of prostate abscess formation should be considered along with the poor sensitivity of the causative organism to the drug, and the diagnosis should be made with the help of TRUS within 48 hours of ineffective antibiotic therapy.
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The prognosis is generally good for those who have been treated aggressively for acute prostatitis, but some patients with acute prostatitis can persist, so bacterial cultures should be performed at least during the 3-month follow-up period to guide treatment. In patients with acute prostatitis, the peripheral zone of hypoechogenicity can persist for a long time. Color Doppler ultrasonography, DRE, and prostate-specific antigen (PSA) can help differentiate it from prostate cancer.