Acute prostatitis is a term describing an infection of the prostate, arising due to reflux of urine contaminated by various bacterial pathogens [1] [2] [3] [4]. Enterobacteriaceae (E. coli, klebsiella spp., pseudomonas aeruginosa, proteus mirabilis), as well as E. faecalis and staphylococcus aureus, are the main causative agents [3] [4] [5]. The presence of indwelling catheters is perhaps the greatest risk factor for a urinary tract infection (UTI) of any kind, including prostatitis, while invasive procedures (cystoscopy, transrectal prostate biopsy) can significantly increase the risk of prostatitis [1] [3] [4]. In addition, immunosuppression and diabetes mellitus are also depicted as potential risk factors [3] [4]. The clinical presentation includes an abrupt onset of lower urinary tract symptoms (dysuria, increased urgency to urinate, increased frequency, incomplete voiding and a weak urine stream), painful ejaculation (even hematospermia), and perineal, rectal, or pelvic pain [1] [4] [5] [6]. In addition, prostatitis often causes systemic symptoms - fever, chills, and malaise [1] [4] [5]. In cases when the prostate becomes enlarged, urinary tract obstruction might occur [5] [6]. Many reports have emphasized the serious nature of prostatitis, as it may cause acute urinary retention, potential progression to a chronic infection, but also systemic dissemination and even sepsis, which could be life-threatening in the absence of appropriate therapy [1] [3] [4] [6].

A thorough clinical workup by the physician can provide sufficient clues to make an initial diagnosis. Firstly, a detailed patient history, including the onset of symptoms, their characteristics, as well as the assessment of risk factors (catheterization, immunosuppression), should be obtained [1] [2]. More specific findings of prostatitis, however, are identified during the physical examination. A properly conducted digital rectal exam will reveal an enlarged prostate that is tender on palpation, one of the key features of prostatitis [2] [5] [6]. Physicians must be careful when performing a prostate exam, as prostate massage is contraindicated in the case of acute prostatitis due to an increased risk of subsequent bacteremia and sepsis [1] [2]. As soon as clinical criteria suggest an infection of the urinary tract, laboratory studies (a complete blood count with basic biochemical parameters and serum inflammatory markers), together with urinalysis, urine cultures (of midstream urine), and blood cultures if systemic signs are present, are the next step [1] [2] [3] [5]. If the diagnosis remains inconclusive, or if patients do not respond to antibiotic therapy, imaging studies such as transrectal prostatic ultrasonography (TRUS), pelvic ultrasonography or computed tomography (CT) can be implemented [2]. The use of prostate-specific antigen (PSA) is not recommended, as it is often elevated due to the inflammatory changes in the prostate [2], which could mislead the physicians toward other diagnoses.

The primary treatment for acute prostatitis is antibiotics, as the condition is often caused by a bacterial infection. The choice of antibiotic and duration of treatment depend on the specific bacteria involved and the severity of the symptoms. Commonly prescribed antibiotics include fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines.

In addition to antibiotics, pain management is crucial. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers may be recommended to alleviate discomfort. In severe cases, hospitalization and intravenous antibiotics may be necessary.

With appropriate treatment, the prognosis for acute prostatitis is generally good. Most patients experience significant symptom relief within a few days of starting antibiotics. However, it is essential to complete the full course of antibiotics to prevent recurrence or complications. In some cases, chronic prostatitis may develop if the infection is not fully resolved.

Acute prostatitis is most commonly caused by bacterial infections. The bacteria responsible are often the same types that cause urinary tract infections (UTIs), such as Escherichia coli. Other bacteria, including those transmitted sexually, can also lead to prostatitis. Risk factors for developing acute prostatitis include recent urinary tract infections, catheter use, and certain medical procedures involving the urinary tract.

Acute prostatitis can affect men of all ages but is most common in men aged 30 to 50. It is less common than chronic prostatitis but can occur in conjunction with other urinary tract infections. The exact prevalence is difficult to determine due to variations in diagnostic criteria and reporting.

The pathophysiology of acute prostatitis involves the invasion of bacteria into the prostate gland, leading to inflammation and swelling. This can occur through the urethra, bloodstream, or lymphatic system. The inflammation results in the characteristic symptoms of pain, urinary difficulties, and systemic signs of infection such as fever.

Preventing acute prostatitis involves reducing risk factors for bacterial infections. This can include:

• Practicing good hygiene, especially in the genital area
• Staying hydrated to promote regular urination
• Avoiding activities that can irritate the prostate, such as prolonged sitting or cycling
• Using protection during sexual activity to prevent sexually transmitted infections

Acute prostatitis is a sudden and often severe inflammation of the prostate gland, typically caused by bacterial infection. It presents with symptoms such as pelvic pain, urinary difficulties, and fever. Diagnosis involves clinical evaluation and laboratory tests, while treatment primarily consists of antibiotics and pain management. With timely and appropriate treatment, the prognosis is generally favorable.

If you suspect you have acute prostatitis, it is important to seek medical attention promptly. Symptoms can include pain in the pelvic area, difficulty urinating, and fever. Treatment usually involves antibiotics, and most patients recover well with proper care. Maintaining good hygiene and staying hydrated can help prevent future episodes.

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3. Grabe M, Bartoletti R, Bjerklund-Johansen TE, et al. Guidelines on Urological Infections. European Association of Urology. 2015.
4. Dickson G. Prostatitis--diagnosis and treatment. Aust Fam Physician. 2013;42(4):216-219.
5. Videčnik Zorman J, Matičič M, Jeverica S, Smrkolj T. Diagnosis and treatment of bacterial prostatitis. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24(2):25-29.
6. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236.