Acute Bacterial Prostatitis

These patients are generally very ill. They present with dysuria, urgency, frequency, nocturia, perineal and low back pain, and fever, chills, and malaise. The prostate is enlarged, boggy, and tender on exam, and vigorous exam can result in bacteremia.
The urinalysis and urine culture show findings typical of infection, the white blood count is elevated. Treatment consists of appropriate parenteral antibiotics, a suprapubic cystotomy if the patient is in retention, and analgesics and antipyretics. If a prostatic abscess is suspected (spiking fevers, failure to respond to therapy, fluctuance on rectal exam), it can be diagnosed by CT scan or transrectal ultrasound and drained surgically in a variety of ways.