Summary: Referral only needed for symptoms unresponsive to treatment

Advice: Urological referral only indicated for acute prostatitis and for chronic prostatitis unresponsive to standard treatment
Refer To: Any adult urologist for emergency admissions with acute prostatitis; any adult urologist for other problems


Type I (acute prostatitis)

This is associated with acute pain and severe systemic upset.

Emergency admission is indicated for treatment with intravenous antibiotics.

Catheterisation should only be performed suprapubically; some patients develop prostatic abscesses which require formal transurethral prostatic incision for drainage

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Type II (chronic bacterial prostatitis)

Chronic bacterial prostatitis usually presents as recurrent urinary infection. Give a 2-month course of antibiotics (e.g. Ciprofloxacin or Ofloxacin) supplemented with NSAIDs if necessary. Relapse is common and referral is usually unnecessary unless the patient has persistent urinary infections

Granulomatous prostatitis is rare but is associated with a raised PSA, a clinical suspicion of prostate cancer on DRE and is caused by chronic infection with E Coli. A 6-week course of Augmentin is indicated in this condition

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Type IIIa (chronic abacterial prostatitis)

Symptomatic treatment only with a 6 to 8-week course of NSAIDs supplemented, if necessary, with alpha-blockers or muscle relaxants (e.g. LibriumĀ®, ValiumĀ®); relief of symptoms is the aim but cure is rarely possible. However, the Department runs a Chronic Pelvic Pain Syndrome clinic to which such patients may be referred if necessary. Contact Mr A Doble for further details

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Type IIIb (chronic pelvic pain)

As for Type IIIa

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Type IV (incidental prostatitis)

This is usually found at the time of prostatic biopsy and specific treatment should only be instituted on the advice of a Consultant Urologist

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Special information

This information contains guidelines and advice from professional bodies, together with information about the prescription of drugs. Since all NHS hospitals have local arrangements with their Primary Care Trusts (PCTs) about which medicines can be used, some drugs mentioned cannot be prescribed by local hospitals.

Treatment of patients will be planned with the Consultant responsible for care, taking into account those drugs which are or are not available at the local hospital and what is appropriate for optimum patient care.

Healthcare professionals are advised to check prescribing arrangements with their local hospital or PCT

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