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Prostatitis

Key Concepts:

Terms in this set (36)

Overview
Inflammation of the prostate gland
National Institutes of Health classification: acute bacterial prostatitis; chronic bacterial prostatitis; chronic prostatitis/chronic pelvic pain syndrome (prostatodynia), and asymptomatic inflammatory prostatitis
Acute bacterial prostatitis: easily recognized and treated
Chronic bacterial prostatitis: less severe than acute but the most common cause of recurrent UTI in men
Chronic prostatitis/chronic pelvic pain syndrome: inflammatory or noninflammatory
Asymptomatic inflammatory prostatitis: inflammation without infection or genitourinary complaints
Overview-Acute Prostatitis
Easily recognized and treated
Overview-Chronic Prostatitis
Most common cause of recurrent urinary tract infection (UTI) in men
More difficult to recognize than acute prostatitis
Overview-Other Prostatitis Forms
Granulomatous prostatitis (also called tuberculous prostatitis )
Nonbacterial prostatitis
Prostatodynia (painful prostate) or chronic pelvic pain syndrome
Overview-Pathophysiology
Infectious organism spreads to the prostate gland by the hematogenous route, an ascending urethral infection, invasion of rectal bacteria via lymphatic vessels, or reflux of infected bladder urine into prostate ducts.
Inflammation results. (See Prostatic inflammation.)
Overview-Causes
Acute bacterial prostatitis: usually gram-negative bacteria (Escherichia coli, Enterobacter, Proteus, Pseudomonas, Serratia, or Enterococcus )
Chronic bacterial prostatitis: most commonly E. coli, but also enterococci, Pseudomonas, Chlamydia trachomatis, Ureaplasma, Trichomonas vaginalis, cytomegalovirus, or human immunodeficiency virus (HIV)
Chronic prostatitis/chronic pelvic pain syndrome: possibly bacterial, structural, or functional bladder problems or ejaculatory duct obstruction; possibly cause unknown
Asymptomatic inflammatory prostatitis: similar to chronic prostatitis
Overview-Risk Factors
Invasive urethral procedures, such as catheterization, cystoscopy, urethral dilation, or transurethral resection of the prostate (TURP)
Infrequent or excessive sexual intercourse
Age older than 50
Trauma
Bladder infection
Overview-Incidence
Acute prostatitis occurs most commonly in sexually active men between ages 30 and 50.
Chronic prostatitis is more common in men older than age 50.
Bacterial prostatitis occurs more commonly in men who are HIV-positive than in those in the general population.
Chronic prostatitis/chronic pelvic pain syndrome is the most common type of prostatitis, accounting for more than 90% of cases; acute and chronic bacterial prostatitis account for the remaining cases.
Overview-Complications
UTI
Prostatic abscess
Acute urine retention
Pyelonephritis
Epididymitis
Sepsis
Renal damage
Assessment-History
Sudden fever, chills
Abdominal, groin, perineal, or lower back pain
Perineal fullness
Arthralgia, myalgia
Urinary urgency and frequency
Dysuria, nocturia
Transient erectile dysfunction
Assessment-Acute bacterial prostatitis
Sudden fever, chills
Abdominal, groin, perineal, or lower back pain
Perineal fullness
Arthralgia, myalgia
Urinary urgency and frequency
Dysuria, nocturia
Transient erectile dysfunction
Assessment-Chronic bacterial prostatitis
May not produce symptoms
Usually causing the same urinary symptoms as the acute form, but to a lesser degree, and occurring intermittently
Hematospermia
Persistent urethral discharge
Scrotal pain
Painful ejaculation
Assessment-Chronic prostatitis/chronic pain syndrome
Pelvic pain or discomfort
Urinary frequency, dysuria
Ejaculatory pain
Erectile dysfunction
Assessment-Asymptomatic inflammatory prostatitis
Absence of symptoms
Assessment-Physical Findings
Cloudy urine
Distended bladder
Suprapubic tenderness (acute bacterial prostatitis)
Prostatic tenderness, induration, swelling, firmness, and warmth (acute or chronic bacterial prostatitis)
Mild tenderness or normal prostate (chronic prostatitis/chronic pelvic pain syndrome)
Crepitation (if prostatic calculi are present)
Diagnostic Test Results-Laboratory
Urine culture identifies infectious organism
Urinalysis reveals increased number of white blood cells.
In nonbacterial prostatitis, inflammatory cells are found in smears of prostatic secretion.
In prostatodynia, negative urine cultures and absence of inflammatory cells are found in smears of prostatic secretions.
pH of prostatic fluid is alkaline with chronic bacterial prostatitis.
Prostate-specific antigen level may be elevated.
Diagnostic Test Results-Imaging
Computed tomography or magnetic resonance imaging may reveal malignancy or abscess.
Transrectal ultrasonography reveals capsular thickening and prostatic calculi.
Diagnostic Test Results-Diagnostic Procedures
In granulomatous prostatitis: prostate tissue biopsy shows Mycobacterium tuberculosis.
Urodynamic evaluation reveals detrusor hyperreflexia and pelvic floor myalgia (from chronic spasms).
Diagnostic Test Results-Other
Rectal examination findings may suggest prostatitis.
Treatment-General
Sitz baths
Psychotherapy if sexual dysfunction is present
Urinary catheterization if urine retention is present
Pelvic floor training/biofeedback (chronic prostatitis/chronic pelvic pain)
Treatment-Diet
Increased oral fluids
Treatment-Activity
Bed rest with limited activity until the condition improves
Regular, protected sexual intercourse
Treatment-After surgery
Avoidance of lifting, strenuous exercise, and long automobile rides
No sexual activity for several weeks after discharge
Treatment-Medications
Analgesics such as acetaminophen and NSAIDs
Antipyretics
Stool softeners such as docusate
Treatment-Acute bacterial prostatitis
Systemic antibiotic therapy, such as oral amoxicillin or trimethoprim-sulfamethoxazole, fluoroquinolones, and I.V. amoxicillin or gentamicin
Treatment-Chronic bacterial prostatitis
Oral antibiotics, such as ofloxacin and ciprofloxacin for 4 to 6 weeks
Treatment-Chronic prostatitis/chronic pelvic pain and asymptomatic inflammatory prostatitis
Alpha-adrenergic blocking agents, such as terazosin hydrochloride and tamsulosin hydrochloride
Diazepam
Antibiotic therapy for 4 to 6 weeks
Treatment-Surgery
TURP or total prostatectomy, if drug therapy is unsuccessful
Nursing Considerations-Nursing Diagnoses
Acute pain
Impaired urinary elimination
Ineffective coping
Ineffective sexuality patterns
Risk for infection
Sexual dysfunction
Situational low self-esteem
Nursing Considerations-Expected Outcomes
express feelings of increased comfort
demonstrate skill in managing urinary elimination problems
use available counseling, referrals, or support groups
resume sexual activity to the fullest extent possible
remain free from signs or symptoms of infection
express his feelings about potential or actual changes in sexual activity
express feelings related to self-esteem.
Nursing Considerations-Nursing Interventions
Give prescribed drugs; if the patient is hospitalized, administer I.V. antibiotics and ensure patent I.V. access. Provide I.V. site care according to facility policy.
Expect to switch to oral antibiotic therapy after the patient has remained afebrile for 24 to 48 hours; give analgesics and antipyretics as ordered.
Administer stool softeners to promote bowel elimination without straining.
Ensure bed rest if prostatitis is severe.
Encourage fluid intake to ensure adequate hydration.
Give sitz baths to assist in relieving pain and spasm, assist with catheterization if urine retention occurs, and provide catheter insertion site care as indicated.
Avoid rectal examinations.
Encourage the patient and his family to verbalize their feelings and concerns, including those related to sexual functioning and sexual activity; provide emotional support and encouragement.
Prepare the patient and his family for possible surgery if the patient doesn't respond to therapy.
Nursing Considerations-Monitoring
Vital signs
Pain
Urinary elimination
Fluid balance and hydration
Sexual function
Coping
Nursing Considerations-After surgery
Urinary elimination
Intake and output
Catheter function and drainage
Signs of infection
Pain control
Coping
Nursing Considerations-Associated Nursing Procedures
Health history interview and physical assessment
Intake and output assessment
Nutritional screening
Oral drug administration
Postoperative care
Preoperative care
Preparing a patient for urologic surgery, OR
Urine specimen collection from an indwelling urinary catheter (Foley)
Urine specimen collection, random
Venipuncture
Patient Teaching-General
disorder, underlying cause, diagnosis, and treatment, including antibiotic therapy and pain relief measures
prescribed medication therapy regimen, including the drug name, dosage, frequency of administration, and duration of therapy
that antibiotic therapy for acute bacterial prostatitis typically lasts for 30 days; that drug therapy for chronic bacterial prostatitis may require 4 to 12 weeks of therapy
procedure for sitz baths and frequency of sitz baths
importance of increased fluid intake
benefits of regular sexual activity (with chronic prostatitis)
prescribed activity limits as appropriate
importance of getting immediate medical attention for fever, inability to void, or bloody urine
importance of adhering to follow-up, including the need for urinalysis and culture after 30 days of treatment for acute bacterial prostatitis or every 30 days for possibly several months for chronic bacterial prostatitis.
Patient Teaching-Discharge Planning
Refer the patient for counseling if indicated to address sexual dysfunction.
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