What is the typical presentation of acute prostatitis and which physical exams should be performed?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Acute prostatitis typically presents with spiking fever, chills, malaise, myalgia, dysuria, pelvic or perineal pain, and cloudy urine. Obstructive symptoms can result from swelling of the acutely inflamed prostate, and these range from dribbling and hesitancy to anuria. A less common presentation is with a vague, flulike illness.

Careful examination of the prostate is not contraindicated in acute bacterial prostatitis, but prostatic massage is contraindicated. Upon examination, the prostate is warm, swollen, soft ("boggy"), and extremely tender. The patient may have a fever and appear acutely uncomfortable; hypotension may be noted.

A rectal examination with a 360° sweep of the interior of the rectum followed by careful palpation of the prostate can be performed. However, in patients with suspected acute bacterial prostatitis, palpation can be painful and may lead to bacteremia. Some authorities note that it is of little benefit in diagnosing acute prostatitis and state that prostatic massage should not be conducted in the setting of UTI or urethritis.


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