| At a glance | Age-related stromal-glandular prostate hyperplasia causing lower urinary tract symptoms; alpha-blockers + 5-ARIs. | Acute bacterial infection of the prostate — fever, pelvic pain, exquisitely tender prostate; treat with prolonged antibiotics. |
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| Classic presentation | Storage symptoms: urinary frequency, urgency, nocturia, urge incontinence; Voiding symptoms: hesitancy, weak stream, intermittency, incomplete emptying, terminal dribbling, straining; International Prostate Symptom Score (IPSS): 0-7 mild, 8-19 moderate, 20-35 severe; Hematuria (rule out other causes); Digital rectal exam: smooth,… | Older man (or younger with recent instrumentation) with fever, perineal pain, urinary symptoms, and exquisitely tender prostate on DRE.; Fever, chills, rigors; Lower abdominal, perineal, or low back pain; Dysuria, frequency, urgency, hematuria; Hesitancy, weak stream, retention; Painful defecation, painful ejaculation; Generalized… |
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| Workup / key labs | Urinalysis ± culture — exclude infection, hematuria; Serum creatinine only if renal impairment, retention, or hydronephrosis is suspected; the routine initial AUA evaluation is history, DRE, symptom score (AUA-SI/IPSS), and urinalysis; PSA — discuss in men with >10-year life expectancy; helps estimate prostate volume and treatment… | Urinalysis with leukocyte esterase, nitrites; urine culture and sensitivity; CBC (leukocytosis), BMP, lactate; Blood cultures if febrile/septic; PSA often markedly elevated during infection — defer screening until resolution; NAAT for GC/CT in sexually active younger men; HIV, syphilis screening in at-risk populations |
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| Imaging | Post-void residual volume — bedside bladder ultrasound; concerning if >100-150 mL; Renal ultrasound if elevated creatinine, recurrent UTIs, retention, or hematuria; Cystoscopy if hematuria, recurrent UTI, or refractory symptoms; Urodynamics in atypical cases or surgical planning; Transrectal ultrasound — limited role; useful for… | Often not needed initially if responsive to therapy; Transrectal ultrasound or pelvic CT/MRI — if abscess suspected (persistent fever/symptoms after 48-72 h of antibiotics, palpable fluctuance, immunocompromise); Post-void residual / renal ultrasound if retention or AKI |
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| First-line treatment | Mild symptoms / not bothersome: watchful waiting + lifestyle modification (limit fluids before bed, avoid bladder irritants — caffeine, alcohol, decongestants, antihistamines); Moderate-to-severe symptoms: pharmacotherapy; Alpha-blocker (uroselective preferred to limit hypotension) — tamsulosin, alfuzosin, silodosin (also doxazosin,… | Outpatient (mild-moderate, hemodynamically stable, no abscess, tolerating PO):; • Fluoroquinolone — ciprofloxacin 500 mg PO BID OR levofloxacin 500 mg PO daily × 2-4 weeks; • OR trimethoprim-sulfamethoxazole DS BID × 2-4 weeks; Inpatient (severe illness, sepsis, immunocompromise, retention):; • Broad-spectrum IV —… |
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