Benign Prostatic Hyperplasia vs Acute Bacterial Prostatitis
Benign Prostatic Hyperplasia and Acute Bacterial Prostatitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Benign Prostatic Hyperplasia vs Acute Bacterial Prostatitis at a glance
- Benign Prostatic Hyperplasia: Age-related stromal-glandular prostate hyperplasia causing lower urinary tract symptoms; alpha-blockers + 5-ARIs.
- Acute Bacterial Prostatitis: Acute bacterial infection of the prostate — fever, pelvic pain, exquisitely tender prostate; treat with prolonged antibiotics.
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Side-by-side comparison
| Feature | Benign Prostatic Hyperplasia | Acute Bacterial Prostatitis |
|---|---|---|
| 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. |
| Classic presentation | Storage symptoms: urinary frequency, urgency, nocturia, urge incontinence; Voiding symptoms: hesitancy, weak stream, intermittency, incomplete emptying,… | Older man (or younger with recent instrumentation) with fever, perineal pain, urinary symptoms, and exquisitely tender prostate on DRE.; Fever, chills,… |
| Workup / key labs | Urinalysis ± culture — exclude infection, hematuria; Serum creatinine; PSA — discuss in men with >10-year life expectancy; helps estimate prostate volume and… | Urinalysis with leukocyte esterase, nitrites; urine culture and sensitivity; CBC (leukocytosis), BMP, lactate; Blood cultures if febrile/septic; PSA often… |
| Imaging | Post-void residual volume — bedside bladder ultrasound; concerning if >100-150 mL; Renal ultrasound if elevated creatinine, recurrent UTIs, or severe… | Often not needed initially if responsive to therapy; Transrectal ultrasound or pelvic CT/MRI — if abscess suspected (persistent fever/symptoms after 48-72 h… |
| First-line treatment | Mild symptoms / not bothersome: watchful waiting + lifestyle modification (limit fluids before bed, avoid bladder irritants — caffeine, alcohol,… | Outpatient (mild-moderate, hemodynamically stable, no abscess, tolerating PO):; • Fluoroquinolone — ciprofloxacin 500 mg PO BID OR levofloxacin 500 mg PO… |
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