question
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an asymptomatic 62 year old man comes foer a fllow up visit.1 month ago he had cystitis treated with ciprofloxacin. at his initial visit, urine culture grew klebsiella pneumoniae. he has a 2 year history of chronic prostatitis and 4 episodes of cystitis in the past year. examination including prostate examination shows no abnormality.whats the most appropriate measure to prevent recurrent episodes of cystitis>
trimethoprim -sulfamethoxazole prophylaxis
TURP
no treatment available
total prostatectomy
insertion of foley catheter
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| srf
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TURP
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| question
Forum Junior
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srf, why not trimethoprim-sulfa prophylaxis? can you please explain why you say TURP? prostate ex. ws normal
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| babli
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Surgery usually is not indicated for chronic prostatitis. However, in select situations when a patient has recurrent episodes of chronic prostatitis and improves with antibiotics, a TURP may remove a nidus of infection. This nidus may be in the form of prostatic stones. These stones usually are visible on transrectal ultrasound images.
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| srf
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recurrent infection suggests that something more is needed in this case.
infection is difficult to eradicate in presence of obstrction.
removal of obstrction will cure infection.
prostate exam or other investigation may be normal, but recurrent infection suggests obstrction.
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| question
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thanks srf, babli.....yeah makes sense ...and besides giving antibiotic prophylaxis will not help much ..on the contrary may develop drug resistance
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| yasmeen
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i dont think turp is right.treatment of recurrent uti is prophylactic trimethoprim sulphamethoxazole prophylaxis.turp has sooo many complications .
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| achilles
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i also think the answer is A.
recurrent UTI(more than 3 episodes in a year) needs prophylaxis. any of these three agents are used- bactrim, nitrofurantion or cephalexin.
but a thorough urologic evaluation is warranted to exclude any anatomic abnormalities.
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| achilles
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this is given in CMDT.
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| Korotkoff
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definitely TMP-SMZ
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| Ivonne
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A but
Surgery usually is not indicated for chronic prostatitis. However, in select situations when a patient has recurrent episodes of chronic prostatitis and improves with antibiotics, a TURP may remove a nidus of infection. This nidus may be in the form of prostatic stones. These stones usually are visible on transrectal ultrasound images.
http://www.emedicine.com/med/TOPIC3571.HTM#sectio...
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| sherry39
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bbbbbbbbbbbbb
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| simi
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question...what is the ans given for this qs?
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