Prostatitis

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Prostatitis

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anastamosis
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01/08/08 - 03:13 PM

A 60 yom with h/o BPH comes with Acute Prostatitis with urine retention. Next step in management?

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DrVirgo
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01/08/08 - 04:02 PM

Did you do a DRE yet? Its suposed to be the first test -cheapest first.

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anastamosis
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01/08/08 - 05:08 PM

accepted ... cosidered DRE done in the statement.

How do you releive the Urine Retention?

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anastamosis
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01/08/08 - 05:11 PM

i am sending the full question.

Attached Files:
Acute Prostatitis.jpg (216 KB, 30 downloads)

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DrVirgo
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01/08/08 - 05:23 PM

Anytime you have a patient who presents with PASSING NO URINE, think of a Mechanical problem like obstruction... And do a bladder cath. He might need intermittent cath as the bladder fills.

On the other hand if he IS PASSING SOME URINE (oliguria) think of a problem with the kidneys.

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anastamosis
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01/08/08 - 05:40 PM

ACUTE PROSTATITIS is a contra indication to any mechanical manipulation of the prostate. Be it Catheterization or DRE.

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anastamosis
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01/08/08 - 05:55 PM

this is the explanation given

Do you agree?

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Prstatitis answer.jpg (259 KB, 25 downloads)

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multifactorial
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01/08/08 - 06:38 PM

i dont agree with the explanation.for one thing,that acute bacterial prostatitis is a contraindication to DRE coz it might lead to septic shock.i think it should be bladder catheterization and amoxicillin prophylaxis.

DrVirgo
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01/08/08 - 06:43 PM

anastamosis wrote:
ACUTE PROSTATITIS is a contra indication to any mechanical manipulation of the prostate. Be it Catheterization or DRE.

Well in Acute Bacterial Prostatis continued prostatic massage could lead to septic shock (Kap surg notes)... They don't say anything about NOT doing a cath. I just think DREs are contraindicated here.
And this man has NO urine output and a big bladder.. so you must relieve it.

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anastamosis
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01/08/08 - 06:49 PM

#10

CMDT says in such conditions do suprapubic bladder drainage.

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anastamosis
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01/08/08 - 06:52 PM

#11

CMDT says in such conditions do suprapubic bladder drainage. Do not catheterize as per CMDT.

DRE can be done / Prostate Massage is contraindicated. In earlier post I inadvertently mentioned that DRE is contraindicated.

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anastamosis
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01/08/08 - 07:13 PM

#12

OK guys ... the whole confusion is words ... WHICH OF THE FOLLOWING ... means we have to think among the following ... so that explains all !!

thanks for your time and efforts

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DrVirgo
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01/08/08 - 08:37 PM

#13

So in Prostatitis, you CAN do a DRE as long as you don't massage the prostate?
hhhmmm.....OK.

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drduck
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01/08/08 - 09:56 PM

#14

Acute prostatitis....no DRE rightly said risk of septic shock....but patients urinary retention shud be relieved earliest possible.
catheterisation rarely sucessfull as enlarge prostrate will not let catheter pass thru constricted urethra up to the bladder.
but no way it is contraindicated....only problem is that when u encounter any obstruction or resistence during passage of the cath....u shud not force it any further or u again risk septic shock or even traumatic rupture of urethra.

suprapubic drainge or cystostomy......bet option availabe....not only u relieve patients problem a good way to culture the urine.

drduck
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01/08/08 - 09:59 PM

#15

Also once u done with ur drainage....treat the patient with antibiotics for acute bacterial prostatitis....and post the patient for TURP...ONLY IF THE BACTERIAL PROSTATITIS HAS BEEN TREATED SUCESSFULLY.

doctorjo
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01/09/08 - 04:25 AM

#16

so whats the final answer confused

DrVirgo
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01/09/08 - 07:48 AM

#17

drduck wrote:
Also once u done with ur drainage....treat the patient with antibiotics for acute bacterial prostatitis....and post the patient for TURP...ONLY IF THE BACTERIAL PROSTATITIS HAS BEEN TREATED SUCESSFULLY.

Thanks for the explanation. Which antibiotics would you use?

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