Conditions of the Prostate
Prostatitis is an inflammation of the prostate gland caused by in-fectious agents (bacteria, fungi, mycoplasma) or other conditions (eg, urethral stricture, prostatic hyperplasia). E. coli is the most commonly isolated organism. Microorganisms are usually carried to the prostate from the urethra. Prostatitis may be classified as bacterial or abacterial, depending on the presence or absence of microorganisms in the prostatic fluid.
Symptoms of prostatitis may include perineal discomfort, burn-ing, urgency, frequency, and pain with or after ejaculation. Prosta-todynia (pain in the prostate) is manifested by pain on voiding or perineal pain without evidence of inflammation or bacterial growth in the prostate fluid.
Acute bacterial prostatitis may produce sudden fever and chills and perineal, rectal, or low back pain. Urinary symptoms, such as dysuria, frequency, urgency, and nocturia (urination during the night), may occur. Some patients do not have symptoms. Chronic bacterial prostatitis is a major cause of relapsing urinary tract infection in men. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. High temperature and chills are uncommon.
Complications of prostatitis may include swelling of the pros-tate gland and urinary retention. Other complications include epididymitis, bacteremia, and pyelonephritis.
The diagnosis of prostatitis requires a careful history, culture of prostate fluid or tissue, and occasionally a histologic examination of the tissue. To locate the source of a lower genitourinary infec-tion (bladder neck, urethra, prostate), it is necessary to collect a divided urinary specimen for segmental urine culture. After cleaning the glans penis and retracting the foreskin (if present), the patient voids 10 to 15 mL of urine into a container. This rep-resents urethral urine. Without interrupting the urinary stream, he collects 50 to 75 mL of urine in a second container; this rep-resents bladder urine.
If the patient does not have acute prostatitis, the physician im-mediately performs a prostatic massage and collects any prostatic fluid that is expressed into a third container. If it is not possible to collect prostatic fluid, the patient voids a small quantity of urine. The specimen may contain the bacteria present in the pros-tatic fluid. Urinalysis after prostate examination commonly reveals many white blood cells.
The goal of therapy for acute bacterial prostatitis is to avoid the complications of abscess formation and septicemia. A broad-spectrum antibiotic agent (to which the causative organism is sensitive) is administered for 10 to 14 days. Intravenous administra-tion of the agent may be necessary to achieve high serum and tis-sue levels; the agent may be administered at home. The patient is encouraged to remain on bed rest to alleviate symptoms quickly. Comfort is promoted with analgesic agents (to relieve pain), anti-spasmodic medications and bladder sedatives (to relieve bladder irritability), sitz baths (to relieve pain and spasm), and stool soft-eners (to prevent pain from straining).
Chronic bacterial prostatitis is difficult to treat because most antibiotics diffuse poorly from the plasma into the prostatic fluid. Nevertheless, antibiotics may be prescribed, including trimethoprim-sulfamethoxazole (TMP-SMZ) or a fluoro-quinolone. Continuous therapy with low-dose antibiotics to sup-press the infection may also be indicated. The patient is advised that the urinary tract infection may recur and is taught to recog-nize its symptoms. In addition, treatment for chronic prostatitis may include reducing the retention of prostatic fluid by ejacula-tion through sexual intercourse or masturbation. Other treat-ments include antispasmodics, sitz baths, stool softeners, and evaluation of sexual partners to reduce the possibility of cross-infection. The treatment of nonbacterial prostatitis is directed toward relieving symptoms.
If the patient experiences symptoms of acute prostatitis (fever, se-vere pain and discomfort, inability to urinate, malaise), he may be hospitalized for intravenous antibiotic therapy. Nursing man-agement includes administration of prescribed antibiotics and provision of comfort measures, including prescribed analgesic agents and sitz baths.
The patient with chronic prostatitis is usually treated on an outpatient basis and needs to be instructed about the importance of continuing antibiotic therapy.
The nurse instructs the patient tocomplete the prescribed course of antibiotics. If intravenous anti-biotics are to be administered at home, the nurse instructs the patient and family about correct and safe administration. Arrange-ments for home care to oversee administration may be needed. Hot sitz baths (10 to 20 minutes) may be taken several times daily. Fluids are encouraged to satisfy thirst but are not “forced” because an effective medication level must be maintained in the urine. Foods and liquids that have diuretic action or that increase pros-tatic secretions, such as alcohol, coffee, tea, chocolate, cola, and spices, should be avoided. During periods of acute inflammation, sexual arousal and intercourse should be avoided.
To minimize discomfort, the patient should avoid sitting for long periods. Medical follow-up is necessary for at least 6 months to 1 year because prostatitis caused by the same or different or-ganisms can recur.