Assessment

HISTORY. Take a careful history to elicit genitourinary symptoms. Generally, patients with suspected acute bacterial prostatitis have symptoms that are similar to those of a urinary tract infection: dysuria, frequency, urgency, and nocturia. In addition, patients report perineal pain radiating down to the sacral region of the back, down the penis and suprapubic area, and possibly into the rectal area. Hematuria or a purulent urethral discharge may be present. The patient may also complain of fever, chills, myalgia (muscle aches), arthralgia (painful joints), and malaise. Patients with chronic bacterial prostatitis are usually asymptomatic but complain of chronic cystitis.

PHYSICAL EXAMINATION. Although some patients are asymptomatic, the patient may appear acutely ill with fever, muscle ache, weakness, and malaise. Inspect the urethra for redness, swelling, or discharge. Inspect the urine for cloudiness, purulence, or hematuria. The nurse practitioner or physician palpates the prostate rectally to determine the degree of tenderness and consistency of the gland and to rule out the presence of a perirectal abscess, tumor, or foreign body. In acute bacterial prostatitis, the prostate may feel warm, firm, indurated, swollen, and tender to palpation. In chronic prostatitis, the prostate may be normal or feel boggy or indurated. Prostatic massage should not be performed because of the risk of bacteremia. Patients with chronic bacterial prostatitis have varying symptoms, often symptoms similar to those of acute bacterial prostatitis but milder.

PSYCHOSOCIAL. Discuss the patient's fear of sexually transmitted disease and impotence related to this illness. Assess the patient's ability to cope with a painful, prolonged illness with a high probability of recurrence or chronicity. If the patient has chronic bacterial prostatitis, assess the patient's and partner's coping strategies and support systems.

Diagnostic Highlights

General Comments: Prostatitis is primarily diagnosed by symptoms; however, a urine

culture will confirm the diagnosis and identify the causative organism. Although prostatic massage is not recommended to obtain prostatic fluid, if this is done and leukocytes are present with a negative culture, a diagnosis of nonbacterial prostatitis can be made.

Test

Normal Result

Abnormality with Condition

Explanation

Urine culture

Negative findings

Positive for bacteria growth, >10,000 bacteria/mL of urine

The causative pathogen is identified

Other Tests: Complete blood count, transrectal ultrasound

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