Approach to the Critical Patient

Sepsis and hemodynamic instability

Sepsis recognition triggers

Septic shock protocol

Urinary retention emergencies

Retention assessment

Decompression approach

Prostatic abscess alert

Abscess warning signs

Escalation pathway

Post-biopsy infection alert

High-risk scenario recognition

Empiric regimen for post-biopsy sepsis

History

Onset and symptom characterization

Temporal pattern

Urinary symptoms

Pain characterization

Systemic and associated symptoms

Systemic features of acute infection

Sexual function symptoms

Psychological symptoms (CP/CPPS)

Risk factors and exposures

Procedural and instrumentation history

Anatomic and urologic risk factors

Immunosuppression

Sexual history

Prior infection history

Differentiating features

Important negatives to seek

Physical Exam

Vital signs and general assessment

Hemodynamic snapshot

Abdominal and bladder exam

Abdominal findings

Genital and perineal exam

External genitalia

Digital rectal examination

PITFALLS

Examination pitfalls

Differential Diagnosis

Life-threatening and urgent diagnoses

Sepsis and bacteremia

Prostatic abscess

Fournier gangrene

Genitourinary mimics

Acute pyelonephritis

Epididymo-orchitis

Acute cystitis

STI-related urethritis

Chronic and structural differentials

Benign prostatic hyperplasia

Prostate cancer

Urethral stricture

Interstitial cystitis and bladder pain syndrome

Pelvic floor dysfunction

Laboratory Tests

Core infection workup

Urinalysis

Urine culture

Blood cultures

Systemic and severity markers

Complete blood count

Basic metabolic panel

Lactate

Targeted testing

STI NAAT testing

PSA testing

Expressed prostatic secretion analysis (four-glass test)

Diagnostic Tests

Scoring Systems

NIH Chronic Prostatitis Symptom Index (NIH-CPSI)

MRI

MRI prostate indications

CT

CT pelvis and abdomen indications

Ultrasound

Transrectal ultrasound (TRUS)

Bladder and renal ultrasound

Scrotal ultrasound

Disposition

Admission criteria

Inpatient admission indications

ICU escalation

ICU indications

Discharge criteria

Outpatient management criteria

Specialist consultation triggers

Urology consultation

Infectious disease consultation

Treatment

Initial stabilization

Resuscitation priorities

Antibiotic therapy — acute bacterial prostatitis (NIH Type I)

Mild illness outpatient regimens

Moderate to severe illness inpatient regimens

Post-biopsy infection empiric regimens

Antibiotic therapy — chronic bacterial prostatitis (NIH Type II)

First-line oral regimens

Alternative oral regimens

Relapsing CBP

CP/CPPS treatment (NIH Type III)

Alpha-blocker therapy

Analgesic therapy

Herbal and supplemental adjuncts

Non-pharmacological therapies

Antibiotics in CP/CPPS

Adjunctive management

Dietary and lifestyle counseling

Stool softeners

Special Populations

Pregnancy

Prostatitis in pregnancy context

Pregnant transgender men with prostate

Geriatric

Age-related presentation differences

Medication safety in older adults

Functional and disposition considerations

Pediatrics

Pediatric prostatitis considerations

Antibiotic dosing in pediatric patients

Pediatric-specific workup

Background

Epidemiology

Prevalence and incidence

Burden and quality of life

Pathophysiology

Mechanism of infection

Microbiology

Therapeutic Considerations

Fluoroquinolone pharmacology and prostatic penetration

Antibiotic duration evidence

CP/CPPS therapeutic evidence base

Patient Discharge Instructions

copy discharge instructions

Prostatitis home care instructions

Medication side effects to watch for

Follow-up plan

Return to emergency department immediately for

References

Guidelines and key sources

Primary evidence sources

Systematic reviews

Classification and microbiology standards

ICD-10 coding references