10-06-2006, 09:35 AM
In a 70 yr man prostatic secretion shows no bacteria in culture but 10 wbc..a diagnosis of simple abacterial prostatitis is made.........whats will yu do now?.....
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any brilliant soul - amith
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10-06-2006, 09:46 AM
A patient with abacterial prostatitis can be evaluated in 2 ways, described as follows:
The first approach is to adhere strictly to the fact that these patients do not have an infection by performing an exhaustive search to exclude an infectious source. This often involves repetitive culturing of EPSs or prostate biopsy specimens using nonstandard culture media for Chlamydia, Ureaplasma, gonorrheal organisms, or anaerobes. Sophisticated research methods using RT-PCR techniques can also be employed. This first approach is very time-consuming and likely only of value in the research setting. A second method involves a trial of antibiotics for 2-4 weeks followed by a reevaluation of the patient for symptomatic improvement. If the patient improves, continued therapy with antibiotics for another 2-4 weeks is required for a clinical cure. This second method is often the one most commonly employed and is used first to treat patients with nonbacterial prostatitis. It succeeds approximately 50% of the time when used over a course of 4-6 weeks. If the patient does not improve with antibiotics, then another cause of symptoms must be sought and different treatment regimens must be initiated until symptoms are controlled. Imaging Studies: Voiding cystourethrography findings can aid in the diagnosis of bladder neck dysfunction by demonstrating intraprostatic and ejaculatory duct urinary reflux. Retrograde urethrography findings may demonstrate a urethral stricture. This test is indicated if the patient demonstrates decreased peak urinary flow on uroflowmetry findings. other tests: If no improvement is observed after treatment with antibiotics and the patient has symptoms that are mostly irritative (eg, dysuria with urinary urgency and frequency), then carcinoma in situ of the bladder must be excluded using urine cytology studies and cystoscopy. Other causes can also be sought, and they are evaluated in no particular order. Further workup is based on the clinical suspicion of the urologist. In addition, some patients may complain of symptoms that are not life-limiting, whereas others are completely limited in their activities of daily life. The search for a cause to these symptoms may be based on each individual, and the appropriate health care consultant should be used for the more esoteric diagnoses. Interstitial cystitis requires a more complex workup. See Interstitial Cystitis. Many patients with abacterial prostatitis have emotional strife and some psychological difficulties (ie, socially, sexually, or both). Patients should be questioned with regard to their overall social adjustment. Stress level is important because stress is responsible for increased tension of the pelvic floor and the internal urinary sphincter, resulting in the symptoms of prostatitis.
10-06-2006, 09:51 AM
gud the catch is in the elderly with abacterial prosttitis with irritating voiding problem n neg culture......first step is to do a urine cytology n cystoscopy to rule out bladder cancer...UW
10-06-2006, 09:53 AM
hey whts the treatment of prostatodynia.... had read abt this condition on UW but they din sepcify wht to do abt it
10-06-2006, 09:54 AM
prostatodynia
- pt hav irritative voiding symp. physical exam as well as urinalysis is normal. expressed prostatic secr hav normal WBC nd culture is negative for bacteria. Usually no past hist of UTI but voiding abn may be present in the past... this much is givn in UW |
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