UroToday - Acute genitourinary infections, in particular acute prostatitis, acute epididymitis and orchitis, represent an important problem in daily urological practice which warrant evidence-based therapeutic strategies to reduce the risk for chronification and severe sequelae, and to optimise the therapeutic outcome.

Acute bacterial prostatitis (ABP):

Data detailing incidence and prevalence of ABP do not exist. According to the classification proposed by the European Association of Urology (EAU) it is summarised analogously to complicated UTIs. ABP does not seem to represent a major diagnostic and therapeutical problem as long as prostatic abscess formation is absent. Its diagnosis is usually based on typical signs and symptoms; leukocyturia and bacteriuria are mandatory. Fever and chills may be found to a various extent and may even result in urosepsis. Sonographic determination of residual volume should rule out infravesical obstruction. Transrectal ultrasound (TRUS) is recommended to reveal prostatic abscess formation. Elevated levels of prostate-specific antigen (PSA), particularly of bound PSA, have been described in the majority of men with ABP which may persist at least 30 days following adequate antimicrobial therapy. Failure of normalisation of PSA has been associated with prostate cancer in about 20% of cases. In severe cases, parenteral administration of high doses of bactericidal antibiotics, such as a broad-spectrum penicillin, a third-generation cephalosporin or a fluoroquinolone, have been recommended. After defeverescence, oral therapy can be substituted for 2-4 weeks. A suprapubic catheter should be placed in men with increased residual volume. Two different forms of acute prostatitis should be differentiated according to their clinical course. Patients with ABP secondary to manipulation may require modified treatment options. Prostatic abscess formation normally warrants surgical treatment options though conservative treatment in men with small abscesses is worth trying.

Acute epididymitis and epididymo-orchitis:

In acute epididymitis, epidemiological data are scanty. Bacterial infections are the most common aetiology for epididymitis. In men

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