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Acute bacterial prostatitis complicated by acute urinary retention — MSRA MCQ

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HardUrologyAcute bacterial prostatitis complicated by acute urinary retentionMSRA

A 66-year-old man is reviewed 36 hours after starting trimethoprim for acute bacterial prostatitis. At presentation he had fever, dysuria, urinary frequency, severe perineal pain and a tender, boggy prostate on digital rectal examination. Midstream urine culture has since grown Escherichia coli susceptible to trimethoprim. He now reports worsening suprapubic discomfort and has passed only a few drops of urine over the past 7 hours. His temperature is 37.6°C, heart rate 98 beats/min and blood pressure 136/78 mmHg. He is alert and has no vomiting or flank pain. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Refer to hospital immediately for assessment and management of acute urinary retention complicating acute prostatitis

Explanation lettering: B = shown as A · A = shown as B

This man has acute bacterial prostatitis complicated by acute urinary retention: he has progressive suprapubic discomfort and near-complete inability to pass urine. This is not uncomplicated early non-response to antibiotics. NICE recommends hospital referral for acute prostatitis when there are symptoms or signs of a serious complication, including acute urinary retention; this applies even though he has not yet completed 48 hours of antibiotics. ([nice.org.uk](https://www.nice.org.uk/guidance/ng110/chapter/Recommendations?utm_source=openai)) A is inappropriate because the 48-hour reassessment threshold applies to patients without an earlier serious complication. B is initially attractive because culture-directed antibiotic treatment is important, but the organism is already trimethoprim-susceptible and changing oral therapy does not address retention. C delays necessary acute management in a patient requiring hospital assessment. D may form part of subsequent investigation but must not delay treatment of retention. Men with acute urinary retention require immediate bladder drainage, while prostatitis-associated retention warrants hospital management because of risks including sepsis and prostatic abscess. ([nice.org.uk](https://www.nice.org.uk/guidance/cg97/chapter/recommendations?utm_source=openai))

Reference: NICE: Prostatitis (acute): antimicrobial prescribing — Recommendations (2018) — https://www.nice.org.uk/guidance/ng110/chapter/Recommendations NICE: Lower urinary tract symptoms in men: management — Treating urinary retention (2015) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations