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Acute bacterial prostatitis complicated by acute urinary retention — MRCEM SBA MCQ

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EasyInfection and sepsisAcute bacterial prostatitis complicated by acute urinary retentionMRCEM SBA

A 58-year-old man attends the emergency department with two days of fever, dysuria and perineal pain. He has been unable to pass urine for eight hours and has increasing suprapubic discomfort. His temperature is 38.4°C, pulse 102/min and blood pressure 126/74 mmHg; he is alert and can take oral medicines. Gentle examination finds a markedly tender prostate. Bladder scanning shows 780 mL of retained urine. A urine sample passed earlier at triage has been sent for culture. What is the most appropriate initial treatment and disposition plan?

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

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Correct answer: D — Start empirical antibiotics and admit for urgent urological assessment and bladder drainage.

Fever, dysuria, perineal pain and a tender prostate indicate acute bacterial prostatitis. His inability to void, suprapubic discomfort and 780 mL bladder volume establish acute urinary retention. Both problems need action: start an empirical antibiotic appropriate for prostatitis, arrange prompt bladder drainage with urological assessment, and admit him. NICE specifically recommends hospital referral when acute prostatitis is complicated by urinary retention; its guidance on acute retention calls for immediate catheterisation. The route and choice of antibiotic should reflect clinical severity and local resistance guidance: his ability to take oral medicines does not make discharge appropriate. ([nice.org.uk](https://www.nice.org.uk/guidance/ng110/chapter/Recommendations)) A addresses retention but incorrectly assumes drainage removes the need for hospital assessment in this case. B delays drainage of established retention and sends him home before the complication is treated. C prioritises imaging over drainage; the stem gives no specific reason to investigate a prostatic abscess before relieving retention. E recognises the need for admission but delays treatment of retention that is already established. ([nice.org.uk](https://www.nice.org.uk/guidance/ng110/chapter/Recommendations))

Reference: NICE NG110: Prostatitis (acute): antimicrobial prescribing — Recommendations (31 October 2018) — https://www.nice.org.uk/guidance/ng110/chapter/Recommendations NICE CG97: Lower urinary tract symptoms in men: management — Recommendations (Recommendation 1.7.1: 2010) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations