急性前立腺炎の症状や所見

 

本日は前立腺炎について。

 

BMC Infect Dis. 2008 Jan 30;8:12. doi: 10.1186/1471-2334-8-12.

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.

Etienne M¹, Chavanet P, Sibert L, Michel F, Levesque H, Lorcerie B, Doucet J, Pfitzenmeyer P, Caron F.

 

371名(中央値61歳)の急性前立腺炎患者が対象。患者は4つの診療科から集まった。

 

入院原因と臨床症状；

Table 2

Causes of admission and clinical symptoms during the course of the disease of 371 patients with acute prostatitis (AP).

	Total patients	Department of admission
		Urology	Infectious Diseases	Internal Medicine	Geriatrics
	n = 371	n = 178	n = 115	n = 48	n = 30
Cause of admission
Fever	297 (80%)	142 (80%)	97 (84%)	37 (78%)	19 (63%)
Urinary symptoms
Functional symptoms	266 (72%)	153 (86%)	69 (60%)	27 (57%)	15 (50%)
Bladder outlet obstruction	61 (23%)	52 (29%)	9 (8%)	12 (25%)	6 (20%)
Cognitive disorder	14 (4%)	0 (0%)	5 (4%)	4 (8%)	10((33%)
Miscellaneous symptoms	28 (8%)	0 (0%)	2 (2%)	21 (44%)	7 (23%)
Main clinical symptoms during the course of AP
Fever	297 (80%)	154 (84%)	86 (80%)	38 (78%)	19 (63%)
Chills	135 (35%)	47 (25%)	60 (56%)	14 (28%)	7 (23%)
Urinary symptoms	266 (72%)	158 (86%)	65 (60%)	28 (57%)	15 (50%)
- burning micturition	143 (54%)	79 (50%)	36 (55%)	23 (82%)	5 (33%)
- pollakiuria	200 (52%)	77 (49%)	35 (54%)	18 (64%)	9 (60%)
- dysuria	79 (30%)	53 (34%)	15 (23%)	7 (25%)	4 (27%)
- bladder outlet obstruction	61 (23%)	46 (29%)	5 (8%)	7 (25%)	3 (20%)
- macroscopic haematuria	46 (17%)	33 (21%)	9 (14%)	2 (7%)	2 (13%)
Pelvic pain	144 (43%)	98 (58%)	27 (28%)	18 (42%)	1 (4%)
Abnormal digital rectal examination	235 (83%)	135 (89%)	55 (70%)	25 (83%)	20 (91%)
- painful prostate palpation	175 (63%)	115 (77%)	31 (39%)	15 (50%)	14 (64%)
- prostatic hypertrophy	152 (54%)	86 (57%)	36 (46%)	16 (53%)	14 (63%)
- prostate irregularity	66 (24%)	44 (30%)	10 (13%)	4 (13%)	8 (22%)

上記表から臨床症状のみをグラフ化；

発熱と尿路症状がある場合、前立腺の障害を考えることが必要。

頻度は低いが血尿も5人に1人。

身体所見として、前立腺の触診が書いてあるが、したことないです。

直聴診異常は80%と高率ですが、前立腺触診による圧痛は63%・肥大54%とされ、そこまで精度が高いわけではなさそうです。

 

尿路異常を訴えた男性は、発熱がないか(平熱と比べ何度高いか)？尿路症状の詳しい問診などが特に必要という感じ。