The usual infecting organisms are aerobic gram-negative bacilli or, less frequently, Staphylococcus aureus. The patient usually is 40 to 60 yr of age and has urinary frequency, dysuria, or urinary retention. Perineal pain, evidence of acute epididymitis, hematuria, and a purulent urethral discharge are less common. Fever is present in some patients. Rectal examination may show prostatic tenderness and fluctuance, but often prostatic enlargement is the only abnormality, and sometimes the gland feels normal.
Leukocytosis is common.
Although pyuria and bacteriuria are frequent, the urine may be normal. Blood cultures are positive in a few patients. Continued or recurrent UTIs despite antimicrobial therapy and persistent perineal pain suggest a prostatic abscess. Prostatic ultrasound may be helpful. Treatment involves drainage by transurethral evacuation or perineal incision plus appropriate antibiotics.