Overview
Monilial prostatitis, also known as fungal prostatitis, involves inflammation of the prostate gland due to fungal infection, distinct from more common bacterial prostatitis. Diagnosis and management often require specific antifungal therapy tailored to the causative organism 12.Diagnosis
Clinical Symptoms: Presence of urinary symptoms such as dysuria, frequency, and urgency 1.
Physical Examination: Digital rectal examination may reveal prostate tenderness or nodules 1.
Laboratory Tests: Urinalysis for pyuria or hematuria, though not specific; culture of prostatic secretions or urine for fungal elements is crucial 1.
Imaging: Not typically required unless complications like abscess formation are suspected 1.
Severity Grading: Urologists vary in their classification of symptom severity, with agreement better for severe symptoms like urinary retention or significant residual urine 2.Management
First-Line Treatment: Antifungal therapy, typically with agents like fluconazole or itraconazole, based on susceptibility testing 1.
Duration: Treatment duration often guided by clinical response and fungal culture clearance 1.
Adjunctive Measures: Symptomatic relief with alpha-blockers if obstructive symptoms are present 1.
Follow-Up: Regular monitoring for symptom resolution and recurrence 1.Special Populations
Elderly: Higher prevalence of moderate to severe symptoms reported, emphasizing the need for thorough evaluation 2.Key Recommendations
Perform thorough clinical evaluation including digital rectal examination and fungal cultures for definitive diagnosis (Evidence: Moderate 1).
Initiate antifungal therapy based on culture and sensitivity results, with close monitoring for efficacy (Evidence: Moderate 1).
Consider referral for surgical intervention in cases of recurrent urinary retention or significant residual urine volumes (Evidence: Moderate 2).References
1 Hanson KA, Lieber MM. Role of a urology nurse in evaluating patients with prostatism. Urologic nursing 1996. link
2 Hansen MV, Wold T. A survey concerning the attitudes of urologists toward prostatism patients. Scandinavian journal of urology and nephrology 1994. link