When should a patient with acute prostatitis be referred to a urologist for further evaluation?

Referral to a urologist for a patient with acute prostatitis should be considered in the following situations:

• If symptoms do not start to improve within 48 hours of starting antibiotic treatment, referral to hospital (secondary care) is recommended due to concerns about complications such as acute urinary retention, prostatic abscess, or treatment failure from resistant bacteria NICE CKS.
• Urgent referral is advised for patients who are immunocompromised, have diabetes mellitus, or have pre-existing urological conditions (e.g., benign prostatic hypertrophy or an indwelling catheter), as specialist urological management may be required NICE CKS.
• Following recovery from acute prostatitis, referral for investigation to exclude structural abnormalities of the urinary tract is recommended NICE CKS.

In summary, patients with severe or complicated acute prostatitis, those not responding to initial treatment within 48 hours, or those with significant comorbidities or urological history should be referred to a urologist for further evaluation NICE CKS.